Journal of Orthopaedic Surgery and Research最新文献

Background: This study evaluated the long-term clinical and radiological outcomes of operatively treated scapular fractures using the tissue-sparing posterior Brodsky approach. We hypothesized that osteosynthesis using this approach would yield favorable functional outcomes.

Methods: This retrospective study included patients with acute scapular fractures treated operatively using the posterior Brodsky approach from January 2015 to December 2019. Radiologic evaluation included fracture classification and fracture union. Functional outcomes were assessed using the Constant-Murley Score (CMS), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, the Shoulder Pain and Disability Index (SPADI), Visual Analogue Scale (VAS), and range of motion. Postoperative complications were documented.

Results: A total of 16 patients with a mean follow-up of 6.3 years were included. The cohort included both extra-articular and intra-articular fracture patterns, with associated injuries such as coracoid fractures. All fractures achieved radiographic union. The mean Constant-Murley Score was 75 ± 14 points, the SPADI score was 85 ± 15, the DASH score was 15 ± 15, and the mean VAS score was 2 ± 1. Shoulder motion was largely preserved, with a mean external rotation of 70° ± 12°. Postoperative complications were observed in one patient due to incorrect screw placement during coracoid fracture fixation. Five patients required a staged surgical procedure due to associated coracoid fractures.

Conclusions: Operative treatment of scapular fractures using a tissue-sparing posterior approach was associated with favorable long-term functional outcomes, preserved shoulder motion, low pain levels, and reliable fracture union, with a low complication rate, even in cases requiring staged procedures due to associated injuries.

This study aimed to determine whether patient-specific 3D-printed guide plates enhance femoral tunnel placement accuracy, reduce operative time, and promote faster functional and kinematic recovery in medial patellofemoral ligament (MPFL) reconstruction compared to conventional techniques. Prospective, randomized controlled trial. Single academic tertiary care hospital. Sixty patients diagnosed with recurrent patellar dislocation were enrolled and randomly assigned to either a 3D-printed guide plate group (n = 30) or a conventional fluoroscopy-guided group (n = 30). Patients in the intervention group underwent MPFL reconstruction assisted by customized 3D-printed guide plates for femoral tunnel placement. The control group received conventional fluoroscopy-assisted MPFL reconstruction. Both groups followed an identical rehabilitation protocol postoperatively. Primary outcomes included operative time, femoral tunnel placement accuracy (distance from the Schöttle point), knee function scores (Lysholm, Kujala, Tegner, IKDC), and 3D gait kinematics using the Opti-Knee system. Knee function scores were assessed preoperatively at 3, 6, and 12 months, and 3D gait kinematics were tested preoperatively at 3, 6, 9, and 12 months. The 3D-printed group had significantly shorter operative times (68 ± 12 min) than the conventional group (85 ± 16 min; p < 0.05). Femoral tunnel deviation was lower in the 3D group (5.42 ± 2.29 mm) compared to controls (7.65 ± 2.47 mm; p < 0.001). Functional scores were higher in the 3D group at 3 and 6 months (p < 0.05), and flexion-extension kinematics normalized by 6 months in the 3D group compared to 12 months in controls. 3D-printed guide plates improve femoral tunnel accuracy and reduce surgical time, accelerating early functional recovery. These findings support their clinical utility as a superior alternative to conventional guidance methods.

Background: Hip fractures remain a serious threat, particularly among the elderly. Characterizing longitudinal patterns of quality of life (QoL) is important to understand recovery after hip fracture. Identifying subgroups with similar trajectories can help design tailored rehabilitation strategies. This study aimed to investigate the trajectories of QoL over one year following hip fracture surgery and to identify factors associated with each trajectory class.

Methods: This longitudinal study utilized a hip fracture registry database from a single medical center. QoL was assessed using the EuroQoL 5-dimension 3-level (EQ-5D-3L) questionnaire at admission, 6 months, and 1 year following hip fracture surgery. Growth mixture modelling was applied to identify subgroups of patients experiencing different trajectories of QoL. Baseline characteristics were compared between groups, and multivariate multinomial logistic regression was used to examine factors associated with trajectory group membership.

Results: Three hundred and eighty-two patients with hip fracture (mean age 80.2; 71.3% female) experienced four distinct QoL trajectories after surgery that were identified: the consistently high QoL group (60.47%) maintained near-optimal QoL throughout follow-up, the partially declined then stable group (21.99%) showed a moderate drop at 6 months with stabilization by 1 year, the notably decreased QoL group (12.83%) demonstrated a steep and persistent decline, representing the poorest recovery, and the recovered Qol group (4.71%) started with the lowest baseline QoL but showed continuous improvement over one year. Multivariate multinomial regression showed that osteosarcopenia, a lower pre-fracture EQ-5D-3L utility score, and poorer activity of daily living predicted a notably decreased QoL trajectory, while older age and worse cognition predicted a partially declined then stable trajectory. No baseline covariates significantly predicted the recovered trajectory.

Conclusion: Four QoL trajectories within one year following hip fracture surgery in elderly patients were explored. Age, comorbidity burden, musculoskeletal health, cognitive status, baseline QoL, and functional independence were significantly associated with trajectory membership. Routine assessment of these factors can help guide personalized management to help maintain QoL and prevent further decline.

Background/objective: Marginal impaction in acetabular posterior wall fractures significantly influences long-term prognosis, yet current assessment methods remain qualitative. This study introduces quantitative volumetric analysis using three-dimensional computed tomography to evaluate the prognostic significance of impaction volume-representing the first volumetric quantification of marginal impaction in the literature.

Methods: Twenty-two patients with acetabular posterior wall fractures and marginal impaction treated between May 2021 and October 2023 at a tertiary trauma center were retrospectively analyzed. Preoperative computed tomography scans were processed using 3D Slicer-5.8.1 software to measure impacted fragment volumes and impaction volume-to-acetabular volume ratios. Functional outcomes were assessed using Harris Hip Score (HHS) and Modified Merle d'Aubigné-Postel Score (MMAS) at 6 months and 2 years. Statistical analysis included correlation analysis, receiver operating characteristic curves, and multivariate regression to identify prognostic factors.

Results: Mean patient age was 45.3 ± 16.8 years (range 23-74) with mean body mass index of 26.4 ± 3.8 kg/m². Mean impaction volume was 1,847.3 ± 1,124.6 mm³ (range 89-3,842 mm³). Receiver operating characteristic curve analysis identified an exploratory threshold of 2000 mm³ for predicting poor functional outcomes, with area under the curve 0.91 (95% CI: 0.78-1.00, p < 0.001). Patients with impaction volumes > 2000 mm³ (n = 8, 36.4%) demonstrated significantly worse functional outcomes at 2 years compared to those with ≤ 2000 mm³ (HHS: 68.3 ± 10.8 vs 88.5 ± 7.2, p < 0.001; MMAS: 13.4 ± 2.3 vs 17.6 ± 1.2, p < 0.001). Post-traumatic osteoarthritis developed in 9 patients (40.9%), with significantly higher rates in the high-volume group (75.0% vs 21.4%, p = 0.012). Impaction volume showed strong negative correlation with functional scores at 2 years (HHS: r = -0.782, p < 0.001; MMAS: r = -0.758, p < 0.001). The impaction volume-to-acetabular volume ratio averaged 5.12 ± 3.15% and demonstrated similar prognostic value.

Conclusions: This study presents the first quantitative volumetric measurement of marginal impaction in acetabular fractures, which may offer improved prognostic discrimination compared to qualitative assessment in this cohort. An exploratory threshold of 2000 mm³, derived from receiver operating characteristic analysis, appears to stratify patients into different risk categories in this cohort for poor functional outcomes. This objective measurement tool may enhance surgical decision-making and patient counseling in acetabular fracture management. Future multicenter studies are needed to validate this threshold and establish standardized volumetric protocols.

Objective: To assess the clinical efficacy of medial patellofemoral ligament reconstruction (MPFL-R) combined with medial-approach derotational distal femoral osteotomy (DDFO) in the treatment of recurrent patellar dislocation (RPD).

Methods: In this retrospective Level IV case series, we reviewed 45 patients with recurrent patellar dislocation (2 males, 43 females; age 13-44 years, mean 22.8 ± 6.0 years) and a femoral anteversion angle (FAA) > 30° as measured using the Jarrett method (Kaiser et al. in Arch Orthop Trauma Surg 136(9):1259, 2016), who underwent combined medial patellofemoral ligament reconstruction (MPFL-R) and medial-approach derotational distal femoral osteotomy (DDFO) between January 2018 and January 2022. Clinical and radiographic parameters were assessed preoperatively and at a minimum two-year follow-up, including J-sign grading, visual analogue scale (VAS) pain score, Caton-Deschamps index (CD-I), FAA, patellar tilt angle (PTA), tibial tubercle-trochlear groove (TT-TG) distance, and patient-reported outcome measures (PROM) scores (Tegner, Kujala, and Lysholm). A subgroup analysis compared outcomes between patients who did and did not undergo adjunctive tibial tubercle osteotomy (TTO).

Results: At the two-year follow-up, patients demonstrated significant improvements in J-sign grading, VAS pain scores, femoral anteversion angle, patellar tilt angle, TT-TG distance, and functional outcomes (Tegner, Kujala, and Lysholm scores) (all P < 0.05). The Caton-Deschamps index showed no significant change (P > 0.05). In subgroup analysis, the TTO cohort experienced a greater reduction in TT-TG distance than the non-TTO cohort (P < 0.05), whereas postoperative VAS, Kujala, and Lysholm scores did not differ significantly between groups (P > 0.05).

Conclusion: Medial patellofemoral ligament reconstruction combined with medial-approach derotational distal femoral osteotomy effectively restores patellofemoral stability and enhances functional outcomes in patients with recurrent patellar dislocation and excessive femoral anteversion. The indication for concomitant tibial tubercle osteotomy should be individualized according to each patient's specific anatomical and clinical characteristics.

Background: Intraoperative culture is critical for diagnosing periprosthetic joint infection (PJI) and antibiotic guidance, yet its value is limited by high culture-negative rates. To improve microbial yield, we developed a multi-site intraoperative sampling protocol (MSP) with following objectives: (1) to evaluate whether MSP could improve the yield of cultures; (2) to identify the optimal specimen types and anatomical sites for culture.

Methods: A retrospective study was conducted on 163 PJIs from 2015 to 2025. Among these cases, 69 underwent traditional intraoperative sampling protocol (TSP), while 94 underwent MSP. Pathogen detection rates and contamination rates were compared between the two groups. Additionally, culture positivity rates were compared across various specimen types and anatomical sites within MSP group.

Results: The MSP showed significantly higher pathogen detection rates than TSP (P = 0.003), consistent across knee (P = 0.038) and hip PJIs (P = 0.034). The adoption of MSP (OR = 2.430, P = 0.030) was independent predictor of pathogen detection. Regarding specimen type, synovial fluid (unadjusted P < 0.001, adjusted P = 0.001), pseudocapsule (unadjusted P < 0.001, adjusted P = 0.001), and interface membrane (unadjusted P = 0.001, adjusted P = 0.004) had higher culture positivity rates than synovium. Besides, synovial fluid had higher culture positivity rates than sinus tract (unadjusted P = 0.012, FDR-adjusted P = 0.046). Regarding sampling site, for hip, femoral neck specimens demonstrated higher culture positivity rates than medullary cavity (unadjusted P = 0.008, adjusted P = 0.040) and superficial layer specimens (unadjusted P = 0.008, adjusted P = 0.040). For knee, femoral intercondylar area specimens showed higher culture positivity rates than tibial medullary cavity (unadjusted P = 0.003, adjusted P = 0.037), infrapatellar fat pad (unadjusted P = 0.002, adjusted P = 0.037).

Conclusions: The MSP enhanced the yield of cultures without increasing the contamination rate. The optimal specimen types for culture included synovial fluid, interface membrane, and pseudocapsule. For hip, the optimal anatomical site for culture was femoral neck. For knee, the optimal anatomical site for culture was intercondylar area.

Background: Residual laxity after anterior cruciate ligament reconstruction (ACL-R) is found in some cases. Nowadays, anterolateral augmentation procedures are performed to prevent this laxity.

Materials and methods:  A prospective randomized comparative clinical study took place from January 2021 to November 2022. The study included 48 patients after exclusion of losses to follow-up, who acquired ACL-R combined with either lateral extraarticular tenodesis (LET) in 25 or anterolateral reconstruction (ALL) in 23 patients. The patients were evaluated with the Tegner-Lysholm score, and follow-up was for 26 ± 7 months. Also, laxity tests, pivot shift and Lachman preoperatively and postoperatively were evaluated. The failure rate was assessed.

Results: Tegner-Lysholm score improved significantly from 51.28 preoperatively to 93.76 points two years postoperatively in the LET-group and from 54.55 preoperatively to 94.23 points two years postoperatively in the ALL-group (P-value < 0.0001 in both groups). There was no significant difference between values of the Tegner-Lysholm score for the two groups at two-year follow-up (P-value = 0.24). Also, there was a significant reduction in the number of patients with positive pivot shift and Lachman tests in each group (P value < 0.0001 in both groups). The failure rate was 8% for LET and 8.7% for ALL (P-value = 0.46). Revisions were done from the contralateral side within the follow-up period.

Conclusions: The clinical outcome and stability after anterior cruciate ligament reconstruction combined with either lateral extraarticular tenodesis or anterolateral ligament reconstruction improved significantly after two years. However, no significant difference between them was found after two years. Both groups had comparable failure rates. However, the intraoperative and postoperative findings support anterolateral ligament reconstruction.

Level of evidence: Level 1, prospective randomized comparative study.

Trial registration: Clinical trial registry: NCT06222814. Registered at 01/01/2024, retrospectively.

Key points: Comparative study between extraaricular tenodesis and anterolateral reconstruction combined with ACL-R., Clinical outcome after ACL reconstruction combination. Anterolateral Ligament Reconstruction or extraaricular tenodesis, rotatory and anterior laxity knee, lateral stabilization of the knee.

Background: This study aims to determine whether long non-coding RNA (lncRNA) taurine up-regulated gene 1 (TUG1) can promote the osteogenic differentiation of human umbilical cord mesenchymal stem cells (hUC-MSCs) by modulating the miR-138/silent information regulator 1 (SIRT1) axis and to explore the underlying mechanisms.

Methods: Techniques including flow cytometry, cell staining analysis, quantitative real-time polymerase chain reaction (qRT-PCR), Western blot assay, and dual-luciferase reporter assay were utilized. Osteogenic induction was performed on hUC-MSCs that had undergone passage culture and surface marker characterization, and the level changes of TUG1 were detected. By respectively knocking down or overexpressing TUG1 and miR-138, the effects on osteogenic differentiation of hUC-MSCs were clarified, as well as the interaction between miR-138 and TUG1.Through the knockdown or overexpression of miR-138, the impact of miR-138 on the expression level of SIRT1 was determined. hUC-MSCs were categorized into three groups: the Vector + miR-NC group, the TUG1 + miR-NC group, and the TUG1 + miR-138 mimic group. The expression levels of SIRT1 and osteogenic marker genes were compared across these groups to elucidate the relationship among TUG1, miR-138, and SIRT1 during osteogenic differentiation.

Results: During the osteogenic differentiation of hUC-MSCs, the level of TUG1 increased progressively. The overexpression of TUG1 was capable of facilitating the expression of osteogenic marker genes, accompanied by an increase in the number of mineralized nodules. TUG1 and miR-138 exhibit a reciprocal inhibitory relationship. Moreover, miR-138 shows a negative correlation with both the expression of osteogenic marker genes and the formation of mineralized nodules. SIRT1 serves as a downstream target of miR-138, and its expression is subject to negative regulation by miR-138. Compared with the Vector + miR-NC group, the expression of SIRT1 and osteogenic marker genes was significantly increased in the TUG1 + miR-NC group, while overexpression of miR-138 could counteract the effect of TUG1.

Conclusions: The lncRNA TUG1 promotes the osteogenic differentiation of hUC-MSCs by modulating the miR-138/SIRT1 axis. This molecular mechanism may offer valuable insights for the prevention and treatment of osteoporosis.

Background: This study aimed to elucidate key molecular alterations in the osteoarthritis (OA) synovial microenvironment through transcriptomic analysis and to investigate the multi-target mechanisms of ShenTong ZhuYu Tang (STZYT) using network pharmacology and molecular docking.

Methods: We systematically integrated microarray data from OA synovial tissue available in the Gene Expression Omnibus (GEO) database. An integrated bioinformatics approach, including differential expression analysis, weighted gene co-expression network analysis (WGCNA), immune infiltration profiling, and machine learning, was employed to identify core genes and pathways. Subsequently, a network pharmacology analysis was conducted to construct an herb-compound-target-disease network and elucidate the potential mechanism of action of STZYT. Molecular docking was performed to validate the interaction between key STZYT compounds and matrix metalloproteinase-9 (MMP-9).

Results: A total of 294 differentially expressed genes (DEGs) were identified. Enrichment analysis revealed that these DEGs were significantly involved in inflammatory response and immune regulatory processes, as well as the pathways of osteoclast differentiation, NF-kappa B signaling, and IL-17 signaling. WGCNA and protein-protein interaction network analysis identified 51 hub genes. Subsequently, four machine learning algorithms further refined these to five key diagnostic biomarker candidates (CD4, MMP9, TNFSF11, CX3CR1, and EIF5B). Immune infiltration analysis showed significant infiltration of CD4 + T cells and M2-polarized macrophages. Network pharmacology identified 79 active STZYT compounds and 22 OA-related targets, suggesting the formula acts by inhibiting inflammation, metalloproteinase activity, and fibrosis. Molecular docking studies confirmed that quercetin, luteolin, and baicalein exhibit strong binding affinity to MMP-9.

Conclusions: Elevated MMP expression, particularly of MMP-9, in synovial tissue is closely associated with OA progression. STZYT may exert therapeutic effects against OA through multi-target mechanisms, including suppressing inflammation, inhibiting metalloproteinases, and preventing synovial fibrosis.

Purpose: The factors that predict delayed union in patients undergoing surgical management of osteoporotic vertebral compression fractures (OVCFs) have not been definitively established. This review aimed to comprehensively identify and analyze these factors to inform clinical practice and improve patient outcomes.

Methods: Four English and three Chinese databases were systematically searched from inception to July 1, 2025. Stata 16.0 was utilized for data analysis. Predictors of delayed union reported in two or more studies were combined. Sensitivity analyses were performed to ensure stability and reliability. Egger and Begg's tests were applied to evaluate publication bias.

Results: This review included 14 studies with a total of 2,349 patients and found that the incidence of delayed union after surgical treatment in patients with OVCFs ranged from 7.86 to 50%. Twelve predictors associated with delayed union were included in this meta-analysis. Ten of them had a statistically significant effect on delayed union, covering baseline characteristics, biological and molecular factors, outcome measures, and therapeutic interventions. The most frequently reported predictor was high bone mineral density (OR = 0.173, 95% CI: 0.068 to 0.442, p < 0.001), followed by advanced age (OR = 1.122, 95% CI: 1.046 to 1.203, p < 0.001), combined diabetes (OR = 2.066, 95% CI: 1.697 to 2.514, p < 0.001), Bone Morphogenetic Protein-2/7 (OR = 0.890, 95% CI: 0.792 to 0.999, p = 0.048), and vertebral height restoration rate (OR = 1.848, 95% CI: 1.246-2.742, p = 0.002).

Conclusions: A total of ten factors were identified as significant predictors of delayed union, encompassing five baseline characteristics, three biological molecular factors, one outcome measure, and one therapeutic intervention. The findings of this study highlight the importance of comprehensive pre- and post- operative evaluations, along with careful surgical techniques, in reducing the risk of delayed union in patients with OVCFs.