Journal of orthopaedics最新文献

{"title":"The Cost of PRP: Disparities in orthobiologic utilization","authors":"Ellen Lutnick,&nbsp;Eoin Devoy,&nbsp;Nicholas Frappa,&nbsp;Joseph Barbarino,&nbsp;Robert Ablove","doi":"10.1016/j.jor.2025.12.047","DOIUrl":"10.1016/j.jor.2025.12.047","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aims to assess cost and access to orthobiologic injection via platelet rich plasma (PRP).</div></div><div><h3>Methods</h3><div>Retrospective review at one academic affiliated orthopedic practice identified PRP injections for musculoskeletal indications in adult patients between January 1, 2010 and January 1, 2025 via CPT code. Cost of injection per patient category including race, sex, and anatomic location of the injection was analyzed, and US census data utilized to determine correlations between injection utilization and social determinants of health (SDoH) via ZIP code. Comparisons were performed via Wilcoxon rank-sum test or Kruskal–Wallis test. Injection counts aggregated at the ZIP code level were linked to publicly available ZIP-level SDoH variables. Analyses using per-capita injection rates were performed. P &lt; 0.05 was significant. Analyses were performed using R version 4.5.0.</div></div><div><h3>Results</h3><div>Of 727 PRP injections analyzed (57.4 % male, age of 53.0 ± 18.2 years, BMI 28.2 ± 5.5 kg/m²), patient race was predominantly White (87.2 %), followed by Black/African American (8.0 %). The mean charge was $574 ± 362. Males incurred higher charges than females ($598 vs $541; p = 0.001); charges did not differ by race (p = 0.64). Injection utilization demonstrated a strong socioeconomic gradient. The highest-income quartile (mean income ∼$115k) accounted for 40.7 % of injections; the lowest-income quartile (mean ∼$46k) accounted for only 13.6 % (χ²(3) = 114.7, p &lt; 0.001). Education level correlated positively with injection counts; uninsured rate correlated negatively. Injection distribution across income quartiles remained highly unequal after adjusting for population share (χ²(3) = 81.2, p &lt; 0.001). The uninsured rate was the only independent predictor of per-capita injection volume (IRR = 0.90, 95 % CI 0.85–0.95, p &lt; 0.001): each 1 % increase in uninsured residents was associated with a ∼10 % decrease in utilization.</div></div><div><h3>Conclusion</h3><div>PRP injections are disproportionately utilized by older, white, and insured patients from higher-income communities. Given the lack of universal insurance coverage and high out-of-pocket costs, these treatments remain inaccessible for many uninsured and lower-income patients.</div></div><div><h3>Level of evidence</h3><div>Level III; retrospective cohort study.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 370-373"},"PeriodicalIF":1.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145837456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Industry 6.0 capabilities in orthopaedics: Towards hyper-personalized and autonomous surgical care","authors":"Anil Regmi ,&nbsp;Vivaan Jain ,&nbsp;Surakshya Baral ,&nbsp;Vijay Kumar Jain ,&nbsp;Karthikeyan P. Iyengar","doi":"10.1016/j.jor.2025.11.042","DOIUrl":"10.1016/j.jor.2025.11.042","url":null,"abstract":"<div><h3>Background</h3><div>Industry 6.0 represents the next frontier in technological evolution, integrating artificial intelligence (AI), autonomous robotics, digital twins, hyper-personalization, and predictive analytics to create adaptive, precision-driven systems. This comprehensive narrative review explores the current and emerging applications of Industry 6.0 in orthopaedics, focusing on AI-driven diagnostics, robotic-assisted surgery, patient-specific implants, wearable monitoring systems, and immersive Augmented Reality/Virtual Reality interfaces.</div></div><div><h3>Materials and methods</h3><div>A comprehensive electronic search was performed on the databases, PubMed, Embase, Scopus, and Web of Science, to identify Industry 6.0 relevant literature published up to October 2025. A narrative synthesis was undertaken to summarize its evolution, current clinical applications of each technology in trauma and orthopaedics, reported advantages, limitations, and regulatory considerations and future trajectories and integration models under the Industry 6.0 framework.</div></div><div><h3>Results</h3><div>AI systems and Robotic platforms facilitate surgical planning with seamless, autonomous human–AI co-surgery. Digital twins allow patient-specific simulations for peri-operative planning. Advanced 3D printing and biomaterials support hyper-personalized implants and regenerative applications, while Internet of Things (IoT)-enabled wearables and smart implants provide continuous, data-driven insights into rehabilitation and recovery. Blockchain frameworks offer secure, interoperable data management.</div></div><div><h3>Conclusion</h3><div>Industry 6.0 offers a roadmap for safer, more efficient, and individualized orthopaedic surgery in the coming decade. Though barriers such as high costs, regulatory gaps, cybersecurity concerns, and integration challenges remain, the convergence of multi-omics, predictive modeling, and sustainable, human-centric design has the potential to redefine orthopaedic care from reactive, standardized intervention to hyper-personalized, autonomous, and preventative paradigms.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 184-192"},"PeriodicalIF":1.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary immunodeficiency disorders increase the risk of postoperative complications following total hip and knee arthroplasty: A national matched cohort study","authors":"Jared Sasaki ,&nbsp;Catherine Hand ,&nbsp;Francisco Oh ,&nbsp;Yuan Liu ,&nbsp;Margot Richards ,&nbsp;Kyleen Jan ,&nbsp;Morgan Angotti ,&nbsp;Brian Forsythe","doi":"10.1016/j.jor.2025.12.023","DOIUrl":"10.1016/j.jor.2025.12.023","url":null,"abstract":"<div><h3>Introduction</h3><div>Total hip (THA) and knee arthroplasty (TKA) are widely successful procedures but remain susceptible to complications. Patients with primary immunodeficiency (PI) conditions may face increased postoperative risks, though data is limited. This study evaluated postoperative outcomes after THA and TKA in PI patients, hypothesizing higher complication rates compared with matched controls.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using the PearlDiver Mariner database (2010–2020). Patients undergoing primary THA or TKA were identified by CPT codes and matched 1:1 by age, sex, and Charlson Comorbidity Index, obesity, tobacco use, alcohol abuse, and osteoarthritis. Patients with PI conditions were identified with a comprehensive list of International Classification of Diseases (ICD) 9/10 codes. Postoperative complications were assessed at 90 days, 1 year, and 2 years. Multivariable logistic regression was used to identify independent associations with PI status.</div></div><div><h3>Results</h3><div>After 1:1 matching, PI patients had significantly higher 90-day postoperative incidence of deep vein thrombosis (DVT), pneumonia, urinary tract infection (UTI), and any complication following THA. At 1 year, PI patients were found to have increased odds of periprosthetic joint infection (PJI), DVT, acute kidney injury (AKI), pneumonia, UTI, and any complication. 2 years postoperatively, PI was associated with increased odds of PJI revision. Within 90 days of TKA, PI patients displayed a higher incidence of surgical site infection (SSI), AKI, wound disruption, pneumonia, UTI, readmission, and any complication. After one year, PI patients had higher rates of PJI, SSI, DVT, AKI, wound disruption, pneumonia, UTI, readmission, and any complication. At 2 years follow up, there were no significant differences between groups.</div></div><div><h3>Conclusions</h3><div>In patients undergoing THA and TKA, PI was associated with significantly higher odds of infectious and medical complications, despite lower overall rates of metabolic comorbidities. These findings highlight the need for PI-specific perioperative protocols to improve both clinical outcomes and economic benefits.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 177-183"},"PeriodicalIF":1.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femoral neck system vs conventional fixation: Long-term outcomes from a single-center study","authors":"Grégoire Châtelier ,&nbsp;Romain Huguet ,&nbsp;Igor Benezis ,&nbsp;Johan Lebecque","doi":"10.1016/j.jor.2025.12.021","DOIUrl":"10.1016/j.jor.2025.12.021","url":null,"abstract":"<div><h3>Background</h3><div>The Femoral Neck System (FNS) is a minimally invasive fixation device for femoral neck fractures, but its comparative long-term performance versus conventional fixation remains debated.</div></div><div><h3>Materials and methods</h3><div>In this single-center retrospective study (Jan 2020–Oct 2022) all patients treated surgically for femoral neck fractures were included. Primary outcomes were operative time, peri-operative bleeding, fixation failure, avascular necrosis, reoperation, mortality, and autonomy using Parker score. A multivariable logistic regression assessed risk of postoperative loss of autonomy. FNS results were compared to a large multicenter series from the literature.</div></div><div><h3>Resultsa</h3><div>total of 143 patients (mean age 78.7 ± 13.8 years; 58.7 % women) were included and grouped by implant: 31 FNS, 62 triple cannulated screws, 50 dynamic hip screw (DHS). Operative time differed across groups with DHS being the longest. Peri-operative bleeding, fixation failure, infection, and mortality did not differ significantly between groups. In adjusted analysis, each additional year of age increased the risk of postoperative loss of autonomy by 5.1 % independently of the surgical system. Mean follow-up was approximately two years enabling detection of later complications.</div></div><div><h3>Conclusion</h3><div>FNS provided outcomes broadly comparable to conventional fixation with shorter operative time than DHS. Given the older, more displaced case-mix and longer follow-up, cautious interpretation is warranted. Age emerged as the strongest predictor of functional outcome.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 95-100"},"PeriodicalIF":1.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridge Enhanced ACL Repair (BEAR) versus Bone Patella Tendon Bone (BPTB) ACL reconstruction among young athletes: A systematic review and meta-analysis","authors":"Kunal P. Shah ,&nbsp;Timothy Gelatt ,&nbsp;Kunal Damaraju ,&nbsp;Jonathan Elias ,&nbsp;Sameer Shah ,&nbsp;Elizabeth Ford ,&nbsp;Sean McMillan","doi":"10.1016/j.jor.2025.12.008","DOIUrl":"10.1016/j.jor.2025.12.008","url":null,"abstract":"<div><h3>Introduction</h3><div>Anterior cruciate ligament (ACL) tears are among the leading causes of injuries among young athletes and are traditionally treated with surgical intervention. Recently, the Bridge Enhanced ACL Restoration (BEAR) procedure has gained popularity among surgeons as an alternative to ACL reconstruction (ACLR). Previously, BEAR has been compared to hamstring ACLR; however, little has been reported in comparison to bone-patella-tendon-bone (BPTB) ACLR, auto-, and allograft.</div></div><div><h3>Purpose</h3><div>To examine differences in the International Knee Documentation Committee (IKDC) scores of patients undergoing the BEAR procedure compared to BPTB for ACL tears.</div></div><div><h3>Methods</h3><div>A comprehensive search was conducted utilizing PRISMA 2020 guidelines. The search yielded 261 studies. Using Rayyan.ai, after the initial inclusion and exclusion, 14 studies underwent a full-text review. Inclusion criteria were randomized clinical trials for patients receiving either BEAR or BPTB with IKDC scores at 12- and 24-months. Statistical analysis was performed for random-effects meta-analysis using SPSS for the extracted IKDC scores.</div></div><div><h3>Results</h3><div>5 studies were included in the meta-analysis. At 12 months, comparison of BEAR (Cohen's d = 3.14) and BPTB (Cohen's d = 2.68) demonstrated no statistical difference. BEAR was found to have a higher clinical significance with an effect size difference of 0.48. A 24-month analysis yielded no clinical or statistical significance for BEAR (Cohen's d = 3.56) compared to BPTB (Cohen's d = 3.39).</div></div><div><h3>Conclusion</h3><div>Both BEAR and BPTB ACLR seemed to obtain comparable IKDC scores for addressing ACL injuries at 12- and 24-months post-procedure.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 30-41"},"PeriodicalIF":1.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior cruciate ligament anatomy of Vietnamese adults and applications in arthroscopic anterior cruciate ligament reconstruction surgery with all-inside single-bundle technique","authors":"Lam Tran Quoc ,&nbsp;Trinh Le Khanh ,&nbsp;Hanh Tran Mi","doi":"10.1016/j.jor.2025.12.027","DOIUrl":"10.1016/j.jor.2025.12.027","url":null,"abstract":"<div><div>Arthroscopic anterior cruciate ligament (ACL) reconstruction is increasingly performed in Vietnam, with the all-inside technique offering advantages such as minimized invasiveness, reduced postoperative pain, and the ability to use shorter, larger-diameter grafts to lower failure rates. Accurate tunnel placement is critical for optimizing surgical outcomes, and detailed understanding of population-specific ACL anatomy plays an essential role. This study aimed to describe the anatomical characteristics of the ACL in Vietnamese adults and to evaluate clinical outcomes of all-inside single-bundle ACL reconstruction based on these anatomical parameters.</div><div>Twenty fresh Vietnamese adult knee specimens were dissected to assess ACL length, femoral attachment morphology, tibial attachment morphology, and key anatomical reference distances. Additionally, 68 patients with ACL rupture underwent arthroscopic anatomic reconstruction with a 4-strand hamstring autograft using the all-inside technique and were clinically followed at 3, 6, 12, and 18 months. Functional recovery was assessed using Lysholm and IKDC scores.</div><div>The mean ACL length was 28.08 ± 1.01 mm. The femoral attachment measured 14.19 ± 1.87 × 11.24 ± 1.76 mm; distances from its center to the Resident's ridge, posterior cartilage, and distal cartilage were 5.67 ± 0.11 mm, 8.26 ± 0.55 mm, and 12.54 ± 0.52 mm, respectively. The tibial attachment measured 13.59 ± 1.57 × 10.67 ± 1.34 mm, with distances to the RER ridge and ACL ridge of 11.63 ± 0.55 mm and 9.46 ± 0.41 mm. Clinically, Lysholm scores improved from 58.84 ± 6.79 preoperatively to 97.8 ± 5.73 at final follow-up. IKDC results showed 54 grade A, 11 grade B, and 3 grade C outcomes, with no reruptures.</div><div>Applying Vietnamese-specific ACL anatomy in all-inside reconstruction yielded favorable clinical results and represents a promising approach for ACL injuries in Vietnam.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 241-246"},"PeriodicalIF":1.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical effect of double level osteotomy combined with arthroscopy in the treatment of severe varus deformity of knee joint","authors":"Jinyang Yu ,&nbsp;Guorui Cao ,&nbsp;Xiao Wang ,&nbsp;Shengrui Wang ,&nbsp;Peizhao Wang ,&nbsp;Xiaotao Shi ,&nbsp;Qingpu Zhang ,&nbsp;Honglue Tan","doi":"10.1016/j.jor.2025.12.011","DOIUrl":"10.1016/j.jor.2025.12.011","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;To report the radiological and functional results of a double-level osteotomy (distal femoral lateral closed wedge and proximal tibial medial open wedge) combined with arthroscopy in the treatment of patients with severe varus knee osteoarthritis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A retrospective analysis of 52 patients with severe varus knee osteoarthritis treated with double level osteotomy (DLO) combined with arthroscopy from January 2016 to December 2022, including 19 men and 33 women, with a mean age of 59.1 ± 4.3 years (range 48–67 years). All patients were followed up for at least 2 years. Radiological and clinical outcomes were evaluated at postoperative years 1 and 2. Preoperative and postoperative full-length standing radiographs of both lower limbs and frontal and lateral radiographs of the knee joint were measured and analyzed. The anatomical tibiofemoral angle (aFTA), hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA) and the joint line convergence angle (JLCA), posterior proximal tibial angle (PPTA) and medial tibial plateau depression (MTPD) were measured. In addition, VAS score, Lysholm score, Tegner Activity Scale (TAS), Knee Injury and Osteoarthritis Outcome score (KOOS), and International Knee Documentation Committee score (IKDC) were used to evaluate the clinical effects of patients during follow-up. In cases where patients required hardware removal, secondary arthroscopy was performed concurrently with the removal procedure. The assessment of cartilage regeneration was conducted in accordance with the International Cartilage Repair Society (ICRS) Cartilage Repair Assessment (CRA) grading system.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;All 52 patients were followed up for 29.2 ± 3.5 months (range 24–39 months). At 1 and 2 years after surgery, aFTA, HKA, mLDFA, mMPTA, JLCA and MTPD were significantly improved compared with the preoperative period (P &lt; 0.001). The postoperative PPTA was 82.49° ± 1.61° at year 1 and 82.05° ± 1.57° at year 2, with no statistically significant difference from the preoperative value 82.51° ± 1.43° (p = 0.230). Patients' VAS, Lysholm, Tegner Activity Scale, KOOS, and IKDC scores were significantly improved at 1 and 2 years postoperatively compared to preoperative scores (P &lt; 0.001). Arthroscopic evaluation was performed at the time of internal fixation removal in 27 patients, and cartilage regeneration was seen in the medial femoral condyle: 74 % of the knees; and in the medial tibial plateau: 81 % of the knees. There was a significant difference in the cartilage status or cartilage grading before and after surgery (P &lt; 0.001).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;DLO combined with arthroscopy effectively corrects lower extremity varus deformity, maintain the joint line in a physiologic state, and allow the patient to return to normal daily activities quickly. DLO combined with arthroscopy","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 296-302"},"PeriodicalIF":1.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessments and interventions in individuals with lower extremity torsional abnormality: A scoping review","authors":"M. Gagnon ,&nbsp;N. Abdel Fattah ,&nbsp;L. Groszman ,&nbsp;N. Kabbes ,&nbsp;M. Bernstein ,&nbsp;L.N. Veilleux","doi":"10.1016/j.jor.2025.12.029","DOIUrl":"10.1016/j.jor.2025.12.029","url":null,"abstract":"","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 247-261"},"PeriodicalIF":1.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in contralateral knee adduction moment and their biomechanical determinants following valgus high tibial osteotomy for medial knee osteoarthritis","authors":"Kazuki Sasaya ,&nbsp;Koji Iwasaki ,&nbsp;Kengo Ukishiro ,&nbsp;Kensaku Kawakami ,&nbsp;Sho'ji Suzuki ,&nbsp;Shigeyuki Sakurai ,&nbsp;Tatsunori Maeda ,&nbsp;Taiki Tokuhiro ,&nbsp;Junki Shiota ,&nbsp;Yuki Suzuki ,&nbsp;Rikiya Baba ,&nbsp;Tomohiro Onodera ,&nbsp;Eiji Kondo ,&nbsp;Norimasa Iwasaki ,&nbsp;Yasumitsu Ohkoshi","doi":"10.1016/j.jor.2025.12.037","DOIUrl":"10.1016/j.jor.2025.12.037","url":null,"abstract":"<div><h3>Background</h3><div>Valgus high tibial osteotomy (HTO) reduces medial knee loading in the operated limb; however, its biomechanical influence on the contralateral knee remains unclear. This study aimed to determine the biomechanical factors associated with changes in contralateral knee adduction moment (KAM) following medial opening wedge HTO (MOWHTO).</div></div><div><h3>Methods</h3><div>A total of 46 limbs that underwent MOWHTO were evaluated with three-dimensional gait analysis preoperatively and at 2 years postoperatively. Contralateral KAM, trunk lean angle, shank adduction angle, and lower-limb alignment (%mechanical axis: %MA) were measured. Determinants of postoperative changes in contralateral KAM were identified using regression models that considered alignment changes in both the operative and contralateral limbs, as well as contralateral kinematic parameters.</div></div><div><h3>Results</h3><div>Group-level contralateral KAM did not change significantly after HTO (2.50 vs 2.36 %Nm/(BW × Ht), P = .37). However, individual changes varied ranging from −2.4 to +1.5 %Nm/(BW × Ht). Regression analysis showed that greater alignment correction of the operated limb (P = .03), increased trunk lean toward the operated side (P = .07), and greater contralateral shank adduction angle (P = .10) were associated with increased contralateral KAM.</div></div><div><h3>Conclusion</h3><div>Contralateral KAM exhibited marked individual variability despite the absence of a significant group-level change. Alignment correction, trunk mechanics, and contralateral shank adduction were identified as key determinants of postoperative increases in contralateral KAM. Because even small increases in KAM can contribute to elevated medial knee loading, the individual change may have clinical relevance. These findings emphasize the importance of considering bilateral lower-limb biomechanics when planning and evaluating HTO.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 266-271"},"PeriodicalIF":1.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-reported outcomes (PROMs) of arthroscopic versus mini-open rotator cuff repair-an overview of meta-analysis","authors":"Raju Vaishya ,&nbsp;Ayaz Saiyed ,&nbsp;Mohit Kumar Patralekh ,&nbsp;Abhishek Vaish ,&nbsp;Filippo Migliorini","doi":"10.1016/j.jor.2025.11.035","DOIUrl":"10.1016/j.jor.2025.11.035","url":null,"abstract":"<div><h3>Background</h3><div>Rotator cuff tears are a leading cause of shoulder pain and disability. While both arthroscopic repair (ASR) and mini-open rotator cuff repair (MOR) techniques are widely practised, evidence remains inconclusive regarding their relative clinical efficacy. This overview of meta-analyses aimed to compare patient-reported and functional outcomes between ASR and MOR.</div></div><div><h3>Methods</h3><div>A systematic overview of published meta-analyses was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. Databases including PubMed, Scopus, and Google Scholar were searched using relevant keywords. Meta-analyses evaluating outcomes in adults undergoing ASR or MOR were included. Data extraction focused on functional scores (Constant-Murley, UCLA, ASES), pain (VAS), range of motion, surgical duration, and complications (retear rate, adhesive capsulitis). Statistical analyses were performed using RevMan 5.4 with random- or fixed-effects models depending on heterogeneity (I² threshold of 50 %).</div></div><div><h3>Results</h3><div>Eight meta-analyses comprising a mean of 995.75 procedures (ASR: 533.5, MOR: 462.25) were included. No significant differences were observed between ASR and MOR for Constant-Murley Score (p = 0.70), ASES (p = 0.90), VAS (p = 1.0), range of motion, retear rate (p = 0.08), or adhesive capsulitis (p = 0.58). MOR demonstrated a significantly shorter operative time compared with ASR (p = 0.007). However, ASR demonstrated a higher UCLA score compared with MOR (p = 0.03).</div></div><div><h3>Conclusion</h3><div>Both arthroscopic and mini-open rotator cuff repair techniques yield comparable clinical and patient-reported outcomes. While the mini-open approach offers a shorter operative duration, the choice of technique should be guided primarily by surgeon expertise, tear characteristics, and patient-specific factors. Further high-quality studies incorporating imaging and long-term follow-up are warranted to optimise rotator cuff repair strategies.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 1-7"},"PeriodicalIF":1.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145658765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}