Journal of Orthopaedic Research®最新文献

Ultrasound-guided tenotomy and debridement is a minimally invasive treatment with a low risk of complications for individuals with chronic Achilles tendinopathy. Yet the benefits of this procedure on pain, function, and pain-related psychological factors, as well as predictors of treatment success, remain understudied. A total of 56 individuals with chronic Achilles tendinopathy (mean (SD): age = 55.9 (11) years, BMI = 34.8 (8.2) kg/m², women = 68%) underwent baseline ultrasonography, followed by ultrasound-guided tenotomy and debridement, and rehabilitation. Participants reported pain (0–10), function (Foot and Ankle Ability Measure—ADL), kinesiophobia (Tampa Scale of Kinesiophobia-17), and pain catastrophizing (Pain Catastrophizing Scale) at baseline and for a year following the procedure. Baseline pain was 6.1 (2.2), kinesiophobia was 40.8 (7.1), pain catastrophizing was 13.7 (10.2), and function was 55.9 (17.3). By 6 weeks, there were decreases in pain (mean change (95% CI): −1.9 (−1.1 to −2.6), function: 14.4 (9.3–19.5), kinesiophobia: −5 (−3.2 to −6.9), and pain catastrophizing: −7 (−4.9 to −9.1)). Patient-reported outcomes were similar at 52 weeks (pain: −2.99 (−2.2 to −3.8), function: 25.1 (19.6–30.7), kinesiophobia: −7.5 (−6.1 to −11.4), catastrophizing: −8.5 (−6.1 to −10.8)) following the procedure. Haglund deformity (β: −13.1 (−0.6 to −25.5)) and intratendinous calcifications (β: −14.7 (−1.4 to −28.1)) were associated with smaller improvements in function. No procedure-related complications were reported. Clinical significance: Ultrasound-guided tenotomy and debridement for chronic Achilles tendinopathy may provide positive outcomes for pain, function, and pain-related psychological factors at 6-week and 1-year follow-up. Haglund deformity and tendon calcifications were associated with smaller improvements in function.

The aim of the study was to design a standardized mechanical test setup and a corresponding finite element analysis to assess the stability and strength of both patient-specific and conventional implants for posterior wall acetabular fractures. Ten synthetic hemi-pelves with posterior wall fractures were biomechanically tested with two types of implants: a patient-specific implant (PSI) and a seven-hole plate conventional implant. 3D-printed guides ensured reproducibility. The models were tested using an Instron machine. The protocol involved 10,000 cyclic load cycles with static tests at 3200 N before and after to simulate early postoperative weightbearing conditions. Construct stiffness, stiffness over cyclic loading and fracture gapping were measured and compared. A finite element analysis was created with similar conditions to investigate stresses within the synthetic bone and fixation materials. The mechanical tests showed comparable stiffness for PSI (1.75 kN/mm) and the conventional implant (1.71 kN/mm, p = 0.47). Stability over 10,000 cycles was similar, and fracture gapping remained minimal (0.0–0.8 mm) without significant differences. No failure or plastic deformation occurred under 3200 N loading. Finite element analysis confirmed that von Mises stresses remained below the yield stress. This study introduces a reproducible workflow for biomechanical testing of acetabular fractures using synthetic bone models and 3D-printed guides. It serves as a step-by-step guideline and standard reference for pelvic biomechanical testing. Both patient-specific and conventional implants, using a seven-hole plate construct with one or two screws through the plate in the fracture fragment, provide stable fixation for large posterior wall fragments.

Total knee replacement (TKR) is a successful intervention for relieving pain and improving quality of life. In this context, mid-flexion instability and paradoxical anterior femoral movement remain challenging. However, the role of implant design in cruciate-sacrificing (CS) scenarios is unclear. Therefore, this study investigated the influence of newly developed CS TKR designs on mid-flexion stability and anterior-posterior (AP) translation using a musculoskeletal multibody simulation during squat motion. The multibody model of the lower extremity, which represented the knee joint with ligaments and muscle structures, was previously validated using instrumented knee data. It was used to analyze newly developed (oneKNEE® cruciate-retaining (CR)/CS and medial-stabilized (MS)) and clinically established (Columbus® ultra-congruent (UC) and P.F.C.™ Sigma® CR) TKR designs. For this purpose, the overall femoral AP translation and tibial internal-external rotation during squat motion (flexion from 0° to 90°) in the CS condition were evaluated. During mid-flexion, the P.F.C.™ Sigma® CR exhibited greater anterior femoral translation than the Columbus® UC, with posterior movement starting at 35.5° (3.4 mm anterior) versus 20° (2.1 mm). In contrast, the oneKNEE® CR/CS and MS designs showed continuous posterior femoral movement (reduced paradoxical translation), with anterior-to-posterior turning points at 9° (1.2 mm) and 13° (0.8 mm) during squat motion, respectively, without inhibiting internal-external rotation. The kinematics of the oneKNEE® designs were achieved by combining the single-radius femoral design and steep anterior ramp of the tibial components. These designs reduced paradoxical anterior femoral movement in mid-flexion in the CS condition, while not restricting tibial internal-external rotation.

Traumatic bone marrow lesions (BMLs) occur in ~80% of anterior cruciate ligament (ACL) injuries, typically in the lateral femoral condyle (LFC) and lateral tibial plateau (LTP). Associated with microfractures, vascular proliferation, inflammation, and bone density changes, BMLs may contribute to posttraumatic osteoarthritis. However, their relationship with knee pain is unclear. This study examined the prevalence, characteristics, and progression of BMLs after ACL injury, focusing on associations with pain, meniscal and ligament injuries, and fractures. Participants (N = 100, aged 14–55) with MRI-confirmed ACL tears were scanned within 6 weeks post-injury (mean = 30.0, SD = 9.6 days). BML volumes were quantified using a validated machine learning method, and pain assessed via the Knee Injury and Osteoarthritis Outcome Score (KOOS). Analyses included t-tests, Mann–Whitney U, chi-square, and Spearman correlations with false discovery rate correction. BMLs were present in 95% of participants, primarily in the LFC and LTP. Males had 33% greater volumes than females (p < 0.05), even after adjusting for BMI. Volumes were higher in cases with depression fractures (p = 0.022) and negatively associated with baseline KOOS Symptoms. At 1 year, 92.68% of lesions (based on lesion counts) resolved in Nonsurgical participants, with a 96.13% volume reduction (p < 0.001). KOOS outcomes were similar between groups, except for slightly better Pain scores in the Nonsurgical group. Baseline Pain and Sport scores predicted follow-up outcomes. BMLs are common post-ACL injury, vary by sex and fracture status, and modestly relate to early symptoms. Most resolve within a year, with limited long-term differences by surgical status.

Arthroplasty surgery is a common and successful end-stage intervention for advanced osteoarthritis. Yet, postoperative outcomes vary significantly among patients, leading to a plethora of measures and associated measurement approaches to monitor patient outcomes. Traditional approaches rely heavily on patient-reported outcome measures (PROMs), which are widely used, but often lack sensitivity to detect function changes (e.g. gait limitations) that may persist after surgery. Accessible measurement systems for objectively capturing functional outcomes have steadily emerged recently. Notably, wearable motion sensing and sensor-embedded prostheses offer high-resolution, real-time data on patient mobility, revealing discrepancies between PROMs and functional recovery trajectories. Coupled with advancements in mobile health platforms, opportunities for remote monitoring and remotely engaging arthroplasty patients is burgeoning. Smartphone applications have improved adherence to rehabilitation protocols, pain management, and patient satisfaction while enabling remote care and reducing healthcare utilization. However, barriers such as inconsistent protocols, the need for clinical validation, reliance on patient compliance with sensor use, small sample sizes, privacy concerns, cost and reimbursement challenges, and limited long-term data remain. Other emerging technologies are further enabling uptake, including but not limited to smart implants, in-home monitoring systems, and artificial intelligence (AI)/machine learning (ML)-enhanced analyses. Together, these technologies hold promise for more personalized, cost-effective strategies for comprehensive and patient-centered assessments that can inform tailored rehabilitation approaches, allow for near real-time assessment of patient outcomes, improve function, and promote earlier mobilization. Further research should focus on standardization and clinical validation, economic and environmental impact, and long-term efficacy to optimize their integration into routine clinical practice.