Journal of Orthopaedic Surgery and Research最新文献

Background: Medial Meniscus Posterior Root Tears (MMPRTs) are known to accelerate medial compartment knee osteoarthritis (OA). This study aimed to evaluate the short-term clinical outcomes of arthroscopic all-suture anchor (ASA) repair combined with high tibial osteotomy (HTO) for patients with medial compartment OA and MMPRTs, offering a potential new surgical approach for this condition.

Methods: This study retrospectively reviewed 36 patients undergoing arthroscopic ASA repair combined with HTO for medial compartment OA with MMPRTs at our institution between June 2022 and June 2023. All patients underwent second-look arthroscopy during hardware removal. We collected demographic data (age, sex, affected side, duration of symptoms, complications), preoperative and postoperative Tegner activity scores, Lysholm scores, International Knee Documentation Committee (IKDC) scores, and Knee injury and Osteoarthritis Outcome Scores (KOOS). Radiographic comparisons (pre- and post-op) included Kellgren-Lawrence (K-L) grading, hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), and posterior tibial slope (PTS). Medial meniscus extrusion rate (MMER) was also assessed. At second-look arthroscopy, the healing status of the medial meniscus posterior root was evaluated. Patients were subgrouped based on root healing status to examine correlations with clinical scores, MMER, K-L grade, and symptom duration.

Results: The cohort comprised 30 females (83.3%) and 6 males (16.7%), with a mean age of 59 years. Mean follow-up was 24.8 ± 2.4 months. Significant improvements were observed in all final scores: Lysholm (46.58 ± 16.04 to 79.08 ± 14.29), IKDC (37.08 ± 14.57 to 65.81 ± 12.33), KOOS total scores (116.50 ± 26.13 to 65.89 ± 15.50), and Tegner (1.00 ± 1.27 to 2.33 ± 1.15) (all P < 0.001). Subgroup analysis revealed no significant differences between healed and non-healed groups regarding Lysholm, IKDC, KOOS, Tegner scores, symptom duration, or K-L grade. No complications (infection, nonunion, neurovascular issues) occurred by final follow-up.

Conclusion: ASA repair combined with HTO provides significant short-term improvement in clinical outcomes for MMPRTs with medial compartment OA. However, meniscal root healing did not correlate with clinical improvement, suggesting mechanical realignment plays a primary role.

Background: Open reduction and internal fixation (ORIF) has been a long-established and accepted technique for the treatment of lateral malleolar fractures. However, minimally invasive percutaneous plate osteosynthesis (MIPPO) may be preferred in cases with compromised soft tissue conditions or in the presence of comorbidities. MIPPO is increasingly being used in the treatment of long bone fractures. The aim of this study was to compare the clinical, functional and radiological outcomes of the MIPPO technique for lateral malleolus fractures with those of ORIF.

Methods: This prospective randomized controlled study analysed patients who underwent surgery for lateral malleolus fractures treated with ORIF or MIPPO between the years 2022 and 2024. The study included patients with lateral malleolus fractures of Danis-Weber types B and C requiring surgical intervention. Postoperative pain, the American Orthopaedic Foot and Ankle Society (AOFAS) score, hospital stay, surgical time, fluoroscopy time, and radiological measurements were compared.

Results: The study included 68 patients (ORIF n = 34, MIPPO n = 34). The minimum follow-up for all the patients was 12 months and maximum was 24 months with a mean of 18,20 months postoperatively. The postoperative pain scores at 8 h (p = 0.001), 24 h (p < 0.001) and 2 weeks (p = 0.003) were lower in the MIPPO group. Pain scores were similar between the preoperative measurement and those observed at 4 weeks, 6 weeks, 3 months, 6 months and 1 year postoperatively. AOFAS scores were similar between both groups at 3 months, 6 months and 1 year postoperatively. Surgical time and the postoperative hospitalisation period were shorter in the MIPPO group (p < 0.001, p = 0.005). A higher level of fluoroscopy exposure was observed in the MIPPO group (p = 0.001). Similar results were obtained in radiological measurements between groups.

Conclusion: The MIPPO technique leads to lower pain scores in the short term, shorter surgery times, and earlier discharge. In the long term, it provides similar clinical, functional, and radiological results to those obtained with ORIF.

Background: The pericapsular nerve group (PENG) block has proven to be an effective strategy for postoperative pain management in total hip arthroplasty (THA). However, its implementation requires specialized equipment and expertise, which limits its reproducibility. The objective of this study was to describe the technique of direct visualization-guided PENG block (PENG-DV) and assess its outcomes for postoperative pain control.

Methods: A retrospective cohort study was conducted in patients who underwent THA through a direct anterior approach (DAA) and received the PENG-DV block as part of a standardized multimodal analgesia protocol. Demographic variables, pain score on the visual analogue scale (VAS), opioid consumption, muscle strength, and ambulation within the first 24 h were evaluated.

Results: Of the 128 patients identified, 112 were included in the analysis. The cohort was predominantly female (60.7%), with a mean age of 63 years. The median postoperative VAS score was 2 and 3 at 12 and 24 h respectively, increasing to 5 during physical therapy. By postoperative day one, 83.9% of patients ambulated, and most achieved muscle strength ≥ 3 for both hip flexion and knee extension. A total of 54.5% of patients required opioid rescue, with a mean morphine equivalent consumption of 10 mg within the first 24 h.

Conclusion: PENG-DV for THA via DAA appears to be a promising strategy for effective pain control in the immediate postoperative period, as part of a multimodal analgesic approach designed to reduce opioid consumption and promote early mobilization.

Objective: Surgical site infections (SSIs) particularly periprosthetic joint infection (PJI, a deep/organ-space infection) remain devastating after total hip arthroplasty (THA). Because routine systemic perioperative antibiotics are standard of care, we focused on the added value of intrawound (local) prophylaxis. We evaluated whether intrawound antibiotics, used in addition to standard systemic prophylaxis, reduce infection after THA and explored effects across surgery type (primary vs. revision).

Methods: We searched PubMed, Cochrane Library, ScienceDirect, EMBASE, CNKI, VIP, Wanfang, and CBM (January 2010 to final search) for cohort studies comparing intrawound antibiotic prophylaxis + standard systemic prophylaxis versus standard systemic prophylaxis alone. We systematically searched studies published since 2010 to include the most recent and relevant data, ensuring that the research included reflects modern surgical techniques, standardized reporting, and advancements in the use of intrawound antibiotics. Two reviewers independently screened, extracted data, and assessed risk of bias; meta-analysis used RevMan 5.3.

Results: Eight cohort studies (n = 16,939) met criteria. Heterogeneity for PJI was low (Chi² = 7.57, df = 7, P = 0.37; I² = 8%). Intrawound prophylaxis plus systemic prophylaxis was associated with lower PJI risk than systemic prophylaxis alone (OR = 0.42, 95% CI: 0.30-0.58, P < 0.00001). Subgroup analysis showed consistent benefit in both primary and revision THA (OR = 0.30, 95% CI: 0.20-0.47, P < 0.00001; I² = 0%). Superficial incisional SSI (skin/subcutaneous) showed no significant difference (OR = 0.41, 95% CI: 0.10-1.66, P = 0.92), and adverse events did not differ significantly (OR = 0.89, 95% CI: 0.45-1.78, P = 0.75). Funnel plots suggested possible publication bias.

Conclusion: There is limited evidence, with a possible risk of publication bias, suggesting that intrawound (local) antibiotic prophylaxis, when added to standard systemic antibiotics, may be associated with reduced postoperative PJI after THA across primary and revision procedures. Evidence for superficial SSI and safety remains limited by few contributing studies. Standardized, head-to-head randomized trials are needed to define optimal regimens (agent, dose, timing) and long-term safety (including antimicrobial resistance).

Introduction: Osteoarthritis (OA) is a common and disabling joint condition that requires accurate assessment for effective management. Variability in radiographic classification of OA severity can impact diagnostic accuracy and treatment decisions. This study evaluates the interobserver reliability of radiographic grading systems for hip and knee OA severity.

Methods: This retrospective study included 576 patients diagnosed with hip or knee OA between 2016 and 2023 who underwent radiographic evaluation. Radiographs were independently scored by three orthopaedic surgeons and three radiologists using established classification systems (Kellgren-Lawrence (K-L), Croft for hip; K-L, Ahlbäck, Brandt and Osteoarthritis Research Society International (OARSI) for knee OA). Interobserver agreement was assessed using kappa statistics.

Results: A total of 296 hip OA patients (mean age 69.5 ± 8.7, 62% female, 67% underwent surgery) and 280 knee OA patients (mean age 69.8 ± 8.4 years, 41% female, 53% underwent surgery) were assessed. For hip OA, interobserver agreement was moderate using K-L (κ = 0.552) and Croft (κ = 0.468). For knee OA, moderate agreement was found for the KL (κ = 0.598) and Ahlbäck (κ = 0.463), and substantial for Brandt (κ = 0.625), and OARSI (κ = 0.648) classifications. Overall, radiologists assigned higher OA severity scores than orthopaedic surgeons.

Conclusion: This study shows fair to moderate agreement between orthopaedic surgeons and radiologists in diagnosing hip and knee OA. Based on our data, we recommend the Kellgren-Lawrence as the grading system for lower extremity osteoarthritis. However, grading minute osteophytes and early-stage osteoarthritis remains challenging.

Background: Virtual fracture clinics (VFCs) are a well-established component of acute orthopedic management pathways. Artificial intelligence (AI) healthcare tools are increasingly sophisticated and have the potential to disrupt current practices. The aim of this review was to determine the opportunities, performance and readiness of AI systems that integrate clinical-text and imaging data for the triage or management of patients in VFCs.

Methods: A search of MEDLINE and Embase was performed between January 2010 and July 2025. The review included primary research studies investigating AI for fracture detection via X-rays and natural language processing (NLP) models for clinical documentation. A random-effects meta-analysis was conducted to calculate pooled sensitivity and specificity, stratified by anatomical region and developer type (commercial vs. researcher-developed).

Results: We included 54 studies: 52 imaging/X-ray studies and 2 NLP/clinical-text studies. Among the imaging studies, 13 evaluated commercial tools, and 39 evaluated researcher-developed models. There were 2 NLP models, both of which interpreted radiology reports rather than text summaries of clinical assessments. No studies that included the use of NLP models in acute orthopedic care could be found. A meta-analysis of commercial tools (n = 11) demonstrated a pooled sensitivity across both multiregional "Limb" tools of 92.58% (95% CI 90.61-94.17%) and anatomy-specific "Wrist" tools of 89.95% (95% CI 72.18-96.86%). Wrist-specific commercial tools demonstrated higher specificity (96.80%; 95% CI 90.12-99.01%) compared to general limb tools (89.69%; 95% CI 84.02-93.51%), suggesting that anatomical targeting may reduce the number of false positives. Researcher-developed models (n = 32) often reported superior metrics for sensitivity compared to the sensitivity of commercial tools.

Conclusions: VFCs require the integration of information from imaging and patient records. Multiple image interpretation tools are available with high performance in fracture identification. The development and integration of NLP tools to interpret clinical documentation from emergency departments and urgent care centers are necessary for AI-VFC.

Background: Informed consent is a legal and ethical prerequisite for elective procedures such as total knee arthroplasty (TKA). However, standard informed consent forms often lack evidence-based content and do not adequately support informed decision-making. The aim was to develop and pilot test an evidence-based informed consent form for TKA.

Methods: We conducted a two-phase study. In Phase 1, we developed an extended, evidence-based informed consent form for TKA, as well as a corresponding form for anaesthesia, based on systematic evidence syntheses, expert reviews, and standards outlined in the Guideline Evidence-based Health Information. We also developed an e-learning program to train clinicians in the appropriate use of informed consent forms. In addition, we developed a multiple-choice test to assess patients' knowledge and risk perception. In Phase 2, we piloted the informed consent forms with potential patients through think-aloud interviews and focus groups, assessing their acceptability, usability and comprehensibility with iterative revisions. The multiple-choice test was also piloted and revised. Qualitative data were analysed using qualitative content analysis.

Results: We developed evidence-based informed consent forms for TKA and anaesthesia. Content and risk communication follow the Guideline Evidence-based Health Information and meet legal requirements under German law. Benefits and complications were presented using natural frequencies and visualised with bar charts. The forms were piloted in six think-aloud and three focus group interviews with 17 participants. Feedback from participants and experts highlighted the need for revisions in the presentation of numerical data, terminology, structure and layout, which were addressed iteratively. Overall, the forms were rated as understandable, relevant and helpful, though individual information needs varied. The 12-item multiple-choice knowledge test was revised to improve clarity and was perceived as comprehensible and applicable. The e-learning programme includes videos, texts and interactive elements, and is designed for flexible use over 90 to 180 min.

Conclusions: The informed consent forms are now available. Evidence-based informed consent forms are feasible and perceived by patients as helpful and understandable. The variety of patients' information needs underlines the need for personalised counselling and structural adjustments in clinical practice so that the potential of evidence-based informed consent forms can be exploited.

Objectives: Abnormal osteogenic differentiation of BMSCs is a core factor in osteoporosis (OP). This study investigates how miR-326 regulates osteogenic differentiation of hBMSCs by targeting NAT10, thereby influencing OP pathogenesis.

Method: Serum miR-326 levels were measured using RT-qPCR. Its diagnostic value for OP was assessed by ROC analysis, and its correlation with bone mineral density (BMD) was examined. Using a dexamethasone (DEX)-induced hBMSC OP model, we evaluated the effects of miR-326 on osteogenesis (RT-qPCR), cell viability (CCK-8 assay), and inflammation (ELISA). The miR-326-NAT10 interaction was confirmed by dual-luciferase assay. A rescue experiment with co-transfection verified their functional relationship.

Results: MiR-326 levels in OP patient serum were significantly decreased, and the area under the ROC curve demonstrated excellent diagnostic performance The OP group exhibited significantly lower BMD, which was positively correlated with reduced miR-326 expression. In DEX-induced hBMSCs, miR-326 overexpression promoted osteogenesis by upregulating key markers, enhanced cell viability, and attenuated inflammation. Dual-luciferase assays confirmed NAT10 as a direct target of miR-326. NAT10 was upregulated in OP patients and negatively correlated with miR-326, and oe-NAT10 rescued the pro-osteogenic and anti-inflammatory effects of miR-326.

Conclusions: miR-326 is downregulated in the OP and can serve as a potential diagnostic biomarker for OP. miR-326 promotes osteogenic differentiation of hBMSCs and inhibits inflammatory responses by targeting NAT10, exerting a protective role in the pathogenesis of OP.

Background: Complex tibial plateau fractures continue to pose a significant challenge for surgeons. In recent years, the widespread use of CT imaging has led to new insights leading to novel classifications that facilitate 360° stabilization techniques. Visualization in 3D has improved both fracture reduction and surgical outcomes. This study investigated whether preoperative planning of complex tibial plateau fracture fixation via finite element modeling (FEM) could enhance the fixation performance achieved by experienced surgeons and potentially improve outcomes for less experienced surgeons.

Methods: In twelve left cadaveric fresh-frozen human knees with intact soft tissue reproducible Schatzker type IV fractures with lateral depression were created. The samples were paired on the basis of bone mineral density and then randomly allocated into two groups. Six senior surgeons with extensive experience in the operative treatment of tibial plateau fractures performed two procedures: one using standard preoperative planning and one using FEM-optimized fixation planning. All fractures were stabilized with a medial locking plate and supplemental single screws when needed. The operation time, radiation dose and implant usage were documented. Surgeon mental workload was measured by the NASA task load index. Finally, the samples were biomechanically tested over four quasistatic load ramps from 10 to 200 N, followed by a cyclic sinusoidal load with increasing load level until failure. Failure was defined as either ≥ 5° varus/valgus malalignment or a vertical impression of the condyles ≥ 3 mm. The initial stiffness and load to failure were assessed via a 3D motion tracking system. Statistical analysis was conducted using Student's t-tests.

Results: No significant differences were observed in terms of operative time or intraoperative radiation exposure. However, the NASA-TLX mental demand test revealed a statistically significant advantage for the FEM-planned group (33 ± 12.4 vs. 49 ± 8.6 (p = 0.043)), indicating a reduced cognitive load. Additionally, the FEM group exhibited superior biomechanical performance, with a higher load to failure of 1050 ± 535 N vs. 442 ± 226 N (p = 0.041).

Conclusion: This biomechanical feasibility study demonstrated that FEM-based preoperative planning is feasible and easy to implement for complex tibial plateau fractures. This planning supports specialized surgeons in challenging operations and can improve the stability of osteosynthesis.