Pub Date : 2025-01-28DOI: 10.1016/j.jor.2025.01.029
Nan Ye, Jian Huang, Yuanzhi Zhang, Yifeng Yang
Given the pivotal role that apoptosis and autophagy play in the pathogenesis of osteoarthritis (OA), the current study aims to examine the regulatory effects of ghrelin on these processes via the ADORA2B/PI3K/Akt/mTOR signaling pathway. Serum levels of ghrelin were measured in both OA patients and healthy controls using an ELISA kit. Cell proliferation was evaluated through the Cell Counting Kit-8 (CCK-8) assay, while Western blot analysis was utilized to determine the expression levels of autophagy-related proteins (LC3II/I, BECLIN-1) and apoptosis markers (BAX, Bcl-2), as well as to assess the activation status of the PI3K/Akt/mTOR signaling pathway in OA synovial cells. These analyses were performed under conditions of ADORA2B and mTOR silencing, as well as in control settings. The results revealed that ghrelin expression was significantly reduced in the serum of OA patients. Furthermore, ghrelin was found to enhance synovial cell proliferation while simultaneously inhibiting apoptosis and autophagy, as evidenced by lowered expression levels of LC3/I, BECLIN-1, and BAX, alongside an increase in Bcl-2 expression. This modulation occurred through the regulation of the PI3K/Akt/mTOR signaling pathway mediated by ADORA2B. These findings underscore the role of ghrelin in the progression of osteoarthritis by influencing synovial cell activity through the ADORA2B/PI3K/Akt/mTOR pathway, thus laying the groundwork for investigating targeted therapeutic strategies in clinical practice.
{"title":"Ghrelin suppresses apoptosis and autophagy in osteoarthritis synovial cells by modulating the ADORA2B/PI3K/Akt/mTOR signaling pathway","authors":"Nan Ye, Jian Huang, Yuanzhi Zhang, Yifeng Yang","doi":"10.1016/j.jor.2025.01.029","DOIUrl":"10.1016/j.jor.2025.01.029","url":null,"abstract":"<div><div>Given the pivotal role that apoptosis and autophagy play in the pathogenesis of osteoarthritis (OA), the current study aims to examine the regulatory effects of ghrelin on these processes via the ADORA2B/PI3K/Akt/mTOR signaling pathway. Serum levels of ghrelin were measured in both OA patients and healthy controls using an ELISA kit. Cell proliferation was evaluated through the Cell Counting Kit-8 (CCK-8) assay, while Western blot analysis was utilized to determine the expression levels of autophagy-related proteins (LC3II/I, BECLIN-1) and apoptosis markers (BAX, Bcl-2), as well as to assess the activation status of the PI3K/Akt/mTOR signaling pathway in OA synovial cells. These analyses were performed under conditions of ADORA2B and mTOR silencing, as well as in control settings. The results revealed that ghrelin expression was significantly reduced in the serum of OA patients. Furthermore, ghrelin was found to enhance synovial cell proliferation while simultaneously inhibiting apoptosis and autophagy, as evidenced by lowered expression levels of LC3/I, BECLIN-1, and BAX, alongside an increase in Bcl-2 expression. This modulation occurred through the regulation of the PI3K/Akt/mTOR signaling pathway mediated by ADORA2B. These findings underscore the role of ghrelin in the progression of osteoarthritis by influencing synovial cell activity through the ADORA2B/PI3K/Akt/mTOR pathway, thus laying the groundwork for investigating targeted therapeutic strategies in clinical practice.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 27-33"},"PeriodicalIF":1.5,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143180625","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}
Pub Date : 2025-01-23DOI: 10.1016/j.jor.2025.01.028
Krishna Kiran Eachempati , Apurve Parameswaran , Sunil Apsingi , Chandra Sekhar Dannana , Deepak Gautam , Neil P. Sheth
Background
Morphologic changes in the posterior medial femoral condyle (PMFC) among varus osteoarthritic knees have not been described in the past. The aims of this study were to compare anterior cruciate ligament (ACL) competent and deficient varus osteoarthritic knees during computer-navigation assisted (CAS) total knee arthroplasty (TKA) in terms of their pre-operative deformity, rotation of the posterior condylar axis (PCA) with respect to Whiteside's axis, and prevalence of PMFC hyperplasia or attrition.
Methods
Data pertaining to pre-operative varus deformity, rotation of the PCA with respect to Whiteside's axis, and presence of PMFC hyperplasia or attrition were analyzed for 250 consecutive patients each, with ACL-competent and deficient knees, who underwent CAS TKA for varus osteoarthritis of the knee.
Results
ACL-deficient knees, compared to ACL-competent knees, were associated with greater pre-operative stressed (9.94° ± 6.14° versus 7.29° ± 4.48°, P < 0.001) and corrected (3.62° ± 4.36° versus 2.41° ± 3.08°, P < 0.001) varus deformities, internal rotation of the PCA with respect to Whiteside's axis (4.06° ± 2.32° versus 3.08° ± 2.03°, P < 0.001), and prevalence of PMFC attrition (8.4 % versus 0 %, P < 0.001) and hyperplasia (27.2 % versus 9.6 %, P < 0.001).
Conclusion
Chronic ACL deficiency in varus osteoarthritic knees may result in progression of the coronal deformity, PMFC attrition, increased internal rotation of the PCA with respect to Whiteside's axis, and eventually PMFC hyperplasia. This needs to be borne in mind during TKA to prevent inadvertent placement of the femoral component in inappropriate rotation.
{"title":"Influence of the functional status of the anterior cruciate ligament on the posterior medial femoral condyle among varus osteoarthritic knees","authors":"Krishna Kiran Eachempati , Apurve Parameswaran , Sunil Apsingi , Chandra Sekhar Dannana , Deepak Gautam , Neil P. Sheth","doi":"10.1016/j.jor.2025.01.028","DOIUrl":"10.1016/j.jor.2025.01.028","url":null,"abstract":"<div><h3>Background</h3><div>Morphologic changes in the posterior medial femoral condyle (PMFC) among varus osteoarthritic knees have not been described in the past. The aims of this study were to compare anterior cruciate ligament (ACL) competent and deficient varus osteoarthritic knees during computer-navigation assisted (CAS) total knee arthroplasty (TKA) in terms of their pre-operative deformity, rotation of the posterior condylar axis (PCA) with respect to Whiteside's axis, and prevalence of PMFC hyperplasia or attrition.</div></div><div><h3>Methods</h3><div>Data pertaining to pre-operative varus deformity, rotation of the PCA with respect to Whiteside's axis, and presence of PMFC hyperplasia or attrition were analyzed for 250 consecutive patients each, with ACL-competent and deficient knees, who underwent CAS TKA for varus osteoarthritis of the knee.</div></div><div><h3>Results</h3><div>ACL-deficient knees, compared to ACL-competent knees, were associated with greater pre-operative stressed (9.94° ± 6.14° versus 7.29° ± 4.48°, <em>P</em> < 0.001) and corrected (3.62° ± 4.36° versus 2.41° ± 3.08°, <em>P</em> < 0.001) varus deformities, internal rotation of the PCA with respect to Whiteside's axis (4.06° ± 2.32° versus 3.08° ± 2.03°, <em>P</em> < 0.001), and prevalence of PMFC attrition (8.4 % versus 0 %, <em>P</em> < 0.001) and hyperplasia (27.2 % versus 9.6 %, <em>P</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>Chronic ACL deficiency in varus osteoarthritic knees may result in progression of the coronal deformity, PMFC attrition, increased internal rotation of the PCA with respect to Whiteside's axis, and eventually PMFC hyperplasia. This needs to be borne in mind during TKA to prevent inadvertent placement of the femoral component in inappropriate rotation.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 1-6"},"PeriodicalIF":1.5,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143182326","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}
Pub Date : 2025-01-22DOI: 10.1016/j.jor.2025.01.023
Brian R. Wolf , Bruno Butturi Varone , Cameron Barton , Qiang An , Matthew J. Bollier
Background
Anterior cruciate ligament reconstruction (ACLR) hamstring (HS) autograft diameter <8 mm is associated with an increased re-rupture rate. Efforts have been made to increase graft diameter by using more than 4 strands.
The purpose of this study was to report graft sizes and outcomes using a novel modified 5- or 6-strand HS ACLR.
Methods
A retrospective study was conducted with patients who underwent primary ACLR through a 5-year period. Patients were divided into 2 groups based on graft choice: 5- or 6-strand HS versus the remainder of the cohort (BTB, QT, or 4-strand HS).
Results
There were 70 patients in group 5/6, and 48 patients in group CG (20 4-strand HS and 28 BTB/QT). The average follow-up was 47.7 months. Re-rupture rate in Group 5/6 was 2.9 % (2/70) compared to 8.3 % (4/48) (p = .2225) in group CG. The subsequent surgery rate for group 5/6 was 5.7 %, versus 12.5 % for group CG (p = .3128).
Conclusion
5 or 6 Strand ACLR provides graft sizes >8 mm in 98.6 % of cases, good clinical outcomes including low re-rupture and subsequent surgery rates, and good patient-reported outcomes. At an average follow-up of 4 years, 5 or 6 Strand ACLR revealed trends of lower re-rupture rates, lower subsequent surgery rates, and lower cyclops lesion rates compared to BTB/Quad and 4-strand hamstring grafts; however, these results were not statistically significant.
{"title":"Clinical outcomes following novel 5- or 6-strand ACL reconstruction with fixed or adjustable loop suspensory button femoral fixation","authors":"Brian R. Wolf , Bruno Butturi Varone , Cameron Barton , Qiang An , Matthew J. Bollier","doi":"10.1016/j.jor.2025.01.023","DOIUrl":"10.1016/j.jor.2025.01.023","url":null,"abstract":"<div><h3>Background</h3><div>Anterior cruciate ligament reconstruction (ACLR) hamstring (HS) autograft diameter <8 mm is associated with an increased re-rupture rate. Efforts have been made to increase graft diameter by using more than 4 strands.</div><div>The purpose of this study was to report graft sizes and outcomes using a novel modified 5- or 6-strand HS ACLR.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted with patients who underwent primary ACLR through a 5-year period. Patients were divided into 2 groups based on graft choice: 5- or 6-strand HS versus the remainder of the cohort (BTB, QT, or 4-strand HS).</div></div><div><h3>Results</h3><div>There were 70 patients in group 5/6, and 48 patients in group CG (20 4-strand HS and 28 BTB/QT). The average follow-up was 47.7 months. Re-rupture rate in Group 5/6 was 2.9 % (2/70) compared to 8.3 % (4/48) (p = .2225) in group CG. The subsequent surgery rate for group 5/6 was 5.7 %, versus 12.5 % for group CG (p = .3128).</div></div><div><h3>Conclusion</h3><div>5 or 6 Strand ACLR provides graft sizes >8 mm in 98.6 % of cases, good clinical outcomes including low re-rupture and subsequent surgery rates, and good patient-reported outcomes. At an average follow-up of 4 years, 5 or 6 Strand ACLR revealed trends of lower re-rupture rates, lower subsequent surgery rates, and lower cyclops lesion rates compared to BTB/Quad and 4-strand hamstring grafts; however, these results were not statistically significant.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 165-169"},"PeriodicalIF":1.5,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143154695","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}
Low back pain is a critical health issue related to the formation and growth of tears (or lesions), along with degenerative changes, which is commonly observed in the posterior regions of intervertebral discs (IVD) in the lower spine segments. Early and accurate prediction of growth of these tears is a challenging task with immense clinical significance. Finite element method is a promising technique in this direction, however, the combined effects of tears and degeneration in the posterior region of annulus has not been studied. The present work focuses on a numerical evaluation of the contribution of annulus material degeneration, the position of tear and regular physiological movements (extension, flexion, left and right lateral bending) on the growth of the posterior circumferential tear in the annulus of the L5-S1 spinal unit. The material models developed previously to describe degeneration effects were adopted for defining the annulus material. The tear is modelled by altering the mesh to determine its effects in the presence of degeneration in the annulus. Degeneration, which is a loss of functional ability due to age-related effects, influenced the stress response significantly across all types of movements. Flexion movement is found to have the most predominant damaging effect on the tears, evident by the higher stresses along the tear boundary. Tears near the outer periphery of the annulus were likely to experience higher magnitudes of stress for an applied load and, hence, were suggested to be more critical. Extension movement seemed to aid in the recovery of the tear, supporting the results of clinical studies. This study highlights the complex interaction between physiological movements and the progression of posterior circumferential tears under different stages of degeneration, which can enable clinicians to develop and implement suitable patient-specific treatment modalities.
{"title":"Stress evaluation along the posterior annular circumferential tears on the L5-S1 spinal unit as an index of tear progression","authors":"Vinyas , Subraya Krishna Bhat , Hiroshi Yamada , Nitesh Kumar , Raviraja Adhikari , Shyamasunder Bhat N","doi":"10.1016/j.jor.2025.01.026","DOIUrl":"10.1016/j.jor.2025.01.026","url":null,"abstract":"<div><div>Low back pain is a critical health issue related to the formation and growth of tears (or lesions), along with degenerative changes, which is commonly observed in the posterior regions of intervertebral discs (IVD) in the lower spine segments. Early and accurate prediction of growth of these tears is a challenging task with immense clinical significance. Finite element method is a promising technique in this direction, however, the combined effects of tears and degeneration in the posterior region of annulus has not been studied. The present work focuses on a numerical evaluation of the contribution of annulus material degeneration, the position of tear and regular physiological movements (extension, flexion, left and right lateral bending) on the growth of the posterior circumferential tear in the annulus of the L5-S1 spinal unit. The material models developed previously to describe degeneration effects were adopted for defining the annulus material. The tear is modelled by altering the mesh to determine its effects in the presence of degeneration in the annulus. Degeneration, which is a loss of functional ability due to age-related effects, influenced the stress response significantly across all types of movements. Flexion movement is found to have the most predominant damaging effect on the tears, evident by the higher stresses along the tear boundary. Tears near the outer periphery of the annulus were likely to experience higher magnitudes of stress for an applied load and, hence, were suggested to be more critical. Extension movement seemed to aid in the recovery of the tear, supporting the results of clinical studies. This study highlights the complex interaction between physiological movements and the progression of posterior circumferential tears under different stages of degeneration, which can enable clinicians to develop and implement suitable patient-specific treatment modalities.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 148-164"},"PeriodicalIF":1.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143154693","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}
Pub Date : 2025-01-20DOI: 10.1016/j.jor.2025.01.027
Griffin Harris , Nikhil Patel , Richard Wang , Anmol Patel , Selina Deiparine , Thomas M. Best , Jean Jose
Objective
The infrapatellar fat pad (IFP) is important in the homeostasis of the knee joint due to its structural and immune-modulating properties. This study investigates the relationship between IFP injury severity during acute Anterior Cruciate Ligament (ACL) tears, and the future development of Patellofemoral Compartment (PFC) chondrosis.
Methods
Adult participants aged 18–45 years old who were known to have first-time ACL tears between 01/01/2009 and 10/1/2022 were included. Patients with concomitant knee pathologies at the time of injury were excluded from the study. All participants received ACL reconstruction surgery and had follow-up MRIs conducted within two years postoperatively. Preoperative IFP edema levels were assessed alongside both pre-and postoperative PFC. We analyzed the relationship between the initial IFP edema and future PFC progression on subsequent MRI scans.
Results
A total of 69 participants were included in this study. No significant correlation was found between the severity of initial IFP injury and the initial presence of PFC chondrosis (r = −0.04, P = 0.61). However, a significant positive correlation was observed between the severity of initial IFP injury and the future progression of PFC chondrosis (r = 0.44, P < 0.001). Additionally, a significant difference in the progression of PFC chondrosis was noted when comparing grade 1 to grade 2 IFP injuries (P = 0.001). No significant difference in PFC chondrosis development was identified when comparing grade 2 to grade 3 IFP injuries (P = 0.72).
Conclusion
Our study underscores the potential role of the IFP in preserving cartilage homeostasis by establishing a link between the severity of IFP injury and the subsequent development of PFC following ACL injury.
{"title":"Impact of infrapatellar fat pad injury severity on subsequent patellofemoral cartilage degeneration following acute ACL tear","authors":"Griffin Harris , Nikhil Patel , Richard Wang , Anmol Patel , Selina Deiparine , Thomas M. Best , Jean Jose","doi":"10.1016/j.jor.2025.01.027","DOIUrl":"10.1016/j.jor.2025.01.027","url":null,"abstract":"<div><h3>Objective</h3><div>The infrapatellar fat pad (IFP) is important in the homeostasis of the knee joint due to its structural and immune-modulating properties. This study investigates the relationship between IFP injury severity during acute Anterior Cruciate Ligament (ACL) tears, and the future development of Patellofemoral Compartment (PFC) chondrosis.</div></div><div><h3>Methods</h3><div>Adult participants aged 18–45 years old who were known to have first-time ACL tears between 01/01/2009 and 10/1/2022 were included. Patients with concomitant knee pathologies at the time of injury were excluded from the study. All participants received ACL reconstruction surgery and had follow-up MRIs conducted within two years postoperatively. Preoperative IFP edema levels were assessed alongside both pre-and postoperative PFC. We analyzed the relationship between the initial IFP edema and future PFC progression on subsequent MRI scans.</div></div><div><h3>Results</h3><div>A total of 69 participants were included in this study. No significant correlation was found between the severity of initial IFP injury and the initial presence of PFC chondrosis (r = −0.04, P = 0.61). However, a significant positive correlation was observed between the severity of initial IFP injury and the future progression of PFC chondrosis (r = 0.44, P < 0.001). Additionally, a significant difference in the progression of PFC chondrosis was noted when comparing grade 1 to grade 2 IFP injuries (P = 0.001). No significant difference in PFC chondrosis development was identified when comparing grade 2 to grade 3 IFP injuries (P = 0.72).</div></div><div><h3>Conclusion</h3><div>Our study underscores the potential role of the IFP in preserving cartilage homeostasis by establishing a link between the severity of IFP injury and the subsequent development of PFC following ACL injury.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 170-176"},"PeriodicalIF":1.5,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143154694","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}
Pub Date : 2025-01-18DOI: 10.1016/j.jor.2025.01.015
William F. Baker , Nabil Mehta , Samantha A. Riebesell , Dennis A. DeBernardis , Luke S. Austin
Background
Tramadol is a synthetic opioid prescribed to control postoperative pain while mitigating the harmful effects of stronger opioids, such as oxycodone. However, it is unknown whether tramadol can serve as an adequate substitute for oxycodone following shoulder surgery. Therefore, the primary purpose of this study was to compare early postoperative pain scores and prescribed narcotic between patients receiving tramadol and oxycodone after arthroscopic rotator cuff repair (ARCR). The secondary purpose was to identify risk factors related to experiencing increased postoperative pain or requiring increased postoperative prescriptions.
Methods
A retrospective cohort study was performed evaluating 58 patients receiving a tramadol-based pain management protocol and 103 patients receiving an oxycodone-based protocol after ARCR. VAS pain scores were obtained preoperatively and at 2 weeks, 6 weeks, and 3 months postoperatively. The change in VAS score from preoperative to 3-month follow-up was calculated. Total milligram morphine equivalent (MMEs) prescribed, number and timing of refills, and the proportion of patients failing the tramadol protocol who required oxycodone were recorded. Multivariate regression analysis was performed to determine risk factors for having higher postoperative pain scores and requiring an increased number of prescriptions.
Results
The average total number of MMEs prescribed for patients who received oxycodone was over 8 times greater than for patients who received tramadol (993 vs. 120 MMEs). Both groups demonstrated improvements in pain scores at all time points. Patients receiving tramadol had a greater change in VAS score from pre to postoperative at all timepoints. Patients who were prescribed oxycodone received a greater number of refills and were 2.7 times more likely to need a refill within 3 months than those receiving tramadol. Only 4 patients (6.9 %) receiving tramadol required oxycodone within 3 months of surgery.
Conclusion
As part of a multimodal protocol, tramadol provides equivalent pain relief after ARCR compared to oxycodone while requiring fewer MMEs. Patients prescribed oxycodone exhibit a smaller magnitude of improvement in VAS pain and require more refills than those prescribed tramadol. Our findings can be used to improve opioid prescription practices to reduce dependency and over prescription of narcotics.
{"title":"Tramadol-based multimodal pain protocols after arthroscopic rotator cuff repair are similarly effective as oxycodone-based protocols with fewer morphine milligram equivalents prescribed and lower risk of refills","authors":"William F. Baker , Nabil Mehta , Samantha A. Riebesell , Dennis A. DeBernardis , Luke S. Austin","doi":"10.1016/j.jor.2025.01.015","DOIUrl":"10.1016/j.jor.2025.01.015","url":null,"abstract":"<div><h3>Background</h3><div>Tramadol is a synthetic opioid prescribed to control postoperative pain while mitigating the harmful effects of stronger opioids, such as oxycodone. However, it is unknown whether tramadol can serve as an adequate substitute for oxycodone following shoulder surgery. Therefore, the primary purpose of this study was to compare early postoperative pain scores and prescribed narcotic between patients receiving tramadol and oxycodone after arthroscopic rotator cuff repair (ARCR). The secondary purpose was to identify risk factors related to experiencing increased postoperative pain or requiring increased postoperative prescriptions.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was performed evaluating 58 patients receiving a tramadol-based pain management protocol and 103 patients receiving an oxycodone-based protocol after ARCR. VAS pain scores were obtained preoperatively and at 2 weeks, 6 weeks, and 3 months postoperatively. The change in VAS score from preoperative to 3-month follow-up was calculated. Total milligram morphine equivalent (MMEs) prescribed, number and timing of refills, and the proportion of patients failing the tramadol protocol who required oxycodone were recorded. Multivariate regression analysis was performed to determine risk factors for having higher postoperative pain scores and requiring an increased number of prescriptions.</div></div><div><h3>Results</h3><div>The average total number of MMEs prescribed for patients who received oxycodone was over 8 times greater than for patients who received tramadol (993 vs. 120 MMEs). Both groups demonstrated improvements in pain scores at all time points. Patients receiving tramadol had a greater change in VAS score from pre to postoperative at all timepoints. Patients who were prescribed oxycodone received a greater number of refills and were 2.7 times more likely to need a refill within 3 months than those receiving tramadol. Only 4 patients (6.9 %) receiving tramadol required oxycodone within 3 months of surgery.</div></div><div><h3>Conclusion</h3><div>As part of a multimodal protocol, tramadol provides equivalent pain relief after ARCR compared to oxycodone while requiring fewer MMEs. Patients prescribed oxycodone exhibit a smaller magnitude of improvement in VAS pain and require more refills than those prescribed tramadol. Our findings can be used to improve opioid prescription practices to reduce dependency and over prescription of narcotics.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 126-131"},"PeriodicalIF":1.5,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143153802","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}
Pub Date : 2025-01-17DOI: 10.1016/j.jor.2025.01.020
Min Zhang , Ling Zhang , Shitao Fang , Yun Wang , Jinkun Guo , Lei Mi
<div><h3>Background</h3><div>The treatment of hallux valgus is currently in face of many challenges in clinical practice. Although conventional surgical procedures can correct deformities to a certain extent, some key parameters such as osteotomy displacement and angle are often difficult to determine, leading to increased uncertainty in surgical outcomes and a relatively high incidence of postoperative complications.</div></div><div><h3>Objective</h3><div>Hallux valgus is a common foot deformity that often leads to pain, difficulty in walking, and other health problems, seriously affecting the quality of life of patients. In order to provide patients with more precise treatment, we aimed to simulate the Scarf osteotomy for the treatment of hallux valgus using the finite element method, and comparatively analyze the mechanical performance indicators under different distal osteotomy displacements. We hoped to provide scientific and reasonable treatment plans for clinical practice and better treatment outcomes for patients.</div></div><div><h3>Methods</h3><div>A volunteer with moderate hallux valgus was selected as the research subject in this study. Preoperative plantar pressure test was conducted, and the CT data of the patient's affected foot was collected to create the finite element model using finite element software. After verifying the validity of the model, it was used to simulate the translational Scarf osteotomy under different settings. Specifically, the distal end of the bone fragment was pushed outwards by varying distances (2 mm, 4 mm, 6 mm, and 8 mm) and was fixed with screws. The maximum Von Mises stresses on the first to fifth metatarsal bones, the sole and the heel under four different surgical settings were compared with the preoperative values, and the changes in the maximum Von Mises stress on the screws were examined.</div></div><div><h3>Results</h3><div>When the distal end of the bone fragment was pushed outwards by 6 mm, the maximum Von mises stress on the first metatarsal bone (9.4711 MPa) reached its highest value, while the maximum Von mises stresses on the second and third metatarsal bones (0.34062 MPa and 1.6246 MPa, respectively) and on the screws (40.99 MPa) were at the lowest values. The maximum plantar pressure detected during static test was 0.292 MPa, while the maximum plantar stress observed in the finite element model was 0.25733 MPa, indicating comparable values between the two.</div></div><div><h3>Conclusions</h3><div>Based on precise and customized preoperative design and finite element analysis, it was found that the Scarf osteotomy with the distal end of the bone fragment pushed outwards for 6 mm could yield the best treatment effect for hallux valgus. Under this setting, the stress on the first metatarsal bone was the highest, while the stresses on the second and third metatarsal bones were the lowest, suggesting that it can relieve the stress on lateral metatarsal bones and improve the stress distributio
{"title":"Finite element analysis of Scarf osteotomy for precise treatment of hallux valgus","authors":"Min Zhang , Ling Zhang , Shitao Fang , Yun Wang , Jinkun Guo , Lei Mi","doi":"10.1016/j.jor.2025.01.020","DOIUrl":"10.1016/j.jor.2025.01.020","url":null,"abstract":"<div><h3>Background</h3><div>The treatment of hallux valgus is currently in face of many challenges in clinical practice. Although conventional surgical procedures can correct deformities to a certain extent, some key parameters such as osteotomy displacement and angle are often difficult to determine, leading to increased uncertainty in surgical outcomes and a relatively high incidence of postoperative complications.</div></div><div><h3>Objective</h3><div>Hallux valgus is a common foot deformity that often leads to pain, difficulty in walking, and other health problems, seriously affecting the quality of life of patients. In order to provide patients with more precise treatment, we aimed to simulate the Scarf osteotomy for the treatment of hallux valgus using the finite element method, and comparatively analyze the mechanical performance indicators under different distal osteotomy displacements. We hoped to provide scientific and reasonable treatment plans for clinical practice and better treatment outcomes for patients.</div></div><div><h3>Methods</h3><div>A volunteer with moderate hallux valgus was selected as the research subject in this study. Preoperative plantar pressure test was conducted, and the CT data of the patient's affected foot was collected to create the finite element model using finite element software. After verifying the validity of the model, it was used to simulate the translational Scarf osteotomy under different settings. Specifically, the distal end of the bone fragment was pushed outwards by varying distances (2 mm, 4 mm, 6 mm, and 8 mm) and was fixed with screws. The maximum Von Mises stresses on the first to fifth metatarsal bones, the sole and the heel under four different surgical settings were compared with the preoperative values, and the changes in the maximum Von Mises stress on the screws were examined.</div></div><div><h3>Results</h3><div>When the distal end of the bone fragment was pushed outwards by 6 mm, the maximum Von mises stress on the first metatarsal bone (9.4711 MPa) reached its highest value, while the maximum Von mises stresses on the second and third metatarsal bones (0.34062 MPa and 1.6246 MPa, respectively) and on the screws (40.99 MPa) were at the lowest values. The maximum plantar pressure detected during static test was 0.292 MPa, while the maximum plantar stress observed in the finite element model was 0.25733 MPa, indicating comparable values between the two.</div></div><div><h3>Conclusions</h3><div>Based on precise and customized preoperative design and finite element analysis, it was found that the Scarf osteotomy with the distal end of the bone fragment pushed outwards for 6 mm could yield the best treatment effect for hallux valgus. Under this setting, the stress on the first metatarsal bone was the highest, while the stresses on the second and third metatarsal bones were the lowest, suggesting that it can relieve the stress on lateral metatarsal bones and improve the stress distributio","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 132-139"},"PeriodicalIF":1.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143153803","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}
Pub Date : 2025-01-17DOI: 10.1016/j.jor.2025.01.011
Udit Dave , Jared Rubin , Nicole Chang , Andrew S. Bi , Myles Atkins , Fernando Gómez-Verdejo , Nikhil N. Verma , Jorge Chahla
Introduction
The patellar tendon plays a crucial role in knee extension and lower extremity mobility. Although PT ruptures are rare, they result in severe loss of function when untreated. The purpose of this study was to evaluate clinical and functional outcomes and complications following primary, acute patellar tendon (PT) repair.
Methods
In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, Embase, and Cochrane Library databases were searched in August 2024 for studies published after 2004. Studies were included if they met these criteria: evaluated patients who underwent acute PT repair with any technique including for mid-substance tear or avulsion, were prospective or retrospective studies, and reported functional outcomes or complications. Studies not written in English were excluded.
Results
The initial screen identified 1737 studies, 9 of which were included in this systematic review. There were three retrospective cohort studies, three retrospective case series, one retrospective case control study, and two prospective case series. Each study had low risk of bias. A total of 970 patients (93.8 % males) were included. Mean age across studies ranged from 32.1 to 44.6 years. Five included studies reported on mean extension at follow-up, ranging from 0 to 6.4 degrees of extension. Five included studies reported on mean flexion at follow-up, ranging from 128.5 to 143.3 degrees of flexion. The range of re-rupture and re-operation were 0–21.4 % with an overall re-rupture rate of 3.9 % and an overall re-operation rate of 5.7 %. Only one study reported a significant difference in re-rupture rates with transosseous repair versus suture anchor repair (7.5 % versus 0 % respectively). Other complications identified were venous thromboembolism (VTE) (0–5.0 %), stiffness (0–35.0 %), hardware discomfort (0–5.0 %), and infection (0–5.0 %).
Conclusions
Patellar tendon repair with both transosseous and suture anchor technique restores range of motion in patients post-operatively with a low complication rate. Decisions regarding operative technique should be tailored to individual patient characteristics and surgeon preferences.
Level of evidence
Level IV, systematic review of level III-IV studies.
{"title":"Patellar tendon repair restores extensor mechanism function with a low complication rate: A systematic review","authors":"Udit Dave , Jared Rubin , Nicole Chang , Andrew S. Bi , Myles Atkins , Fernando Gómez-Verdejo , Nikhil N. Verma , Jorge Chahla","doi":"10.1016/j.jor.2025.01.011","DOIUrl":"10.1016/j.jor.2025.01.011","url":null,"abstract":"<div><h3>Introduction</h3><div>The patellar tendon plays a crucial role in knee extension and lower extremity mobility. Although PT ruptures are rare, they result in severe loss of function when untreated. The purpose of this study was to evaluate clinical and functional outcomes and complications following primary, acute patellar tendon (PT) repair.</div></div><div><h3>Methods</h3><div>In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, Embase, and Cochrane Library databases were searched in August 2024 for studies published after 2004. Studies were included if they met these criteria: evaluated patients who underwent acute PT repair with any technique including for mid-substance tear or avulsion, were prospective or retrospective studies, and reported functional outcomes or complications. Studies not written in English were excluded.</div></div><div><h3>Results</h3><div>The initial screen identified 1737 studies, 9 of which were included in this systematic review. There were three retrospective cohort studies, three retrospective case series, one retrospective case control study, and two prospective case series. Each study had low risk of bias. A total of 970 patients (93.8 % males) were included. Mean age across studies ranged from 32.1 to 44.6 years. Five included studies reported on mean extension at follow-up, ranging from 0 to 6.4 degrees of extension. Five included studies reported on mean flexion at follow-up, ranging from 128.5 to 143.3 degrees of flexion. The range of re-rupture and re-operation were 0–21.4 % with an overall re-rupture rate of 3.9 % and an overall re-operation rate of 5.7 %. Only one study reported a significant difference in re-rupture rates with transosseous repair versus suture anchor repair (7.5 % versus 0 % respectively). Other complications identified were venous thromboembolism (VTE) (0–5.0 %), stiffness (0–35.0 %), hardware discomfort (0–5.0 %), and infection (0–5.0 %).</div></div><div><h3>Conclusions</h3><div>Patellar tendon repair with both transosseous and suture anchor technique restores range of motion in patients post-operatively with a low complication rate. Decisions regarding operative technique should be tailored to individual patient characteristics and surgeon preferences.</div></div><div><h3>Level of evidence</h3><div>Level IV, systematic review of level III-IV studies.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 146-153"},"PeriodicalIF":1.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123054","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}
The aim of this paper is to describe all-inside posterior cruciate ligament (aiPCL) reconstruction surgical technique and to report complications and outcomes in female patients with isolated posterior cruciate ligament (PCL) tears.
Methods
Preoperative and postoperative evaluations included posterior drawer test, dial test at 30o and 90o of knee flexion, Tegner score, and Lysholm score. The mean follow-up was 33.12 months (range 12–74).
Results
Twenty-five female patients with grade II or grade III isolated lesions of the PCL underwent aiPCL reconstruction. The mean age of the patients at the time of surgery was 29.7 ± 12.9 years, while the mean time from injury to surgery was 11 months (range 12–324). No intraoperative/postoperative complications occurred. At the last follow-up, 16 (69.5 %) and 5 (21.5 %) patients had a grade A and B posterior drawer test, respectively, while the dial test (30o and 90o of knee flexion) was negative in all patients. The mean preoperative Lysholm score was 64.08 ± 13.06 points (range 37–85 points), while the mean postoperative Lysholm score was 88.12 ± 13.33 points (range 50–100 points) (p<0.0001). No statistically significant differences were found comparing preoperative and postoperative Tegner score results.
Conclusions
The arthroscopic aiPCL reconstruction seems safe and effective.
{"title":"All-inside technique for isolated posterior cruciate ligament tears: Surgical technique and outcomes","authors":"Stefano Petrillo , Filippo Migliorini , Fabrizio Bertelle , Piero Volpi","doi":"10.1016/j.jor.2025.01.010","DOIUrl":"10.1016/j.jor.2025.01.010","url":null,"abstract":"<div><h3>Introduction</h3><div>The aim of this paper is to describe all-inside posterior cruciate ligament (aiPCL) reconstruction surgical technique and to report complications and outcomes in female patients with isolated posterior cruciate ligament (PCL) tears.</div></div><div><h3>Methods</h3><div>Preoperative and postoperative evaluations included posterior drawer test, dial test at 30<sup>o</sup> and 90<sup>o</sup> of knee flexion, Tegner score, and Lysholm score. The mean follow-up was 33.12 months (range 12–74).</div></div><div><h3>Results</h3><div>Twenty-five female patients with grade II or grade III isolated lesions of the PCL underwent aiPCL reconstruction. The mean age of the patients at the time of surgery was 29.7 ± 12.9 years, while the mean time from injury to surgery was 11 months (range 12–324). No intraoperative/postoperative complications occurred. At the last follow-up, 16 (69.5 %) and 5 (21.5 %) patients had a grade A and B posterior drawer test, respectively, while the dial test (30<sup>o</sup> and 90<sup>o</sup> of knee flexion) was negative in all patients. The mean preoperative Lysholm score was 64.08 ± 13.06 points (range 37–85 points), while the mean postoperative Lysholm score was 88.12 ± 13.33 points (range 50–100 points) (<em>p<</em>0.0001). No statistically significant differences were found comparing preoperative and postoperative Tegner score results.</div></div><div><h3>Conclusions</h3><div>The arthroscopic aiPCL reconstruction seems safe and effective.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 54-58"},"PeriodicalIF":1.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123055","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}
Pub Date : 2025-01-17DOI: 10.1016/j.jor.2025.01.024
Brandon Leon, Dominic J. Ventimiglia, Evan L. Honig, Leah E. Henry, Andrew Tran, Michael A. McCurdy, Jonathan D. Packer, Sean J. Meredith, Natalie L. Leong, R. Frank Henn III
Introduction
Both preoperative expectations and postoperative met expectations can independently influence patient-reported outcomes (PROs), however, their combined effect on PROs is not well understood. This study aimed to determine the prognostic significance of categorizing non-arthroplasty knee surgery patients into clusters based on both preoperative expectations and postoperative met expectations.
Methods
638 patients who underwent non-arthroplasty knee surgery from June 2015 to May 2021 at a single academic institution were analyzed. Patients were grouped based on both preoperative expectations and two-year postoperative met expectations scores using cluster analysis. Four distinct expectations cluster groups were formed: high preoperative-high met expectations (HIGH-HIGH), low preoperative-high met expectations (LOW-HIGH), high preoperative-low met expectations (HIGH-LOW), and low preoperative-low met expectations (LOW-LOW). Socioeconomic data and PROs were compared based on cluster group, and logistic regression was performed to determine the likelihood of achieving a patient-perceived “completely better” status based on cluster group.
Results
Patients with high met expectations, regardless of preoperative expectations, reported better two-year PROs compared to patients with low met expectations. Patients with high preoperative expectations achieved better outcomes only when those expectations were met postoperatively. Low preoperative expectations did not preclude patients from achieving good outcomes, as long as those expectations were met. The HIGH-HIGH group had increased odds of achieving completely better status compared to the LOW-HIGH group (OR = 1.68, p = .02), HIGH-LOW group (OR = 16.69, p < .001), and LOW-LOW group (OR = 5.17, p < .001). The HIGH-LOW group had decreased odds of achieving completely better status compared to the LOW-LOW group (OR = .31, p = .01).
Conclusion
Met expectations may be a stronger predictor of postoperative outcomes than preoperative expectations in non-arthroplasty knee surgery. This study highlights the importance of setting realistic preoperative expectations and focusing on achieving expectations postoperatively. These findings offer valuable insights for clinicians to manage patient expectations effectively based on individual characteristics and expected treatment outcomes.
{"title":"Combining preoperative expectations and postoperative met expectations to predict patient-reported outcomes after knee surgery","authors":"Brandon Leon, Dominic J. Ventimiglia, Evan L. Honig, Leah E. Henry, Andrew Tran, Michael A. McCurdy, Jonathan D. Packer, Sean J. Meredith, Natalie L. Leong, R. Frank Henn III","doi":"10.1016/j.jor.2025.01.024","DOIUrl":"10.1016/j.jor.2025.01.024","url":null,"abstract":"<div><h3>Introduction</h3><div>Both preoperative expectations and postoperative met expectations can independently influence patient-reported outcomes (PROs), however, their combined effect on PROs is not well understood. This study aimed to determine the prognostic significance of categorizing non-arthroplasty knee surgery patients into clusters based on both preoperative expectations and postoperative met expectations.</div></div><div><h3>Methods</h3><div>638 patients who underwent non-arthroplasty knee surgery from June 2015 to May 2021 at a single academic institution were analyzed. Patients were grouped based on both preoperative expectations and two-year postoperative met expectations scores using cluster analysis. Four distinct expectations cluster groups were formed: high preoperative-high met expectations (HIGH-HIGH), low preoperative-high met expectations (LOW-HIGH), high preoperative-low met expectations (HIGH-LOW), and low preoperative-low met expectations (LOW-LOW). Socioeconomic data and PROs were compared based on cluster group, and logistic regression was performed to determine the likelihood of achieving a patient-perceived “completely better” status based on cluster group.</div></div><div><h3>Results</h3><div>Patients with high met expectations, regardless of preoperative expectations, reported better two-year PROs compared to patients with low met expectations. Patients with high preoperative expectations achieved better outcomes only when those expectations were met postoperatively. Low preoperative expectations did not preclude patients from achieving good outcomes, as long as those expectations were met. The HIGH-HIGH group had increased odds of achieving completely better status compared to the LOW-HIGH group (OR = 1.68, p = .02), HIGH-LOW group (OR = 16.69, p < .001), and LOW-LOW group (OR = 5.17, p < .001). The HIGH-LOW group had decreased odds of achieving completely better status compared to the LOW-LOW group (OR = .31, p = .01).</div></div><div><h3>Conclusion</h3><div>Met expectations may be a stronger predictor of postoperative outcomes than preoperative expectations in non-arthroplasty knee surgery. This study highlights the importance of setting realistic preoperative expectations and focusing on achieving expectations postoperatively. These findings offer valuable insights for clinicians to manage patient expectations effectively based on individual characteristics and expected treatment outcomes.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 140-147"},"PeriodicalIF":1.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143153804","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号