Journal of Orthopaedic Surgery and Research最新文献

Purpose: To describe and standardize a reproducible posterolateral approach to the posterior iliac crest for bone marrow aspirate (BMA) harvesting, based on a palpation-guided technique with optional ultrasonographic confirmation, emphasizing anatomical accuracy, safety, and procedural simplicity.

Methods: The technique was performed in 63 patients using a Jamshidi-type cannula introduced through a lateral entry point aligned with the posterior superior iliac spine (PSIS). Guided by palpable anatomical landmarks and optionally confirmed by ultrasound, small-volume aspirations (4-5 mL) were performed with systematic needle reorientation to minimize peripheral blood dilution and optimize marrow cell yield. The procedure was conducted under local anesthesia, with the patient positioned laterally to ensure comfort and ergonomic access for the operator, allowing multiple aspirations through a single entry site.

Results: The posterolateral PSIS approach, using a palpation-based method with optional ultrasonographic confirmation, was feasible and anatomically consistent in this descriptive case series of 63 patients. Using predefined anatomical criteria for procedural success, correct subendosteal cannula positioning at the level of the PSIS was achieved in all procedures. In cases in which ultrasonography was employed, correct positioning was sonographically confirmed. When ultrasonographic confirmation was not used, the procedure was completed based on anatomical landmark guidance alone, without any intention of comparative assessment. The lateral patient position offered ergonomic advantages for the operator and enhanced patient comfort, while maintaining a low risk to adjacent neurovascular structures.

Conclusions: This standardized, palpation-guided lateral technique provides a safe, efficient, and anatomically reliable method for bone marrow harvesting that can be performed under local anesthesia in an outpatient or office-based setting.

Clinical relevance: By combining anatomical precision with procedural simplicity and eliminating the need for fluoroscopy or continuous ultrasound guidance, this approach facilitates broader access to bone marrow aspiration for orthopedic and regenerative applications, enhancing both procedural efficiency and patient experience.

Objective: To compare clinical outcomes and radiographic parameters between interspinous process fixation (ISPF) and posterior lumbar interbody fusion (PLIF) in patients with single-level degenerative lumbar spinal stenosis (LSS) associated with Meyerding Grade I spondylolisthesis.

Methods: We retrospectively analyzed 107 patients who underwent ISPF (n = 55) or PLIF (n = 52) between January 2019 and January 2023. Propensity score matching (PSM) was performed using covariates including age, sex, BMI, symptom duration, smoking history, diabetes mellitus, hypertension, and affected spinal level, resulting in 36 matched pairs. Clinical efficacy was evaluated using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score, and Macnab criteria. Radiographic assessments included lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), segmental angle (SA), and disc height (DH). All patients completed more than 24 months of follow-up.

Results: Post-matching analysis demonstrated good baseline balance (SMD < 0.20, P > 0.05). ISPF showed superior short-term outcomes, with significantly greater improvement in VAS scores both immediately postoperatively (2.52 ± 1.39 vs. 3.21 ± 1.23, P = 0.0078) and at the 3-month follow-up (1.83 ± 1.31 vs. 2.54 ± 1.20, P = 0.0042). Similarly, ODI favored ISPF at the immediate postoperative evaluation (38.64 ± 8.86 vs. 42.17 ± 6.77, P = 0.0221) and at 3 months (25.61 ± 8.84 vs. 30.15 ± 6.75, P = 0.0035), whereas no significant between-group differences were observed at 1 year and at the final follow-up (both P > 0.05). Radiographically, ISPF achieved superior LL (45.13° ± 4.97 vs. 40.37° ± 7.37, P = 0.0002) and lower PT (12.49° ± 7.62 vs. 15.80° ± 8.26, P = 0.0334), whereas PLIF demonstrated greater correction of the slip angle (SA: 10.99° ± 2.53 vs. 12.52° ± 1.48, P = 0.0004). Long-term clinical outcomes and patient satisfaction rates were comparable (Macnab excellent-to-good: 86.11% ISPF vs. 83.33% PLIF, P = 0.9420).

Conclusions: ISPF provided better short-term clinical recovery and maintenance of sagittal alignment, whereas PLIF offered greater slip correction. Both procedures yielded comparable long-term clinical outcomes, supporting individualized surgical decision-making in patients with degenerative LSS and Grade I spondylolisthesis.

Background: Previous studies have not compared lung and airway morphologies before and after treatment for severe scoliosis. Herein, computed tomography (CT) 3-dimensional (3D) reconstruction of the respiratory system was performed to evaluate the changes in lung expansion and airway dilation following posterior spinal fusion for severe scoliosis.

Methods: Twenty-two patients with severe scoliosis (12 women and 10 men) who treated with posterior spinal fusion (PSF) were included. Pre- and postoperative visits included CT scans and radiographic assessments. Changes in airway dilation were assessed using 3D CT reconstruction of the bronchial tree, and changes in lung volume were evaluated using lung 3D CT reconstruction pre- and postoperatively.

Results: Spinal radiographic parameters improved after PSF. The main Cobb angles were 135.89 ± 21.80° and 50.51 ± 16.02° (p < 0.001), and thoracic kyphosis angles were 115.75 ± 35.47° and 47.60 ± 8.56° in the pre- and postoperative groups, respectively (p < 0.001). After PSF, the total lung volume (TLV) values improved from 1.48 ± 0.76L to 1.89 ± 0.33 L, which were significantly different (t = 3.099, p = 0.0101). The preoperative and postoperative values for the left lung volume (0.69 ± 0.34 and 0.88 ± 0.33L) and right lung volume (0.69 ± 0.14 and 0.95 ± 0.28L) were significantly different [t = 3.802; p = 0.0029]; [t = 3.415; p = 0.0066]. The tracheal diameter varied between the pre- and postoperative groups (12.21 ± 1.91 mm vs. 15.32 ± 1.83 mm, respectively) (p < 0.0001). The diameter of the left main bronchus increased from 9.83 ± 2.41 mm to 12.01 ± 1.76 mm (p = 0.0138). The diameter of the right major bronchus increased from 9.88 ± 2.41 to 11.63 ± 1.37 mm (p = 0.0048).

Conclusions: Lung morphology parameters, including lobe volume and bronchial parameters, can be measured using CT-based reconstructions. PSF can safely and effectively correct the curve, relieve airway obstruction, and expand the lungs of patients with severe scoliosis.

Level of evidence iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online  Instructions to Authors  www.springer.com/00266.

Background: Achilles tendon rupture (ATR) often limits early rehabilitation following conventional repair. The ligament augmentation reconstruction system (LARS) offers immediate mechanical stability and enables early mobilization. However, few studies have directly compared LARS with conventional suture techniques in ATR.

Purpose: To compare the efficacy and safety of the LARS versus the conventional Kessler suture technique for managing acute closed ATR.

Study design: Retrospective Cohort Study.

Methods: A retrospective analysis was conducted on 91 patients who underwent surgical repair for ATR. The cohort was divided into two groups: 59 patients were treated with the LARS and 32 with the conventional Kessler suture technique. Functional outcomes were assessed using the Achilles tendon Total Rupture Score (ATRS) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score at 3, 6, and 12 months postoperatively. Complications and re-rupture rates were systematically documented and compared between the groups.

Results: At the 3-month follow-up, the LARS group demonstrated significantly superior functional outcomes, with markedly higher ATRS (78.00 ± 15.01 vs. 55.00 ± 16.30, P < 0.001) and AOFAS scores (87.03 ± 5.44 vs. 82.03 ± 3.92, P < 0.001) compared to the conventional repair group. This superiority was maintained at the 6-month assessment for both the ATRS (88.00 ± 12.18 vs. 76.00 ± 13.23; P < 0.001) and AOFAS scores (94.78 ± 4.90 vs. 89.06 ± 4.54; P < 0.001). However, by 12 months postoperatively, the differences in both ATRS and AOFAS scores between the two groups were no longer statistically significant (P > 0.05). The LARS group reported one case of gastrocnemius weakness, while the conventional group experienced two cases of delayed wound healing and one superficial infection.

Conclusion: LARS repair enables a faster functional recovery in the short term compared to conventional Kessler repair, without increasing complication rates. While both techniques yield comparable excellent results by one year, the accelerated recovery pathway provided by LARS establishes it as a safe and effective treatment option, especially valuable for patients requiring an early return to activity.

Purpose: This study aimed to compare the measurements of Böhler's angle (BA) and the critical angle of Gissane (GA) between lateral radiographs and computed tomography (CT) scans in dry human calcanei, and to assess the inter- and intraobserver agreement for each angle across both imaging modalities.

Methods: A total of 160 dry human calcanei were examined. Both BA and AG were measured on digital radiographs and multiplanar CT reconstructions. Two independent observers - a radiologist and an orthopedist performed all measurements in two separate sessions. Mean values, standard deviations, and agreement metrics were calculated. The inter- and intraobserver reliability were assessed using intraclass correlation coefficients (ICC). Paired statistical tests were used to compare radiographic and tomographic measurements.

Results: The mean value of the BA was 31.8° ± 5.8° and 29.7° ± 5.6° on radiographies and CT-scans, respectively. The GA showed mean values of 108.7° ± 9.2° on radiographs and 125.7° ± 10.3° on CT. CT-based measurements of BA demonstrated the highest reproducibility (ICC > 0.90), with excellent inter- and intraobserver agreement. In contrast, GA showed poor agreement across all comparisons, particularly on radiographs (ICC < 0.30). Observer agreement was consistently higher for BA, and CT substantially reduced interobserver variability.

Conclusion: The BA demonstrated superior measurement reliability compared to the Gissane angle, particularly when assessed by CT. GA measurements demonstrated low reproducibility and should be interpreted with caution, especially when obtained from x-rays. These findings support the preferential use of CT-based BA for morphometric and clinical evaluations of the calcaneus.

Background: This study aimed to compare the long-term polyethylene wear in total hip arthroplasty (THA) using ceramic-on-polyethylene (CoP) bearings with monolithic zirconia femoral heads versus metal-on-polyethylene (MoP) bearings with cobalt-chromium heads. A secondary objective was to assess the in vivo impact of zirconia low-temperature degradation (LTD) on polyethylene wear.

Methods: Sixty-two hips were assigned to two demographically matched cohorts receiving polyethylene liners paired with either 28-mm monolithic zirconia or cobalt-chromium heads. All patients received the same implant design and were followed for a minimum of 20 years. Linear head penetration was evaluated over a 25-year period. A zirconia head retrieved after 25 years was analyzed via Raman spectroscopy to investigate phase transformation and residual stress.

Results: During the first 10 years post-THA, no significant differences were observed in cumulative polyethylene wear or linear wear rates between the MoP and CoP groups. However, beyond 10 years, these groups demonstrated differing wear patterns, with wear tending to increase in the CoP group and decrease in the MoP group. Between 10 and 25 years, the wear rate in the CoP group was approximately 2.4 times higher than that in the MoP group. Analysis of the retrieved zirconia head revealed extensive monoclinic phase transformation (92.3%), high compressive residual stress (- 1.9 GPa), and notable grain uplift, correlating with an elevated wear rate of 0.212 mm/year during the second decade.

Conclusions: MoP and CoP bearings demonstrated similar polyethylene wear characteristics during the first decade after THA. However, a marked divergence emerged in the second decade, with significantly higher wear rates observed in the CoP group, likely attributable to the accelerated progression of zirconia LTD. These findings highlight the long-term implications of ceramic degradation and emphasize the need for careful evaluation of zirconia-based components in THA regarding their durability over time.

Background: Patellofemoral pain syndrome (PFPS) is a common knee disorder associated with biomechanical abnormalities and impaired dynamic stability. While well-studied in younger populations, dynamic balance in middle-aged and elderly individuals with PFPS remains poorly understood. The Y-Balance Test (YBT) is a validated tool for assessing multidirectional balance and has been increasingly used in PFPS evaluations. This cross-sectional study aimed to compare lower-extremity dynamic balance using the YBT between symptomatic patients aged 40-60 years and asymptomatic controls.

Methods: Forty-nine patients with PFPS (symptoms ≥ 3 months) and 21 healthy controls underwent YBT assessment. Anterior reach asymmetry, composite score, posteromedial/posterolateral reach distances, limb symmetry ratio, and inter-limb difference were analysed with independent-samples t-tests.

Results: PFPS patients showed greater anterior reach asymmetry (4.4 ± 1.4 cm vs. 2.4 ± 1.7 cm; p = 0.03) and lower composite scores on the affected side (left: 92.1 ± 4.8% vs. 98.9 ± 3.7%; p = 0.02). Reach distances in the posteromedial and posterolateral directions were also reduced (p < 0.05). Limb symmetry ratios did not differ between groups (p > 0.05).

Conclusion: Middle-aged and elderly individuals with PFPS exhibit multiplanar dynamic stability deficits on the YBT despite preserved inter-limb symmetry. These objective impairment findings support incorporating targeted balance training and kinetic chain exercises into rehabilitation protocols for this age group.

Clinical trial registration: ClinicalTrials.gov Identifier: NCT07068984.

Objective: Long non-coding RNA CASC15 plays a role in the development of various human diseases. However, the diagnostic role and molecular mechanisms of CASC15 in postmenopausal osteoporosis (PMOP) remain unclear.

Methods: This study enrolled 137 healthy postmenopausal women and 141 PMOP patients. CASC15 and miR-152-3p levels in serum and HBMSCs were measured via RT-qPCR. Western blotting and RT-qPCR were employed to analyze the protein and mRNA expression levels of osteogenic markers (RUNX2, ALP, OCN, Col I). CASC15's diagnostic value was assessed by the ROC curve. Proliferation (CCK-8) and apoptosis (flow cytometry) were examined. CASC15-miR-152-3p targeting was confirmed via DLR and RIP assays.

Results: CASC15 expression was increased, while miR-152-3p expression was decreased in PMOP. CASC15 expression levels were higher in PMOP patients with fractures, and this molecule effectively distinguished between healthy individuals and PMOP patients, as well as between those with and without fractures. Functional experiments showed that inhibiting CASC15 enhanced HBMSCs' proliferation and osteogenic differentiation capacity while reducing apoptosis. However, inhibiting miR-152-3p reversed these effects.

Conclusion: The level of CASC15 is closely linked to the occurrence and development of fractures in PMOP patients. Its molecular mechanism may involve targeting miR-152-3p to restrict its levels, thereby reducing osteogenic differentiation in HBMSCs.

Background: Although quantitative T2 mapping magnetic resonance imaging (MRI) is recognized as a non-invasive method for assessing graft maturity after anterior cruciate ligament (ACL) reconstruction, its longitudinal changes and association with clinical outcomes within the first postoperative year are not well established. The purpose of this study was to prospectively investigate hamstring autograft maturity via sequential quantitative T2 mapping and to examine its relationship with patient-reported outcomes and return to sports during the first year after ACL reconstruction.

Methods: Twenty-seven patients undergoing primary ACL reconstruction with hamstring tendon autografts were enrolled for MRI scans at 3, 6, and 12 months after surgery, and 15 patients with healthy ACLs served as controls. The quantitative MRI-based T2 relaxation time and conventional MRI-based signal/noise quotient (SNQ) of the graft were calculated and correlated with the Lysholm score, International Knee Documentation Committee (IKDC) subjective score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and return to preinjury sports levels.

Results: T2 relaxation times and SNQ values of the grafts increased from 3 to 6 months (p < 0.01) and then decreased from 6 to 12 months postoperatively (p < 0.05). Graft T2 relaxation times were significantly lower than those of native ACLs at 3, 6, and 12 months postoperatively (p < 0.01). A significant negative correlation was observed between graft T2 relaxation time and the Lysholm score at 6 months postoperatively (p = 0.028), as well as with the KOOS pain subscale at 12 months (p = 0.023). Patients returning to preinjury sports levels at 12 months postoperatively had relatively lower graft T2 relaxation times (p = 0.045) and SNQ values (p = 0.043) compared to those who did not.

Conclusions: The graft T2 relaxation time and SNQ value increased during the first 6 months, followed by a subsequent reduction from 6 to 12 months after ACL reconstruction, and graft T2 relaxation time showed significant negative correlations with the Lysholm score at 6 months and with the KOOS pain subscale at 12 months postoperatively. Successful return to preinjury sports levels at 12 months was associated with lower graft T2 relaxation times and SNQ values. Quantitative MRI T2 mapping may provide an important assessment technique for monitoring graft maturation and guiding return to sports.

Background and study aims: Elastic stable intramedullary nailing (ESIN) enables stable osteosynthesis with a low rate of complications in pediatric both-bone forearm fractures. However, repeated unsuccessful attempts at closed reduction can cause unnecessary soft tissue trauma and increased radiation exposure. We conducted a retrospective study of pediatric forearm fracture patients to identify predictors for the need for open reduction when using ESIN.

Patients and methods: We included 65 pediatric patients who underwent ESIN osteosynthesis for both-bone forearm fractures. We analyzed gender, age at injury, fracture location, fracture type, radiological parameters (shortening, angulation, and translation), the order in which the bones were stabilized, and the type of reduction performed.

Results: Of the patients, 49 (75.4%) were male and 16 (24.6%) female, with a mean age of 11.5 years. Most fractures (87.7%) occurred in the middle third of the forearm; 4.6% were proximal, and 7.6% distal. Fifteen patients (23%) had an open fracture; the remaining 50 (77%) had closed fractures. Overall, 59.2% (77/130) of fractured bones were fixed after closed reduction, while 40.8% (53/130) required open reduction and fixation. When the radius was the first bone stabilized, significantly greater translation and shortening were observed in cases requiring open reduction. The difference was most pronounced when translation exceeded 100%. When the ulna was the first bone stabilized, significantly greater shortening predicted the need for open reduction.

Conclusions: When the radius is stabilized first, significant shortening and translation-especially translation over 100%-strongly predict failed closed reduction. When the ulna is first, shortening remains a reliable predictor.

Level of evidence: Level III (Retrospective comparative study).