Journal of Orthopaedic Surgery and Research最新文献

Introduction: Guiding the graft through the bone tunnel is a crucial step during arthroscopic ligament reconstruction, which is the preferred surgical treatment for anterior cruciate ligament tearing. Comparative studies on suture selection and fixation methods during graft preparation existed, while longitudinal and linear research was lacking to elucidate the effects of tendon cross-sectional area, knot number, and knot interval on the mechanical properties of the tendon-suture system.

Methods: The flexor tendons from the hind paws of fresh domestic swine were used to simulate graft preparation in vitro. After recording the cross-sectional area, the knot number ranged from 1 to 4, and the knot interval was set to 5-10 mm. The SpeedTrap™ technique was employed to construct the tendon-suture system. Subsequently, the grafts were stretched on a biomechanical instrument, and the peak force before the interfacial sliding between the tendon and suture occurred was recorded. After determining the correlations and significances of each variable, univariate and multivariate statistical analyses were performed with the peak force as the dependent variable.

Results: 90 valid data points were collected. Univariate analysis indicated that the peak force was associated with the cross-sectional area of the tendon and the knot number (P = 0.004). Multiple linear regression analysis of the full-scale data also showed that the cross-sectional area had a significant effect on the peak force (β = 0.19, P = 0.017). The multiple linear regression model optimized by stratifying the knot number revealed that in the group with the knot number ≥ 2, the peak force was significantly correlated with both the cross-sectional area and the knot interval (β = 0.48, P = 0.002; β = 0.37, P = 0.009), and their independent effects were significant, with variance inflation factors of 1.1 and 1.05 respectively.

Conclusion: The cross-sectional area significantly impacts the mechanical properties of the tendon-suture system and positively contributes to the peak force before sliding. Increasing the knot interval within 10 mm can enhance the mechanical stability of the tendon-suture system during graft preparation.

Purpose: To compare the clinical and radiological outcomes of the computer assisted octopod external fixator [Adam Frame (AF)] and the conventional Ilizarov external fixator (IEF) in pediatric and adolescent patients undergoing lower limb deformity correction and lengthening.

Methods: This retrospective comparative study included 48 patients (< 18 years, 69 extremities) treated between 2009 and 2015 at two tertiary orthopedic centers. Patients were divided into AF (25 patients, 35 extremities) and IEF (23 patients, 34 extremities) groups. Demographic data, deformity characteristics, correction parameters, indices, and complications were analyzed. Primary outcomes included correction angles, external fixation indices, and complication rates.

Results: The mean age at surgery was 12.0 years in both groups (AF range 9-14, IEF range 5-14; p = 0.309). Sex distribution was also similar (AF: 14 males, 11 females; IEF: 13 males, 10 females; p = 1.000). Femoral involvement was more common in the IEF group, while tibial involvement was common in the AF group (p = 0.046). Sagittal plane deformities were more frequent in the AF group (34.29% vs. 5.88%; p = 0.005). The sagittal correction angle (p = 0.034) and daily lengthening rate (0.80 vs. 0.70 mm/day; p = 0.038) were slightly higher in the IEF group.

Conclusion: Both AF and IEF are effective for pediatric deformity correction and lengthening. The IEF technique achieved greater sagittal correction and slightly faster lengthening. However, AF facilitates multiple adjustments, which can improve outcomes in complex tibial or sagittal-dominant deformities.

Introduction: The introduction of computer-assisted navigation (CAS) in total knee arthroplasty (TKA) aimed to improve prosthetic alignment and potentially enhance long-term implant survival. However, the actual clinical benefit beyond 10 years remains debated.

Materials and methods: Retrospective comparative study with up to 15-16 years of follow-up, including patients undergoing TKA using either a conventional (CONV) or computer-navigated (NAV) technique. The primary outcome was implant survival (absence of revision for any cause). Secondary outcomes were functional scores: Knee Society Score (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

Results: Fifteen-year implant survival was 70.5% (CONV) vs. 73.4% (NAV) (p > 0.05). No statistically significant differences were found in functional outcomes. Mortality unrelated to the prosthesis was high in both groups.

Conclusions: At 15 years, the navigated technique did not demonstrate significant advantages over the conventional approach in terms of implant survival or functional outcomes. Larger prospective studies are required to confirm these findings.

Background: Lumbar fusion surgery using pedicle screws and intervertebral cages is frequently performed to treat low back pain when conservative therapies were unsuccessful. Screw loosening, however, remains one of the most common postoperative complications. The purpose of this study was to show that the fixation with polymer-enhanced AS-ELARIS^® Pedicle Screws by ultrasonic-assisted extrusion of 0.104 mL resorbable polylactide per screw, represents a suitable alternative to current fixation techniques.

Methods: Forty adult female sheep were enrolled in the study and posterolateral fusions were performed at two non-adjacent lumbar levels (L1+L2, L4+L5), implanting eight AS-ELARIS^® Pedicle Screws per animal. After a survival period of 2 days, 8 weeks, 6, 12 or 24 months, animals were sacrificed and the instrumented vertebrae harvested for macroscopic, radiological, and histological evaluation.

Results: Despite surgical challenges in achieving optimal screw positioning, all evaluations demonstrated good biocompatibility and progressive osseointegration. Ultrasonic liquefaction-mediated polymer enhancement proved safe at all investigated timepoints, without evidence of thermal or inflammatory tissue damage.

Conclusions: The AS-ELARIS^® Pedicle Screw System may offer a promising alternative to current fixation techniques. Its biocompatibility, biodegradability, safe removal, and ease of handling make it a valuable addition to spinal fixation strategies.

Background: Light-emitting diode (LED) therapy is a promising non-invasive approach for tendinopathy, yet clinical adoption is hindered by heterogeneous treatment parameters and undefined molecular mechanisms. The role of the Interleukin (IL)-6/signal transducer and activator of transcription 3(STAT3) signaling axis in LED-mediated tendon repair remains unexplored.

Objective: This study aimed to screen effective LED parameters for mitigating tendinopathy by evaluating their effects on inflammation and extracellular matrix (ECM) synthesis in tenocytes, to preliminarily explore the role of the IL-6/STAT3 axis, and to validate the anti-inflammatory and pro-repair effects of selected parameters in a rodent model.

Methods: Tenocytes from 8 week-old male Sprague-Dawley rat's Achilles's tendon were cultured and stimulated with IL-1β to model inflammatory tendinopathy. Cells underwent LED irradiation at varying wavelengths (625 nm, 810 nm, 940 nm) and energy densities. Cell viability was assessed via CCK-8 assay; expression of inflammatory markers (IL-6, Substance P (SP)), ECM components (type I collagen (COL1), type III collagen (COL3), and lubricin (PRG4) was quantified using qPCR, Western blot, and immunofluorescence to determine optimal LED parameters. STAT3 inhibition was applied to IL-1β-stimulated cells before LED treatment to probe STAT3's role. In vivo, collagenase-I was injected into rat Achilles tendons to induce tendinopathy, followed by LED therapy. Pain thresholds were measured using von Frey filaments, tendon histopathology was evaluated via Hematoxylin and Eosin (H&E) staining and modified Bonar scoring, and expression of COL1, COL3, IL-6, SP, and PRG4 was assessed by immunofluorescence and immunohistochemistry.

Results: LED irradiation at 625 nm/52.8 J/cm² markedly reduced IL-1β-induced IL-6 and SP expression, while 810 nm/39.6 J/cm² and 940 nm/26.4 J/cm² enhanced COL1 synthesis without affecting COL3 or PRG4 levels. Mechanistically, LED therapy restored IL-1β-suppressed STAT3 activation, an effect abrogated by STAT3 inhibition. In vivo, 625 nm and 940 nm LED treatments alleviated mechanical hyperalgesia in collagenase-I-induced tendinopathy, with 625 nm showing superior efficacy in reducing IL-6 and SP, enhancing COL1 deposition, and restoring tendon architecture.

Conclusions: IL-1β disrupts tendon homeostasis by driving inflammation and ECM degradation. LED therapy at 625 nm/52.8 J/cm² mitigates these effects, potentially by restoring STAT3 activity within the IL-6/STAT3 axis, thereby suppressing IL-6 expression.This provides a mechanistic foundation for refining LED-based tendinopathy treatments.

Background: Recycled autografts are widely used in limb salvage surgery for patients with long-bone defects due to bone sarcoma resection. Currently, there are limited number of studies to sufficiently estimate graft survival and its modes of failure.

Purpose: We aim to assess the survival probability of recycled autografts and its associated prognostic factors in limb salvage surgery of long-bone sarcoma.

Methods: We performed a systematic search from PubMed, Embase and Scopus. Observational studies and case series reporting graft survival outcomes with follow-up data were included. Graft survival probabilities at 1, 2, 5, and 10 years were pooled. Using data of individual participant data (IPD), prognostic factors associated with poor graft survival and mean survival time for the recycled autograft were identified using multivariable flexible parametric regression.

Results: A total of 2388 articles were identified. Twenty-eight studies with 395 patients were eligible. The median age of the patients was 20 years (interquartile range, 15-34) and approximately half of them were male. From study-level meta-analysis, the pooled graft 5-year survival probability of the recycled autograft was 91.0% (95%CI 85.4-95.6; I² 49.6%; very low certainty of evidence). From IPD analysis, male gender, femur and tibia osteoarticular resections were significantly associated with poor graft survival rates comparing to intercalary resection. Furthermore, infection ranked the most observed cause among all failures.

Conclusion: The recycled autograft may offer a feasible limb-salvage option for long-bone sarcomas. With individual participant data, our results suggest factors that associated with poor graft survival. However, further prospective studies with large sample size focusing on graft survival would be needed.

Objective: This study aimed to identify key mitochondria-related genes involved in the pathogenesis of osteoarthritis (OA).

Methods: Publicly available OA-related gene expression datasets were analyzed. Differential expression analysis, immune infiltration analysis, weighted gene co-expression network analysis (WGCNA), and machine learning were used to identify hub differentially expressed mitochondria-related genes (DE-MRGs) for constructing a molecular signature to predict OA risk. In addition, a nomogram, protein-protein interaction (PPI) network, gene set enrichment analysis (GSEA), and a competing endogenous RNA (ceRNA) network of signature DE-MRGs were generated to assess their predictive performance and regulatory mechanisms in OA. The expression of signature DE-MRGs was validated in interleukin (IL)-1β-treated chondrocytes, and the effects of IMMT knockdown on OA pathogenesis and mitochondrial dysfunction were investigated in vitro.

Results: A molecular signature comprising seven DE-MRGs (IMMT, LONP1, TUFM, SOD2, CYCS, CAT, and DLD) demonstrated high predictive performance for OA. The nomogram established using these genes also exhibited high predictive accuracy for OA risk. Furthermore, GSEA revealed that IMMT was implicated in pathways such as Notch signaling. A ceRNA network involving MEG3-miR-370-3p-IMMT was predicted. Quantitative PCR confirmed significant downregulation of IMMT, TUFM, CAT, and DLD in IL-1β-treated chondrocytes. Knockdown of IMMT promoted OA development and induced mitochondrial dysfunction in chondrocytes.

Conclusion: The identified DE-MRG signature holds significant potential for predicting OA. The downregulation of IMMT may contribute to OA pathogenesis by inducing mitochondrial dysfunction. These findings provide a foundation for developing more effective diagnostic and therapeutic strategies for OA.

Background: Microvascular dysfunction of the subchondral bone is thought to play a central role in juvenile osteochondritis dissecans (JOCD), but remains difficult to assess with conventional MRI. This study evaluated the diagnostic value of intravoxel incoherent motion MRI (IVIM-MRI) parameters in JOCD of the distal femoral condyle and explored their relationship with lesion morphology and stability.

Methods: In this single-center retrospective cross-sectional study, 57 skeletally immature patients (mean age 13.0 ± 2.0 years) with clinically and radiologically confirmed JOCD underwent bilateral knee IVIM-MRI. Quantitative parameters-apparent diffusion coefficient (ADC), perfusion fraction (f), and pseudodiffusion coefficient (D*)-were calculated for lesional and contralateral condyles. Lesion stability was classified on conventional MRI using the Hefti system. Morphological measurements and clinical scores (IKDC, KOOS-Child, Tegner) were recorded. Within-subject comparisons used Shapiro-Wilk testing, paired t-tests or Wilcoxon signed-rank tests, and effect sizes (Cohen's d). Diagnostic performance for discriminating stable versus unstable lesions was assessed with ROC analysis and multiparametric IVIM models.

Results: JOCD lesions showed significantly reduced perfusion fraction (0.178 ± 0.048 vs. 0.253 ± 0.043, p < 0.001) and ADC (1.178 ± 0.167 vs. 1.363 ± 0.100 × 10⁻³ mm²/s, p < 0.001) compared with contralateral tissue, with large effect sizes, indicating marked microvascular compromise and restricted diffusion. Perfusion fraction yielded high diagnostic accuracy for lesion instability (AUC = 0.91; optimal cutoff 0.20; sensitivity 88.6%, specificity 85.0%), while a combined IVIM model further improved classification accuracy to 94.7%. Correlations between IVIM parameters and baseline IKDC, KOOS-Child, and Tegner scores were weak and non-significant. Age-stratified analyses (≤ 12 vs. > 12 years) revealed no significant differences in microvascular metrics. Based on IVIM profiles, lesions were categorized into three microvascular patterns: preserved (Type I), compromised (Type II), and intermediate (Type III).

Conclusions: IVIM-MRI provides quantitative, non-invasive biomarkers that sensitively characterize microvascular compromise in JOCD and support objective assessment of lesion stability. The prognostic utility of these biomarkers for clinical outcomes, however, remains uncertain and warrants validation in prospective studies with arthroscopic ground truth (ROCK classification) and longitudinal follow-up.

Background: Pyogenic spondylitis (PS) and tuberculous spondylitis (TS) are two common types of spinal infections. Given the significant differences in their antimicrobial treatment regimens, early and accurate differentiation is critical for developing appropriate clinical management strategies. The study aimed to develop and validate MRI-based epidural abscess signal (EAS) and vertebral body signal (VBS) scores for differentiating PS from TS, guiding empirical antibiotic therapy before microbiological confirmation.

Methods: This study enrolled patients with definitive etiological or pathological diagnosis of PS or TS from two tertiary centers into two cohorts: a retrospective derivation cohort (n = 88; December 2021-December 2024) and a prospective validation cohort (n = 34; January-June 2025). The EAS score was calculated using T2-weighted imaging signal intensity, while the VBS score was derived from T1-weighted imaging signal intensity. Diagnostic performance of scores was evaluated using receiver operating characteristic (ROC) curve analysis to determine optimal cutoff values. Multivariable logistic regression analysis was performed to develop the prediction model and externally validated through the prospective cohort.

Results: PS patients consistently demonstrated significantly higher EAS scores and lower VBS scores compared to TS patients across both derivation and validation cohorts (all p < 0.001). ROC analysis within the derivation cohort established EAS ≥ 0.400 (AUC = 0.888, 95% CI 0.801-0.975) and VBS ≤ 2.000 (AUC = 0.870, 95% C I0.784-0.956) as optimal diagnostic thresholds for PS. Implementing these thresholds to guide empirical therapy in the validation cohort significantly improved clinical management. This intervention resulted in a marked reduction in inappropriate empirical therapy (5.9% vs. 23.4%), shorter mean hospitalization duration (23.4 vs. 28.7 days), and reduced total antibiotic therapy duration (20.2 vs. 25.2 days) compared to the derivation cohort managed by standard guidelines. Multivariate analysis confirmed EAS ≥ 0.400 (aOR = 50.04, 95% CI 3.15-794.06) and CRP ≥ 50 mg/L (aOR = 37.47, 95% CI 1.01-1384.31) as independent predictors of PS in the EAS subgroup. Similarly, VBS ≤ 2.000 (aOR = 84.10, 95% CI 9.81-721.18) and CRP ≥ 50 mg/L (aOR = 10.62, 95% CI 1.11-101.46) were significant independent predictors in the VBS subgroup.

Conclusion: The EAS and VBS MRI-based scores enable rapid differentiation of pyogenic from tuberculous spondylitis, significantly reducing inappropriate antibiotic use and optimizing therapeutic decision-making.