Journal of orthopaedics最新文献

{"title":"Smart implantable devices are associated with reduced 90-day acute care utilization and cost following total knee arthroplasty","authors":"Kris Hanby ,&nbsp;Jeffrey Yergler ,&nbsp;Patrick Aubin ,&nbsp;Mouhanad M. El Othmani ,&nbsp;Edward Stolarski ,&nbsp;Steven Lyons","doi":"10.1016/j.jor.2025.12.054","DOIUrl":"10.1016/j.jor.2025.12.054","url":null,"abstract":"<div><h3>Background</h3><div>Remote monitoring has been correlated to reduced acute care usage (emergency department (ED)) in cardiovascular, diabetes and COVID domains. Correspondingly, the use of smart implantable devices (SID) in total knee arthroplasty (TKA) may lead to reduced acute care usage in orthopedics.</div></div><div><h3>Methods</h3><div>Retrospective claims data from a nationally representative, third-party claims aggregator were analyzed for ED and hospital admission incidence and cumulative 90-day costs. Patients who received an SID were identified and matched 1:2 with patients who received a traditional knee prosthesis. A subgroup of patients with complete longitudinal claims data for days 91–365 were analyzed for cost comparisons. Chi-squared tests were used to compare acute care incidence and Wilcoxon rank sum tests were used to compare costs.</div></div><div><h3>Results</h3><div>The analysis included 1621 patients with SID knees (1709 TKAs) and 3041 patients (3418 TKAs) implanted with traditional knees. Cumulative incidence of ED visit (SID: 11.4 %; control: 15.6 %), hospital admission (SID: 6.0 %; control: 8.8 %), or any acute care (ED or hospital admission) (SID: 14.1 %; control: 19.2 %) was significantly lower in the SID group (p &lt; 0.05). Median total cost of all healthcare services from the day after surgery to day 90 was significantly lower in the SID group ($3747) than the controls ($5629), representing 61 % of the cost of control patients. SID patients also had lower costs during day 91–365 ($5322 and $8,454, respectively).</div></div><div><h3>Conclusion</h3><div>Use of SIDs in primary TKA was associated with fewer ED visits and hospital admissions, as well as lower 90-day total healthcare costs. These cost reductions reflect both a lower incidence of unplanned care and lower costs per patient. These findings support the potential of implant-derived recovery data to enhance care coordination, align postoperative management with patient expectations, increase patient confidence in their health status and reduce the burden of post-TKA acute care.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 289-295"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Design-dependent associations between quadriceps strength and sagittal knee biomechanics after posterior-stabilized total knee arthroplasty: A 3D motion analysis study","authors":"Ryota Fujii ,&nbsp;Hyunho Lee ,&nbsp;Christopher Stickley ,&nbsp;Kazuyoshi Nakanishi","doi":"10.1016/j.jor.2026.01.005","DOIUrl":"10.1016/j.jor.2026.01.005","url":null,"abstract":"<div><h3>Purpose</h3><div>Single-radius (SR) and multi-radius (MR) femoral components are widely used in posterior-stabilized total knee arthroplasty (TKA). While previous studies have compared these designs primarily using clinical outcomes or basic kinematics, the relationship between quadriceps strength and dynamic sagittal-plane knee biomechanics remains insufficiently understood.</div></div><div><h3>Methods</h3><div>This prospective exploratory cohort study included 31 posterior-stabilized TKAs (SR: 16 knees; MR: 15 knees). Patients were evaluated at 6 months and 1 year postoperatively. Knee extension strength was measured using a handheld dynamometer. Sagittal-plane biomechanics during level walking, stair ascent, and stair descent were assessed using three-dimensional motion capture. External knee flexion moment (KFM) and KFM impulse were calculated. Associations between quadriceps strength and sagittal-plane biomechanical variables were analyzed using Spearman correlation coefficients.</div></div><div><h3>Results</h3><div>No significant between-group differences were observed in demographics or clinical activity levels. In the SR group, no significant associations were identified between quadriceps strength and sagittal-plane biomechanical variables at any postoperative time point. In contrast, the MR group demonstrated a moderate positive correlation between knee extensor strength and stair-descent knee flexion moment (KFM) impulse at 6 months postoperatively (r = 0.498, p &lt; 0.05), which was not observed at 1 year postoperatively. During stair ascent, a significant positive correlation between knee extensor strength and the first peak KFM was observed in the MR group at 1 year (r = 0.606, p &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>This exploratory study demonstrated design-dependent associations between quadriceps strength and sagittal-plane knee biomechanics after posterior-stabilized TKA. While no significant between-group differences were observed in clinical or absolute biomechanical outcomes, task- and time-dependent strength–biomechanics associations were identified in the MR group, whereas no such associations were observed in the SR group, suggesting potential clinical relevance in patients with delayed quadriceps recovery.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 179-185"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femoral neck system: A comparable fixation technique for femoral neck fractures in young adults","authors":"Brittany McPhee ,&nbsp;Doriann M. Alcaide ,&nbsp;Monica Guirgus ,&nbsp;Brandon Richmond ,&nbsp;Vahe Yacoubian ,&nbsp;Joey P. Johnson ,&nbsp;Rebecca Rajfer","doi":"10.1016/j.jor.2026.01.010","DOIUrl":"10.1016/j.jor.2026.01.010","url":null,"abstract":"<div><h3>Objective</h3><div>To examine outcomes of femoral neck fractures (FNFs) in non-geriatric adults treated with the Femoral Neck System (FNS; DePuy Synthes, Warsaw, IN) compared to three other fixation techniques.</div></div><div><h3>Methods</h3><div>This was a retrospective study in two Level I Trauma Centers (2019–2024) in adults 18–50 years old with FNFs (AO/OTA 31) that underwent surgical fixation. Patients were classified by fixation method: femoral neck system (FNS), dynamic hip screw (DHS), cephalomedullary nail (CMN) device and cannulated screws (CS). Outcomes compared between groups included: rates of reoperation, union, hardware failure, avascular necrosis (AVN), conversion to total hip arthroplasty (THA), operative time, intraoperative radiation exposure, surgical site infection (SSI) and length of stay (LOS).</div></div><div><h3>Results</h3><div>A total of 95 patients were included (FNS n = 27; DHS n = 15; CMN n = 15; CS n = 38). The majority of the patients were male (64.2 %), with an average age of 32.5 years and follow up time of 363 days. While being used predominantly for displaced fractures (66.7 %, p = 0.001), the FNS had significantly lower rates of hardware failure (74.1 %; p = 0.046), AVN (0 %, p = 0.034) and THA conversion (0 %, p = 0.029). CS had the highest union rates (89.5 %; p = 0.046), lowest reoperation rates (13.2 %; p = 0.030) and were used primarily for non-displaced fractures (63.2 %, p = 0.001). There were no differences among groups in surgical time (p = 0.191), or LOS (p = 0.592). A sub-analysis comparing reoperation rates after closed reduction showed that successful closed reduction was associated with not requiring reoperation (40.5 % vs 14.3 %; p = 0.026).</div></div><div><h3>Conclusion</h3><div>Fixation of FNFs in young adults with the FNS has lower rates of AVN, hardware failure and THA conversion compared to other fixation methods. Fixation with screws has the highest union rate and lowest reoperation rate in this demographic. Fixation of FNFs with the FNS has similar if not better outcomes when compared to other fixation methods. However, surgical factors such as fracture displacement and closed reduction may have influenced outcomes and require further study.</div></div><div><h3>Level of evidence</h3><div>III</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 239-243"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of different incision ways of posterior approach for posterior tibial plateau fractures: a systemic review and meta-analysis","authors":"Chun Ru Lin ,&nbsp;You-Rui Lin ,&nbsp;Yi-Chen Liu ,&nbsp;Eric H. Tischler ,&nbsp;Ming-Hao Chen ,&nbsp;Hao-Che Tang ,&nbsp;Chien-Hao Chen ,&nbsp;Chun-Yi Su ,&nbsp;Yi-Sheng Chan ,&nbsp;Sung Huang Laurent Tsai","doi":"10.1016/j.jor.2025.12.062","DOIUrl":"10.1016/j.jor.2025.12.062","url":null,"abstract":"<div><h3>Background</h3><div>Inadequate treatment of posterior tibial plateau fractures can cause instability, yet no agreement exists regarding the optimal surgical approach for achieving favorable outcomes. Hence, the aim of this study is to assess and compare the postoperative outcomes of different posterior surgical techniques, including reverse L-shape, S-shaped, posterior medial, extended posterolateral, and posterolateral prone approaches.</div></div><div><h3>Methods</h3><div>To evaluate the efficacy of surgical approaches, we searched databases such as PubMed, Embase, Web of Science, The Cochrane Library, and Scopus. Studies published before October 26th, 2022 were included, and we followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The study's outcomes comprised complications, infections, range of motion (ROM), operation time, and functional scores, and p-values &lt;0.05 were considered significant. To conduct the meta-analysis, we utilized the R software.</div></div><div><h3>Results</h3><div>We included 8 studies with 104 patients. The extended posterolateral approach reduced incidence of complications and improved ROM, while the posterolateral prone approach reduced ROM. Conversely, the S-shaped approach was linked to lower HSS scores. No significant differences were found in infection rates or operative time among the various surgical approaches.</div></div><div><h3>Conclusions</h3><div>The extended posterolateral approach was associated with a lower incidence of complications and greater ROM compared to other surgical approaches. In contrast, the S-shaped approach was linked to lower HSS scores, and the posterolateral prone approach was associated with reduced ROM. These findings suggest that further prospective studies are necessary to establish the optimal surgical approach for posterior tibial plateau fractures.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 91-98"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A decade of progress and paradigm shifts in osteoporosis therapeutics: A bibliometric analysis","authors":"Yanping Liu,&nbsp;Xijie Yu","doi":"10.1016/j.jor.2025.12.069","DOIUrl":"10.1016/j.jor.2025.12.069","url":null,"abstract":"<div><div>Despite extensive research on osteoporosis therapies, systematic analysis of knowledge evolution and translational bottlenecks remains unexplored. This study presents the multidimensional bibliometric analysis of 10,247 publications (2015–2024) to decode paradigm shifts in osteoporosis therapeutics. Using CiteSpace and VOSviewer for bibliometric and visualization analyses, we observed a notable increase in annual publications, peaking in 2022. China and the United States led in research output, while European countries demonstrated higher citation impact. Shanghai Jiao Tong University, Harvard Medical School, and Chinese Academy of Sciences were the top three contributing institutions. Cooper, Cyrus is the most influential author. In academic publishing, <em>Osteoporosis International</em> has been identified as the journal with the most research results in the field of osteoporosis treatment. Keyword emergence analysis revealed a transition in research focus from randomized controlled trial and ovariectomized rats to drug, discontinuation, osteogenesis, bisphosphonate related osteonecrosis, network pharmacology, molecular docking, reduction, fixation, damage, American association, osteoporotic fracture, gut microbiota in the last five years, and that this is being explored in detail for future work. In summary, this study offers a thorough bibliometric analysis of osteoporosis therapeutics worldwide, providing scholars conducting analogous research in this field with valuable insights.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 104-112"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of demographic and socioeconomic factors and urbanization status on postoperative outcomes following hip arthroscopy","authors":"Dev Dayal ,&nbsp;Maxwell Harrell ,&nbsp;Clay Rahaman ,&nbsp;Caleb Berta ,&nbsp;Joe Dekle ,&nbsp;Jeffrey C. Krout ,&nbsp;Eugene Brabston ,&nbsp;Walter Smith ,&nbsp;Thomas E. Evely ,&nbsp;Amit Momaya ,&nbsp;Aaron J. Casp","doi":"10.1016/j.jor.2025.12.061","DOIUrl":"10.1016/j.jor.2025.12.061","url":null,"abstract":"<div><h3>Introduction</h3><div>Hip arthroscopy (HA) is increasingly used to treat femoroacetabular impingement (FAI) and labral tears, with growing interest in the role of socioeconomic factors on postoperative outcomes. Prior literature suggests socioeconomic deprivation may worsen patient-reported outcomes (PROMs), but findings regarding the Area Deprivation Index (ADI) and urbanization status remain inconsistent. This study aimed to evaluate the difference in PROMs after HA secondary to symptomatic FAI and hip labral tears based on the residential urbanization status, demographic variables, and Area Deprivation Index (ADI) values of patients in our single-center cohort</div></div><div><h3>Methods</h3><div>A single-institution retrospective review was conducted on 86 patients who underwent HA between 2014 and 2023. Patients were categorized as urban or rural based on U.S. Census data and assigned national/state ADI scores based on their residential addresses. PROMs (mHHS, HOS-ADL, HOS-Sport, NAHS) were collected via telephone survey at ≥1 year postoperatively. Statistical comparisons and multivariable regression analyses were used to assess the impact of demographic variables and ADI on PROMs.</div></div><div><h3>Results</h3><div>There were no significant differences in PROMs between urban and rural patients. However, regression analysis revealed that national ADI and age were significantly negatively correlated with all PROMs (p &lt; 0.05). Older age and higher ADI independently predicted worse postoperative outcomes. Interaction effects, such as age × BMI or age × ADI, also negatively influenced certain PROMs. Race and surgical indication showed limited interaction effects.</div></div><div><h3>Conclusion</h3><div>While urbanization status did not impact outcomes, higher socioeconomic deprivation (as measured by national ADI) and increased age were associated with significantly worse PROMs after HA at 1-year follow-up. These findings suggest that neighborhood-level socioeconomic disadvantage plays a more critical role than urban-rural classification in influencing recovery. Strategies aimed at addressing social determinants of health may improve HA outcomes, particularly in socioeconomically disadvantaged populations.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 99-103"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peroneal tendoscopy for peroneal tendon disorders: A systematic review of indications, diagnostic utility, and clinical outcomes","authors":"Alexander Tham ,&nbsp;Ragul Rajivan ,&nbsp;Jared Rubin ,&nbsp;James J. Butler ,&nbsp;Mark Pianka ,&nbsp;Akshay Nair ,&nbsp;Hillary Campbell ,&nbsp;Nicole Rynecki ,&nbsp;Mackenzie Roof ,&nbsp;John G. Kennedy","doi":"10.1016/j.jor.2025.12.057","DOIUrl":"10.1016/j.jor.2025.12.057","url":null,"abstract":"<div><h3>Background</h3><div>Peroneal tendon disorders span tendinopathy, tenosynovitis, intrasheath subluxation, stenosis, and tears, and may be challenging to diagnose accurately with clinical examination and MRI alone. Peroneal tendoscopy offers a minimally invasive, diagnostic–therapeutic option. We systematically reviewed clinical indications, intraoperative findings, procedures, imaging accuracy, complications, and patient-reported outcomes following peroneal tendoscopy.</div></div><div><h3>Methods</h3><div>Eight studies (190 patients; 195 ankles) were reviewed. Data on demographics, indications, procedures, PROMs, return to sport (RTS), complications/failures, and imaging–tendoscopy agreement were extracted and pooled when constructs aligned. Random-effects meta-analyses generated pooled means or proportions with 95 % CIs (Hartung–Knapp adjustment). Where applicable, diagnostic performance of preoperative assessment was compared with tendoscopy as reference.</div></div><div><h3>Results</h3><div>Across 190 patients (195 ankles), pooled mean age was 32 years (95 % CI 25.0–39.0), follow-up 30.3 months (95 % CI 20.8–39.8); 71 % of ankles had traumatic aetiologies. Indications were broad, with recurrent subluxation/dislocation, intrasheath subluxation, and refractory lateral ankle pain common. Frequently performed procedures included synovectomy/debridement (94 ankles), groove deepening (34 ankles), excision of space occupying lesions (65 ankles; predominantly low-lying muscle bellies [LLMB] and peroneus quartus), tendon repair/tubularization (23 ankles), and tendoscopic retinacular repair (14 ankles). Six studies reported validated PROMS with four reporting AOFAS suitable for pooling. Postoperative AOFAS averaged 96.6 (95 % CI 94.3–99.0) with a pooled mean gain of +19.8 (95 % CI 18.5–21.2); JSSF, FAOS and SF-12 improved significantly. RTS occurred at a pooled 13.3 weeks (95 % CI 10.6–16.0), with RTS of 12.2 ± 0.6 weeks after tendoscopic retinacular stabilization and 14.8 ± 2.0 weeks after groove deepening. Overall complications were 7.6 % (13 events) and mainly consisted of persistent ankle pain and minor wound issues. Failure rate was 1.5 % and two revision surgeries (1.0 %) were reported. Diagnostic agreement was high at the aggregate level (MRI overall sensitivity 0.90, specificity 0.72), but lesion-level performance varied: MRI was strong for tears and tenosynovitis, weaker for stenosis. Composite preoperative diagnosis in a large series showed high specificity (0.97) but only moderate sensitivity (0.76), with LLMB frequently under-recognized preoperatively.</div></div><div><h3>Conclusions</h3><div>Peroneal tendoscopy provides meaningful functional gains, timely RTS, and a low adverse-event burden across a wide indication spectrum, and it complements imaging by clarifying dynamic/space-conflict pathology. Longer, prospective comparative studies are warranted.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 24-32"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of surgical procedure and radiographic hip alignment with hip abductor strength ratio at discharge after proximal femoral fracture surgery","authors":"Satoshi Hakukawa,&nbsp;Shunsuke Onuma,&nbsp;Kanata Yoshihara","doi":"10.1016/j.jor.2025.12.068","DOIUrl":"10.1016/j.jor.2025.12.068","url":null,"abstract":"<div><h3>Background</h3><div>Hip abductor weakness is common after proximal femoral fracture and may contribute to gait instability. The influence of postoperative hip alignment on early recovery of hip abductor strength during inpatient rehabilitation after surgery remains unclear.</div></div><div><h3>Objective</h3><div>To examine longitudinal changes in hip abductor strength and identify factors associated with the operated-to-non-operated hip abductor strength ratio at discharge, focusing on surgical procedure and radiographic alignment.</div></div><div><h3>Methods</h3><div>This retrospective observational cohort study enrolled 64 patients transferred to a rehabilitation hospital after proximal femoral fracture surgery (34 femoral neck fractures treated with hemiarthroplasty; 30 intertrochanteric fractures treated with cephalomedullary nailing). Hip abductor strength was measured using a handheld dynamometer at rehabilitation admission and discharge and normalized by body weight. Radiographic parameters were measured on supine anteroposterior pelvic radiographs; side-to-side differences (operated minus non-operated) were calculated for the neck–shaft angle, hip center of rotation, femoral offset, and trochanteric height. Multivariable linear regression (ANCOVA-type) was performed with the discharge strength ratio as the dependent variable and the admission strength ratio as an adjustment factor.</div></div><div><h3>Results</h3><div>Hip abductor strength improved on both sides (p &lt; 0.001). The operated side increased from 1.04 ± 0.5 to 1.8 ± 0.7 N/kg and the non-operated side from 1.6 ± 0.6 to 2.3 ± 0.8 N/kg; the operated-to-non-operated ratio improved from 62.7 % to 72.9 %. In the adjusted model (R² = 0.325), cephalomedullary nailing (vs hemiarthroplasty) was associated with a higher discharge strength ratio (B = 0.114, p = 0.027). A greater neck–shaft angle difference was also associated with a higher discharge strength ratio (B = 0.0073 per degree, p = 0.011). The admission strength ratio remained a significant predictor (B = 0.245, p = 0.002).</div></div><div><h3>Conclusions</h3><div>Early recovery of the hip abductor strength ratio after proximal femoral fracture was associated with surgical procedure and postoperative neck–shaft angle asymmetry, independent of baseline strength ratio. Postoperative radiographic alignment may aid in stratifying recovery and tailoring rehabilitation, although causal inference is limited.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 131-137"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonoperative management of sacral chordomas: A systematic review of the literature","authors":"Sean Bae ,&nbsp;Mark Ehioghae ,&nbsp;Jonathan P. Japa ,&nbsp;Ala Alshomali ,&nbsp;Aaron Phung ,&nbsp;Linus Lee ,&nbsp;Justin Hyde ,&nbsp;Jamie Lee ,&nbsp;Kevin Yoon ,&nbsp;Addisu Mesfin","doi":"10.1016/j.jor.2026.01.007","DOIUrl":"10.1016/j.jor.2026.01.007","url":null,"abstract":"<div><h3>Background</h3><div>Sacral chordomas are rare malignant tumors arising from notochordal remnants that can be identified incidentally or present with sacral pain. Although surgical resection is the accepted standard treatment, some patients forgo surgery due to associated morbidity and complications. Nonoperative alternatives, including radiotherapies, have emerged, but literature on their outcomes remains scarce. The purpose of this study was to evaluate the outcomes of nonoperative management of sacral chordomas.</div></div><div><h3>Methods</h3><div>We conducted a systematic review of the literature utilizing PubMed. Search keywords included “nonoperative treatment,” “sacral chordomas,” “radiotherapy,” and “functional outcomes.” Studies involving sacral chordoma patients who underwent nonoperative treatment were included; patients with surgical treatment and hybrid therapies that included surgery were excluded from the analysis.</div></div><div><h3>Results</h3><div>Eleven clinical studies on nonoperative management of sacral chordomas with 52 patients aged between 35 and 85 years (mean = 62.8) were identified. Males were affected at higher rates than females (73.1 % vs 26.9 %). S1 (15.4 %) and S2 (25 %) were the most affected spinal segments. CT-guided biopsy was the most common method of tumor diagnosis (82.7 %). Carbon ion radiotherapy (CIRT) and proton beam therapy were the most common treatment methods, with 57.7 % of patients reporting recurrence-free survival at a mean follow-up of 24 months.</div></div><div><h3>Conclusion</h3><div>Nonoperative management of sacral chordomas shows promising outcomes for patients who are not candidates for surgery. Although recurrence remains a risk, nonoperative management may offer meaningful functional preservation and local disease control.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 186-194"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rotator cuff repair vs. reverse arthroplasty for massive tears: A patient-centered outcome analysis","authors":"Fatih Emre Topsakal,&nbsp;Ekrem Özdemir,&nbsp;Nasuhi Altay","doi":"10.1016/j.jor.2026.02.004","DOIUrl":"10.1016/j.jor.2026.02.004","url":null,"abstract":"<div><h3>Background</h3><div>The management of massive rotator cuff tears (MRCTs) without glenohumeral arthritis presents a significant clinical challenge. The choice between primary arthroscopic rotator cuff repair (RCR) and reverse shoulder arthroplasty (RSA) remains controversial, with limited comparative data on patient-centered outcomes.</div></div><div><h3>Purpose</h3><div>To compare functional outcomes, patient-priority outcome domains, and complication rates between primary arthroscopic RCR and primary RSA in patients with massive rotator cuff tears.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 70 patients (36 RCR, 34 RSA) treated between 2022-2024 with minimum 12-month follow-up (mean 24.3 ± 6.7 months). Patient demographics, preoperative imaging findings (Goutallier fatty infiltration, Patte retraction, Hamada staging), traditional functional scores (ASES, Constant, DASH, VAS), range of motion, and patient-priority outcome domains (pain-free sleep, overhead activity, internal rotation tasks, heavy work capacity, return to sports) were compared using appropriate statistical methods.</div></div><div><h3>Results</h3><div>RCR patients were significantly younger (64.8 ± 7.2 vs. 72.1 ± 6.9 years, p &lt; 0.001) with lower Goutallier grades (Grade≥3: 44.7% vs. 94.4%, p &lt; 0.001). Both groups achieved significant pain reduction and functional improvement. At final follow-up, RCR demonstrated superior active flexion (146.3° ± 24.8° vs. 117.2° ± 27.3°, p &lt; 0.001), internal rotation (L3 vs. S1 level, p = 0.001), and ASES scores (79.2 ± 23.4 vs. 69.8 ± 26.1, p = 0.042). RCR showed significant advantages in patient-priority domains including overhead activity (3.2 ± 0.8 vs. 2.6 ± 0.9, p = 0.002), internal rotation tasks (3.3 ± 0.7 vs. 2.2 ± 1.0, p &lt; 0.001), and return to sports (2.6 ± 1.1 vs. 1.8 ± 0.9, p = 0.001). Complication rates were similar (11.1% vs. 8.8%, p = 0.734).</div></div><div><h3>Conclusion</h3><div>In younger, active patients with adequate tissue quality, primary arthroscopic RCR provides superior range of motion and patient-centered functional outcomes. RSA remains a reliable option for elderly patients with advanced fatty infiltration and chronic pseudoparalysis. Careful evaluation of these factors is critical for optimal patient selection.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 314-322"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146170268","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}