Journal of orthopaedics最新文献_第2页

A propensity matched cohort analysis: Cemented vs press fit humeral stem fixation in anatomic total shoulder arthroplasty 倾向匹配队列分析：解剖型全肩关节置换术中的肱骨干粘结固定与压合固定

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-02-03 DOI: 10.1016/j.jor.2025.02.003

Amogh I. Iyer, Ryan M. Dopirak, Louis W. Barry, Benjamin L. Brej, Akshar V. Patel, Erryk Katayama, Gregory L. Cvetanovich, Julie Y. Bishop, Ryan C. Rauck

Introduction

Historically, humeral stems were cemented for anatomic shoulder arthroplasty (aTSA). However, cementless, or press-fit, fixation has been increasingly used. This study aims to compare outcomes and revision rates between cemented and press-fit humeral stems.

Methods

Institutional records were searched to identify all patients who underwent aTSA with cemented humeral fixation or press-fit fixation between 2009 and 2021. A 3:1 propensity match based on age, sex, pre-op forward elevation and external rotation was conducted. Mean functional measurements were compared using a 2-Sample t-Test, ordinal variables via Wilcoxon-Mann Whitney test, and categorical variables via the Chi-squared test.

Results

There were 35 cemented humeral fixation shoulders matched with 105 humeral press-fit shoulders included in the final cohort. Both groups had similar characteristics at baseline regarding age, sex, body mass index, Charlson Comorbidity Index, mean follow-up, ROM, and strength measurements. Average age at surgery was 61.88 ± 6.68 years with an average follow-up time of 5.61 ± 2.86 years. Post-operatively, press-fit fixation demonstrated significant improvement in all ROM testing: external rotation (ER), forward elevation (FE), internal rotation (IR)-and all strength testing: ER, FE, and IR. Cement fixation demonstrated significant improvement in all ROM testing but only in FE strength testing. Inter-group post-op ROM and strength testing comparisons revealed superior external rotation (p = 0.007) and forward elevation (p = 0.047) ROM in the press-fit group with similar internal rotation ROM values and similar strength testing. There were higher revision rates in the cement fixation cohort (Cement: 11.4 % vs press-fit: 3.8 %; p = 0.036).

Conclusion

The results of this analysis showcase that press-fit fixation is a viable option for aTSA. Press-fit fixation shoulders had better ROM in terms of external rotation and forward elevation as well a better survival time to revision compared to cement fixation.

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引用次数: 0

Functional outcome and correlation with ultrasound gap size of Achilles tendon rupture treated non-operatively with boot and wedges

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-02-01 DOI: 10.1016/j.jor.2025.01.038

Rohit Ravindran Nair , Suzanne Lane, Brijesh Ayyaswamy, Pradeepsyam Prasad, Anoop Anand, Nithin Babu, Adersh Gopinathannair

Background

The need for surgical management of Achilles tendon ruptures has been decreasing due to a better understanding of their non-operative management. The primary aim of our study was to assess the functional outcome of Achilles tendon ruptures treated with fixed angle walking boots with wedges (FAWW) and its relationship with gap size, functional scores, single leg heel raise height difference (HHD) and calf circumference difference (CCD). The secondary aim was to look at the complication rates.

Methods

34 patients (29 males and 5 females), who presented with acute Achilles tendon ruptures to Blackpool Teaching Hospitals NHS Foundation Trust from October 2020 to April 2022, were treated with an equinus slab for 2 weeks followed by a fixed angle boot, with wedges being sequentially removed every 2 weeks. They were reviewed at 3, 6 and 12 months. At each visit, Achilles Tendon Rupture score (ATRS), HHD and CCD were measured. Any complication, such as deep vein thrombosis (DVT) or re-rupture, was recorded.

Results

The mean age group of patients was 50 years (28–87 years). The average ATRS at 3, 6 and 12 months were 29.84, 61.68 and 76, respectively. The mean HHD was 8.9 centimetres (cm) at 3 months, 3.79 cm at 6 months and 2.4 cm at 12 months. The mean CCD was 1.31 cm at 3 months, 0.88 cm at 6 months and 1.07 cm at 12 months. We did not find a significant correlation between Achilles tendon gap size measured by ultrasound and ATRS, HHD and CCD in our study.

Conclusions

Non-operative management of Achilles tendon ruptures with boot and wedges gives a good functional outcome, which has no relationship with tendon gap size at the time of initial rupture.

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引用次数: 0

Comparative analysis of posterior tibial slope measurements: Accuracy and reliability of radiographs and CT

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-02-01 DOI: 10.1016/j.jor.2025.01.037

Shuhei Hiyama , Reuben P. Rao , Feng Xie , Tsuneari Takahashi , Katsushi Takeshita , Hemant Pandit

Introduction

This study aimed to evaluate the accuracy and reliability of posterior tibial slope (PTS) measurements obtained from radiographs and CT. PTS, particularly its differences in medial and lateral measurements, plays a crucial role in knee alignment, and inconsistencies in measurement techniques across different imaging modalities have raised concerns about accuracy.

Materials and methods

This retrospective study included data from 98 Japanese patients legs and 324 Chinese patients legs. PTS was measured on long-leg and short-leg radiographs and CT. Two independent surgeons assessed the measurements, and the inter- and intra-observer reliability were evaluated. The primary outcome was the comparison of medial and lateral PTS measurements, while the secondary aim was to assess the impact of tibial length on measurement accuracy.

Discussion

The study revealed that lateral PTS was consistently smaller than medial PTS, with an average difference of 1.2°–1.9°. Shorter leg radiographs tend to underestimate PTS compared to full-length tibial measurements. The correlation between measurements from short and long leg radiographs showed that PTS measurements were more prone to errors, which may be due to anatomical factors such as tibial bowing. Inter- and intra-observer reliability were good for medial PTS but poor to moderate for lateral PTS, especially when using radiographs.

Conclusion

For accurate measurement of both medial and lateral PTS, surgeons should consider using additional examination methods such as CT and MRI. If PTS is to be measured on radiographs, the focus should be on the medial PTS, as it tends to provide more reliable results.

{"title":"Comparative analysis of posterior tibial slope measurements: Accuracy and reliability of radiographs and CT","authors":"Shuhei Hiyama , Reuben P. Rao , Feng Xie , Tsuneari Takahashi , Katsushi Takeshita , Hemant Pandit","doi":"10.1016/j.jor.2025.01.037","DOIUrl":"10.1016/j.jor.2025.01.037","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to evaluate the accuracy and reliability of posterior tibial slope (PTS) measurements obtained from radiographs and CT. PTS, particularly its differences in medial and lateral measurements, plays a crucial role in knee alignment, and inconsistencies in measurement techniques across different imaging modalities have raised concerns about accuracy.</div></div><div><h3>Materials and methods</h3><div>This retrospective study included data from 98 Japanese patients legs and 324 Chinese patients legs. PTS was measured on long-leg and short-leg radiographs and CT. Two independent surgeons assessed the measurements, and the inter- and intra-observer reliability were evaluated. The primary outcome was the comparison of medial and lateral PTS measurements, while the secondary aim was to assess the impact of tibial length on measurement accuracy.</div></div><div><h3>Discussion</h3><div>The study revealed that lateral PTS was consistently smaller than medial PTS, with an average difference of 1.2°–1.9°. Shorter leg radiographs tend to underestimate PTS compared to full-length tibial measurements. The correlation between measurements from short and long leg radiographs showed that PTS measurements were more prone to errors, which may be due to anatomical factors such as tibial bowing. Inter- and intra-observer reliability were good for medial PTS but poor to moderate for lateral PTS, especially when using radiographs.</div></div><div><h3>Conclusion</h3><div>For accurate measurement of both medial and lateral PTS, surgeons should consider using additional examination methods such as CT and MRI. If PTS is to be measured on radiographs, the focus should be on the medial PTS, as it tends to provide more reliable results.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 62-67"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143348918","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}

引用次数: 0

Can intraoperative opioid use in hip and knee arthroplasty be reduced further without negatively affecting pain control: A case controlled study

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-01-31 DOI: 10.1016/j.jor.2025.01.035

Adnan Asif , Sam Aktas , Baraniselvan Ramalingam , Hasitha Pananwala , Janna Maier , Femi E. Ayeni , Sol Qurashi S

Background

Whilst forming the backbone of perioperative analgesic regimes in joint replacement surgery, the negative side effect profile of opioids is well known. Common impediments to a smooth running Enhanced Rapid Recovery model of care are often altered cognitive function and postoperative nausea and vomiting (PONV), both related to opioid use.

This study focuses on evaluating whether further reductions in intraoperative opioid use during joint arthroplasty can be safely achieved with minimal impact of such reductions on pain control and postoperative outcomes including opioid requirements and the incidence of PONV and ability to mobilise.

Method

Case controlled review of prospectively collected data assessing intraoperative opioid use, postoperative analgesic requirement, incidence of PONV and cognitive status as well as day 0 mobility postoperatively. 50 patients were randomized in the study and control groups.

Results

The study group received statistically significant lower dose of intraoperative opioids equivalent to 24.18 mg of Morphine compared to control group with equivalent to 69.58 mg of Morphine (p < 0.001). There was no statistically significant increase in analgesia requirement postoperatively and no negative influence on PONV or ability to follow immediate postoperative rehabilitative protocols.

Conclusion

Opioid use intraoperatively can be reduced even further without any compromise of postoperative pain control and PONV and may further reduce impediments to efficiency in rapid recovery models of care.

{"title":"Can intraoperative opioid use in hip and knee arthroplasty be reduced further without negatively affecting pain control: A case controlled study","authors":"Adnan Asif , Sam Aktas , Baraniselvan Ramalingam , Hasitha Pananwala , Janna Maier , Femi E. Ayeni , Sol Qurashi S","doi":"10.1016/j.jor.2025.01.035","DOIUrl":"10.1016/j.jor.2025.01.035","url":null,"abstract":"<div><h3>Background</h3><div>Whilst forming the backbone of perioperative analgesic regimes in joint replacement surgery, the negative side effect profile of opioids is well known. Common impediments to a smooth running Enhanced Rapid Recovery model of care are often altered cognitive function and postoperative nausea and vomiting (PONV), both related to opioid use.</div><div>This study focuses on evaluating whether further reductions in intraoperative opioid use during joint arthroplasty can be safely achieved with minimal impact of such reductions on pain control and postoperative outcomes including opioid requirements and the incidence of PONV and ability to mobilise.</div></div><div><h3>Method</h3><div>Case controlled review of prospectively collected data assessing intraoperative opioid use, postoperative analgesic requirement, incidence of PONV and cognitive status as well as day 0 mobility postoperatively. 50 patients were randomized in the study and control groups.</div></div><div><h3>Results</h3><div>The study group received statistically significant lower dose of intraoperative opioids equivalent to 24.18 mg of Morphine compared to control group with equivalent to 69.58 mg of Morphine (p < 0.001). There was no statistically significant increase in analgesia requirement postoperatively and no negative influence on PONV or ability to follow immediate postoperative rehabilitative protocols.</div></div><div><h3>Conclusion</h3><div>Opioid use intraoperatively can be reduced even further without any compromise of postoperative pain control and PONV and may further reduce impediments to efficiency in rapid recovery models of care.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 40-44"},"PeriodicalIF":1.5,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143181388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Response of Miller ME and Ayoub to Letter to the Editor by Schatzman and BS Miller reading article: Increased blood 1,25 dihydroxyvitamin D levels in infants with metabolic bone disease of infancy in contested cases of child abuse. Journal of orthopaedics. 2024 Oct 29;63:81

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-01-31 DOI: 10.1016/j.jor.2025.01.019

引用次数: 0

Direct anterior total hip arthroplasty after hip arthroscopy: A retrospective review

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-01-29 DOI: 10.1016/j.jor.2025.01.017

Matthew Pate , Joshua Gira , Carl Wierks

Introduction

Limited studies have investigated outcomes of total hip arthroplasty (THA) after ipsilateral hip arthroscopy, with mixed conclusions. There is need to provide clarity on potential risks/complications associated with this sequence of operations.

Methods

This is a retrospective single surgeon cohort study, evaluating patients from 01/01/2012–01/01/2020 undergoing direct anterior THA for osteoarthritis, with minimum 90-day follow-up. There were two groups: previous hip arthroscopy plus THA (THA+) and isolated THA (control) without previous hip arthroscopy. All THA + patients had undergone one previous hip arthroscopy prior to THA. Quantitative variables were evaluated using the Mann-Whitney-U test or a two-tailed unpaired t-test. Nominal variables were evaluated using the chi-square or Fisher's Exact test. Significance was assessed at p < 0.05.

Results

Seventy-one patients were included, 38 patients in the THA + group, and 33 patients in the control group. Surgery duration was longer in the THA + group (74 min THA + [SD = 9.5], 60 min control [SD = 11.3], p < 0.0001). The only secondary outcome with significance was average estimated blood loss (400 mL THA+, 275 mL control, p = 0.009). Only one THA + patient required postoperative transfusion (p = 1.0). There were no postoperative deep infections requiring debridement, intra-operative fractures requiring fixation, or postoperative dislocations in either group. The THA group had one post-operative fracture requiring surgery. The THA + group was younger (average) than the control group (52 THA + [SD = 9.9], 58.4 control [SD = 8.8], p = 0.0062).

Conclusion

This study highlights increased operative time and estimated blood loss after previous ipsilateral hip arthroscopy. Surgeons should recognize implications on time management, and assist surgeons when deciding to perform a THA at a surgery center vs hospital. These results contribute to a growing body of literature indicating no increase in major complication rate of THA after ipsilateral hip arthroscopy.

{"title":"Direct anterior total hip arthroplasty after hip arthroscopy: A retrospective review","authors":"Matthew Pate , Joshua Gira , Carl Wierks","doi":"10.1016/j.jor.2025.01.017","DOIUrl":"10.1016/j.jor.2025.01.017","url":null,"abstract":"<div><h3>Introduction</h3><div>Limited studies have investigated outcomes of total hip arthroplasty (THA) after ipsilateral hip arthroscopy, with mixed conclusions. There is need to provide clarity on potential risks/complications associated with this sequence of operations.</div></div><div><h3>Methods</h3><div>This is a retrospective single surgeon cohort study, evaluating patients from 01/01/2012–01/01/2020 undergoing direct anterior THA for osteoarthritis, with minimum 90-day follow-up. There were two groups: previous hip arthroscopy plus THA (THA+) and isolated THA (control) without previous hip arthroscopy. All THA + patients had undergone one previous hip arthroscopy prior to THA. Quantitative variables were evaluated using the Mann-Whitney-U test or a two-tailed unpaired <em>t</em>-test. Nominal variables were evaluated using the chi-square or Fisher's Exact test. Significance was assessed at p < 0.05.</div></div><div><h3>Results</h3><div>Seventy-one patients were included, 38 patients in the THA + group, and 33 patients in the control group. Surgery duration was longer in the THA + group (74 min THA + [SD = 9.5], 60 min control [SD = 11.3], p < 0.0001). The only secondary outcome with significance was average estimated blood loss (400 mL THA+, 275 mL control, p = 0.009). Only one THA + patient required postoperative transfusion (p = 1.0). There were no postoperative deep infections requiring debridement, intra-operative fractures requiring fixation, or postoperative dislocations in either group. The THA group had one post-operative fracture requiring surgery. The THA + group was younger (average) than the control group (52 THA + [SD = 9.9], 58.4 control [SD = 8.8], p = 0.0062).</div></div><div><h3>Conclusion</h3><div>This study highlights increased operative time and estimated blood loss after previous ipsilateral hip arthroscopy. Surgeons should recognize implications on time management, and assist surgeons when deciding to perform a THA at a surgery center vs hospital. These results contribute to a growing body of literature indicating no increase in major complication rate of THA after ipsilateral hip arthroscopy.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 68-71"},"PeriodicalIF":1.5,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350057","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}

引用次数: 0

Use of augmented reality surgical navigation reduces intraoperative fluoroscopic imaging in anterior total hip arthroplasty with equivalent accuracy for component positioning

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-01-28 DOI: 10.1016/j.jor.2025.01.031

Gloria Coden , Mikhail Kuznetsov , Lauren Schoeller , James Patti , Andrew Grant , James Penn Miller , Carl Talmo

Background

Computer-assisted surgical navigation was designed to reduce the rates of acetabular component malpositioning, a common cause for revision following primary total hip arthroplasty (THA). We compared intraoperative measures such as radiation exposure, radiographic acetabular cup placement, and outcomes of patients who underwent a THA using computer-assisted surgical navigation with augmented reality (AR) compared to those who underwent traditional manual THA with fluoroscopic assistance (FA).

Methods

We retrospectively reviewed 115 hips who underwent primary direct anterior THAs using the intraoperative AR surgical navigation system between 3/30/2021 and 12/30/2022. These were compared to a matched cohort of 115 primary THAs performed with FA through a direct anterior approach during the same time period. Patients were matched based on age, gender, American Society of Anesthesiologists score (ASA), and BMI. Goal inclination and anteversion were set to 42° (°) and 22°, respectively.

Results

THA with AR patients had decreased intraoperative radiation exposure (mean 2.0 versus 3.2 mGy, p < 0.001) and radiation time (mean 0.2 versus 0.4 min, p < 0.001). Deviation from the preoperative plan was similar between AR and FA for both radiographic inclination and anteversion. There was no difference in the operative time, estimated blood loss, or reoperations, all of which were for infection (1.7 versus 0.0 %, p = 0.5).

Conclusion

AR surgical navigation in primary THA has similar radiographic, operative and clinical results as THA with intraoperative FA. However, AR surgical navigation is associated with decreased intraoperative fluoroscopic radiation and time. Further research is needed to evaluate accuracy of acetabular component positioning and complications.

背景计算机辅助手术导航旨在降低髋臼组件错位率，这是初级全髋关节置换术（THA）后翻修的常见原因。我们比较了使用计算机辅助手术导航和增强现实技术（AR）进行全髋关节置换术的患者与使用透视辅助技术（FA）进行传统人工全髋关节置换术的患者的术中辐射暴露、髋臼杯置入放射影像学检查和治疗效果等指标。方法我们回顾性研究了在 2021 年 3 月 30 日至 2022 年 12 月 30 日期间使用术中 AR 手术导航系统进行初级直接前路全髋关节置换术的 115 例髋关节患者。我们将这些患者与同期通过直接前方入路使用FA进行的115例初级THA进行了比较。患者根据年龄、性别、美国麻醉医师协会评分 (ASA) 和体重指数进行匹配。结果使用 AR 的患者术中辐射量（平均 2.0 对 3.2 mGy，p < 0.001）和辐射时间（平均 0.2 对 0.4 分钟，p < 0.001）均有所减少。AR 和 FA 在影像学倾斜度和前倾角方面与术前计划的偏差相似。在手术时间、估计失血量或再次手术方面没有差异，所有再次手术都是因为感染（1.7% 对 0.0%，P = 0.5）。然而，AR手术导航可减少术中透视辐射和时间。需要进一步研究评估髋臼组件定位的准确性和并发症。

{"title":"Use of augmented reality surgical navigation reduces intraoperative fluoroscopic imaging in anterior total hip arthroplasty with equivalent accuracy for component positioning","authors":"Gloria Coden , Mikhail Kuznetsov , Lauren Schoeller , James Patti , Andrew Grant , James Penn Miller , Carl Talmo","doi":"10.1016/j.jor.2025.01.031","DOIUrl":"10.1016/j.jor.2025.01.031","url":null,"abstract":"<div><h3>Background</h3><div>Computer-assisted surgical navigation was designed to reduce the rates of acetabular component malpositioning, a common cause for revision following primary total hip arthroplasty (THA). We compared intraoperative measures such as radiation exposure, radiographic acetabular cup placement, and outcomes of patients who underwent a THA using computer-assisted surgical navigation with augmented reality (AR) compared to those who underwent traditional manual THA with fluoroscopic assistance (FA).</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 115 hips who underwent primary direct anterior THAs using the intraoperative AR surgical navigation system between 3/30/2021 and 12/30/2022. These were compared to a matched cohort of 115 primary THAs performed with FA through a direct anterior approach during the same time period. Patients were matched based on age, gender, American Society of Anesthesiologists score (ASA), and BMI. Goal inclination and anteversion were set to 42° (°) and 22°, respectively.</div></div><div><h3>Results</h3><div>THA with AR patients had decreased intraoperative radiation exposure (mean 2.0 versus 3.2 mGy, p < 0.001) and radiation time (mean 0.2 versus 0.4 min, p < 0.001). Deviation from the preoperative plan was similar between AR and FA for both radiographic inclination and anteversion. There was no difference in the operative time, estimated blood loss, or reoperations, all of which were for infection (1.7 versus 0.0 %, p = 0.5).</div></div><div><h3>Conclusion</h3><div>AR surgical navigation in primary THA has similar radiographic, operative and clinical results as THA with intraoperative FA. However, AR surgical navigation is associated with decreased intraoperative fluoroscopic radiation and time. Further research is needed to evaluate accuracy of acetabular component positioning and complications.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 15-19"},"PeriodicalIF":1.5,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143182360","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}

引用次数: 0

Characterization of distal biceps tendon and triceps tendon injuries in National Football League players from 2009 to 2022

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-01-28 DOI: 10.1016/j.jor.2025.01.033

Ashwin R. Garlapaty , Molly Jones , John Baumann , Christian Gunn , James L. Cook , Steven F. DeFroda

Purpose

The purpose of this study is to determine the incidence and impact of distal biceps and triceps tendon injuries in the National Football League (NFL) from the 2009-10 to the 2022-23 seasons. This study explores the impact that player and injury characteristics have on injury risk, return-to-play, and player performance.

Methods

Data from the 2009-10 to the 2022-23 NFL seasons were analyzed for players with distal biceps or triceps tendon tears. Return-to-play (RTP) and performance metrics were recorded for each player during the season before and first two post-injury seasons. Data were analyzed to determine statistically significant differences in proportions using chi-square, Fisher's exact, or McNemar tests. Statistical significance was set at p < 0.05.

Results

Fifty tendon ruptures (26 biceps, 24 triceps) were identified. Biceps injuries were more common in defensive players (73.1 %), while triceps injuries predominantly affected offensive players (58.3 %). Significant risk factors for biceps injuries included BMI ≥31 (p = 0.0008) and ≥4 seasons of experience (p = 0.031, OR = 2.7). Triceps injuries were associated with BMI ≥31 (p = 0.01), age ≥26 (p < 0.0001), and ≥4 seasons of experience (p = 0.006). RTP rates were 73.1 % for biceps and 70.8 % for triceps injuries. However, only 52.6 % and 41.2 % of players with biceps and triceps injuries, respectively, returned to pre-injury performance levels. Younger players (<26 years) and those with fewer years of experience (≤4 years) were more likely to achieve prior performance levels.

Conclusion

Distal biceps and triceps tendon injuries are typically season-ending for NFL players. Significant risk factors include BMI ≥31, ≥4 years of NFL experience, and game exposure, with age ≥26 being an additional risk factor for triceps tendon injuries. RTP rates exceed 70 %, indicating a strong potential for athletes to return to the NFL post-injury.

{"title":"Characterization of distal biceps tendon and triceps tendon injuries in National Football League players from 2009 to 2022","authors":"Ashwin R. Garlapaty , Molly Jones , John Baumann , Christian Gunn , James L. Cook , Steven F. DeFroda","doi":"10.1016/j.jor.2025.01.033","DOIUrl":"10.1016/j.jor.2025.01.033","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study is to determine the incidence and impact of distal biceps and triceps tendon injuries in the National Football League (NFL) from the 2009-10 to the 2022-23 seasons. This study explores the impact that player and injury characteristics have on injury risk, return-to-play, and player performance.</div></div><div><h3>Methods</h3><div>Data from the 2009-10 to the 2022-23 NFL seasons were analyzed for players with distal biceps or triceps tendon tears. Return-to-play (RTP) and performance metrics were recorded for each player during the season before and first two post-injury seasons. Data were analyzed to determine statistically significant differences in proportions using chi-square, Fisher's exact, or McNemar tests. Statistical significance was set at p < 0.05.</div></div><div><h3>Results</h3><div>Fifty tendon ruptures (26 biceps, 24 triceps) were identified. Biceps injuries were more common in defensive players (73.1 %), while triceps injuries predominantly affected offensive players (58.3 %). Significant risk factors for biceps injuries included BMI ≥31 (p = 0.0008) and ≥4 seasons of experience (p = 0.031, OR = 2.7). Triceps injuries were associated with BMI ≥31 (p = 0.01), age ≥26 (p < 0.0001), and ≥4 seasons of experience (p = 0.006). RTP rates were 73.1 % for biceps and 70.8 % for triceps injuries. However, only 52.6 % and 41.2 % of players with biceps and triceps injuries, respectively, returned to pre-injury performance levels. Younger players (<26 years) and those with fewer years of experience (≤4 years) were more likely to achieve prior performance levels.</div></div><div><h3>Conclusion</h3><div>Distal biceps and triceps tendon injuries are typically season-ending for NFL players. Significant risk factors include BMI ≥31, ≥4 years of NFL experience, and game exposure, with age ≥26 being an additional risk factor for triceps tendon injuries. RTP rates exceed 70 %, indicating a strong potential for athletes to return to the NFL post-injury.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 20-26"},"PeriodicalIF":1.5,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143181387","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}

引用次数: 0

Rethinking tumor viability as prognostic factor in soft tissue sarcoma 重新思考作为软组织肉瘤预后因素的肿瘤存活率

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-01-28 DOI: 10.1016/j.jor.2025.01.030

Julien Montreuil , Eric Kholodovsky , Moses Markowitz , Sergio Torralbas Fitz , Dominic Campano , J. Erik Geiger , Francis Hornicek , Brooke Crawford , H. Thomas Temple

Background

Histopathologic assessment of tumor viability has emerged as a potential predictive factor of outcomes in various cancers. This study evaluates the prognostic significance of viability in high-grade soft tissue sarcoma while accounting for different adjuvant regimens and clinical variables.

Methods

A retrospective chart review was conducted on 147 patients surgically treated for high-grade soft tissue sarcoma between 2010 and 2021 at a single institution. Perioperative, clinical and surveillance data were collected. Tumor viability was determined through histopathologic analysis by a board-certified pathologist.

Results

No significant differences in clinical variables were observed between groups with ≤10 % and >10 % tumor viability. Neoadjuvant treatments, tumor grade, size, and depth did not independently affect tumor viability. There was no statistically decreased risk of local recurrence in the group with ≤10 % viability compared to the group with >10 % viability (HR = 1.19, 95 % CI [0.57,2.50]) (p = 0.64). Margin status was the only variable that significantly increases the risk of LR on multivariate analysis.

Conclusion

This cohort suggests that neoadjuvant radiotherapy, chemotherapy, or their combination did not influence tumor viability predictably. Notably, tumors without neoadjuvant treatment exhibited a high rate of necrosis, potentially confounding the interpretation of treatment effect. Other factors such as tumor type may play a more significant role in the cause of tumor necrosis than originally thought. Pathologic tissue response continues to offer value for the management of STS, but these findings underscore the need for further investigation into tumor viability in soft tissue sarcoma, targeting specific treatments analyzed in large collaborative studies.

{"title":"Rethinking tumor viability as prognostic factor in soft tissue sarcoma","authors":"Julien Montreuil , Eric Kholodovsky , Moses Markowitz , Sergio Torralbas Fitz , Dominic Campano , J. Erik Geiger , Francis Hornicek , Brooke Crawford , H. Thomas Temple","doi":"10.1016/j.jor.2025.01.030","DOIUrl":"10.1016/j.jor.2025.01.030","url":null,"abstract":"<div><h3>Background</h3><div>Histopathologic assessment of tumor viability has emerged as a potential predictive factor of outcomes in various cancers. This study evaluates the prognostic significance of viability in high-grade soft tissue sarcoma while accounting for different adjuvant regimens and clinical variables.</div></div><div><h3>Methods</h3><div>A retrospective chart review was conducted on 147 patients surgically treated for high-grade soft tissue sarcoma between 2010 and 2021 at a single institution. Perioperative, clinical and surveillance data were collected. Tumor viability was determined through histopathologic analysis by a board-certified pathologist.</div></div><div><h3>Results</h3><div>No significant differences in clinical variables were observed between groups with ≤10 % and >10 % tumor viability. Neoadjuvant treatments, tumor grade, size, and depth did not independently affect tumor viability. There was no statistically decreased risk of local recurrence in the group with ≤10 % viability compared to the group with >10 % viability (HR = 1.19, 95 % CI [0.57,2.50]) (p = 0.64). Margin status was the only variable that significantly increases the risk of LR on multivariate analysis.</div></div><div><h3>Conclusion</h3><div>This cohort suggests that neoadjuvant radiotherapy, chemotherapy, or their combination did not influence tumor viability predictably. Notably, tumors without neoadjuvant treatment exhibited a high rate of necrosis, potentially confounding the interpretation of treatment effect. Other factors such as tumor type may play a more significant role in the cause of tumor necrosis than originally thought. Pathologic tissue response continues to offer value for the management of STS, but these findings underscore the need for further investigation into tumor viability in soft tissue sarcoma, targeting specific treatments analyzed in large collaborative studies.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 7-14"},"PeriodicalIF":1.5,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143182358","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}

引用次数: 0

A systematic review of posterior pilon fractures 后皮隆骨折的系统回顾

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2025-01-28 DOI: 10.1016/j.jor.2025.01.034

Joseph Boesel , Dominique DiGiacomo , Brett Hoffman , Jiayong Liu

Posterior pilon fractures (PPFs) are intra-articular ankle injuries of the posterior aspect of the distal tibia, often caused by high-energy mechanisms of trauma such as falling from high heights or motor vehicular accidents. However, the definition, mechanism, classification, and surgical approach for fractures have not been thoroughly investigated. This study aims to explore current literature to expand the understanding of this fracture to help physicians achieve better treatment outcomes. Keywords such as “posterior pilon,” “surgical approach,” “fracture,” etc., were used to find relevant literature on PubMed, MEDLINE, Embase, and the Web of Science. Inclusion criteria involved studies discussing PPFs and retrospective and prospective cohort studies. Exclusion criteria included non-English-published papers, anatomical or biomechanical studies, and studies not discussing PPFs. General demographics, complications, and the American Orthopaedic Foot and Ankle Society (AOFAS) functional outcome scores were collected. A total of 18 publications were selected for data collection, most of which were retrospective studies. The articles discussed 959 (Male: 430, Female: 529) patients. PPFs are defined as distal tibia fractures involving impaction of the articular surface and proximal displacement of talus and posterior malleolus fragments. This characteristic fracture is caused by high-energy rotational and axial load. Five studies in this review describe a classification system for ankle fractures that include studies from Klammer (2013), Bartoníček (2015), Mason (2017), Zhang (2018), and Wang (2020). The posterolateral (PL) approach was used in 34.9 % of cases, followed by the posteromedial (PM) in 7.9 %, modified PM in 20.7 %, and combined PM and PL approach in 6.9 % of cases. PPFs are breaks that occur in the posterior half of the articular surface of the distal tibia, typically affecting the weight-bearing area. These fractures result from a combination of rotational and axial loads, leading to intra-articular ankle fractures that often involve a sizeable posterior fragment. Five classification systems for PPFs identify characteristics observable in X-rays, CT scans, or through morphological analysis. The posterolateral (PL) approach was used more than the posteromedial approach. Common complications included malreduction, nerve injuries, and post-operative pain.

Level of Evidence: III.

皮隆后骨折（PPFs）是胫骨远端后侧的踝关节内损伤，通常由高能量创伤机制引起，如从高处坠落或机动车事故。然而，有关骨折的定义、机制、分类和手术方法尚未得到深入研究。本研究旨在探讨现有文献，以扩大对这种骨折的认识，帮助医生取得更好的治疗效果。本研究使用 "后皮隆"、"手术方法"、"骨折 "等关键词在 PubMed、MEDLINE、Embase 和 Web of Science 上查找相关文献。纳入标准包括讨论PPF的研究以及回顾性和前瞻性队列研究。排除标准包括非英文发表的论文、解剖学或生物力学研究以及未讨论PPF的研究。研究人员还收集了一般人口统计学资料、并发症和美国矫形足踝协会（AOFAS）功能结果评分。共选取了18篇文献进行数据收集，其中大部分是回顾性研究。这些文章讨论了 959 例（男性 430 例，女性 529 例）患者。PPF定义为胫骨远端骨折，涉及关节面的撞击以及距骨和后踝骨碎片的近端移位。这种特征性骨折是由高能量旋转和轴向负荷引起的。本综述中有五项研究描述了踝关节骨折的分类系统，其中包括 Klammer（2013 年）、Bartoníček（2015 年）、Mason（2017 年）、Zhang（2018 年）和 Wang（2020 年）的研究。34.9%的病例采用后外侧（PL）方法，7.9%的病例采用后内侧（PM）方法，20.7%的病例采用改良PM方法，6.9%的病例采用PM和PL联合方法。PPF是发生在胫骨远端关节面后半部的骨折，通常影响负重区。这些骨折是由旋转和轴向负荷共同作用的结果，导致关节内踝关节骨折，通常涉及较大的后方碎片。PPF 有五种分类系统，可通过 X 光片、CT 扫描或形态学分析确定可观察到的特征。后外侧（PL）入路比后内侧入路更常用。常见并发症包括内收不良、神经损伤和术后疼痛：证据等级：III。

{"title":"A systematic review of posterior pilon fractures","authors":"Joseph Boesel , Dominique DiGiacomo , Brett Hoffman , Jiayong Liu","doi":"10.1016/j.jor.2025.01.034","DOIUrl":"10.1016/j.jor.2025.01.034","url":null,"abstract":"<div><div>Posterior pilon fractures (PPFs) are intra-articular ankle injuries of the posterior aspect of the distal tibia, often caused by high-energy mechanisms of trauma such as falling from high heights or motor vehicular accidents. However, the definition, mechanism, classification, and surgical approach for fractures have not been thoroughly investigated. This study aims to explore current literature to expand the understanding of this fracture to help physicians achieve better treatment outcomes. Keywords such as “posterior pilon,” “surgical approach,” “fracture,” etc., were used to find relevant literature on PubMed, MEDLINE, Embase, and the Web of Science. Inclusion criteria involved studies discussing PPFs and retrospective and prospective cohort studies. Exclusion criteria included non-English-published papers, anatomical or biomechanical studies, and studies not discussing PPFs. General demographics, complications, and the American Orthopaedic Foot and Ankle Society (AOFAS) functional outcome scores were collected. A total of 18 publications were selected for data collection, most of which were retrospective studies. The articles discussed 959 (Male: 430, Female: 529) patients. PPFs are defined as distal tibia fractures involving impaction of the articular surface and proximal displacement of talus and posterior malleolus fragments. This characteristic fracture is caused by high-energy rotational and axial load. Five studies in this review describe a classification system for ankle fractures that include studies from Klammer (2013), Bartoníček (2015), Mason (2017), Zhang (2018), and Wang (2020). The posterolateral (PL) approach was used in 34.9 % of cases, followed by the posteromedial (PM) in 7.9 %, modified PM in 20.7 %, and combined PM and PL approach in 6.9 % of cases. PPFs are breaks that occur in the posterior half of the articular surface of the distal tibia, typically affecting the weight-bearing area. These fractures result from a combination of rotational and axial loads, leading to intra-articular ankle fractures that often involve a sizeable posterior fragment. Five classification systems for PPFs identify characteristics observable in X-rays, CT scans, or through morphological analysis. The posterolateral (PL) approach was used more than the posteromedial approach. Common complications included malreduction, nerve injuries, and post-operative pain.</div><div><strong>Level of Evidence</strong>: III.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 34-39"},"PeriodicalIF":1.5,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143182325","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}

引用次数: 0