MUSCULOSKELETAL SURGERY最新文献

Purpose: The aim of this study was to evaluate the radiological-functional outcomes and rotator cuff (RC) status following humeral intramedullary nailing (IMN), comparing the anterolateral standard approach (group 1) and the percutaneous antero-acromial approach (group 2).

Methods: This observational prospective monocentric study was conducted from August 2021 to March 2023. Inclusion criteria included: two-parts proximal (surgical neck) and diaphyseal Humeral fractures treated with IMN; 12-month follow-up; age between 18 and 85 years; good performance status (excluding neurologic deficits or mental disorders). Evaluations included RC status via ultrasound, Constant, DASH, and SPADI scores, as well as fracture healing times. A T-test was used or statistical analysis.

Results: Sixty-one patients were enrolled during the study period (34 in group 1; 27 in group 2). The mean bone healing time resulted 2.9 ± 0.5 months in group 1 and 2.4 ± 0.7 months in group 2, with a statistically significant reduction of 17% in favor of group 2 (p < 0.05). No significant differences were found in the Constant scores at 6 and 12 months of follow-up; however, significant differences were observed in DASH and SPADI scores (p < 0.05). Supraspinatus tears were detected in both groups: 6 in Group 1 (2 full-thickness and 4 partial) localized at the footprint, and 4 in Group 2 (1 full-thickness and 3 partial) assessed medially in the musculotendinous portion.

Conclusion: Intramedullary nailing with a percutaneous approach proved to be a minimally invasive technique with better functional outcomes and shorter fracture healing times. The impact on the RC was comparable to the standard approach.

Total hip arthroplasty (THA) via the direct anterior approach (DAA) is a preferred surgical technique due to its benefits, including reduced soft tissue disruption and faster recovery. However, obesity, defined as a body mass index (BMI) ≥ 30 kg/m², poses unique challenges in DAA-THA, increasing the risk of complications and technical difficulties. This systematic review aims to assess the clinical and functional outcomes, complication rates, and reoperation rates in obese patients undergoing DAA-THA compared to non-obese patients. A systematic search was conducted in PubMed, Cochrane Library, and Web of Science for studies published between January 2000 and December 2024, following PRISMA guidelines. Inclusion criteria focused on studies reporting outcomes for obese patients undergoing DAA-THA. Data on functional outcomes, complications, and reoperations were extracted, and methodological quality was evaluated using the Modified Coleman Methodology Score (mCMS). Eleven studies involving 8,062 THAs (3,658 in obese patients, 4,386 in non-obese patients) met the inclusion criteria. Both groups showed significant postoperative improvements in functional outcomes, with similar Harris Hip Scores (HHS) (94.38 in obese vs. 93.85 in non-obese patients). Obese patients, however, had longer surgical times (82.52 vs. 68.82 min) and higher complication rates (5.5% vs. 4.88%), including increased risks of superficial wound infections, periprosthetic joint infections, and deep vein thrombosis. Reoperation rates were also higher in obese patients (1.69% vs. 0.7%). DAA-THA provides comparable functional improvements for obese and non-obese patients. However, the higher complication and reoperation rates in obese patients emphasize the need for preoperative optimization, meticulous surgical technique, and targeted perioperative care. Further high-quality studies with longer follow-up are necessary to refine strategies for optimizing outcomes in obese patients undergoing DAA-THA.

Introduction: Cervical spine surgeries pose unique challenges due to the proximity of critical structures and limited visualization with traditional techniques. Robotic assistance offers potential solutions by providing precise navigation and reducing radiation exposure. We present a series of 30 consecutive patients undergoing various cervical spine procedures utilizing the MazorX Stealth Edition (MXSE) robotic system with intraoperative imaging.

Methods: Anterior and posterior surgeries were performed using the MXSE system. Surgical parameters, implant placement accuracy, and patient outcomes were assessed. Data analysis included anthropometric measurements, surgical times, blood loss, radiation exposure, and patient-reported outcomes.

Results: Mean age was 52.43 years, with 43.33% females. Procedures included anterior cervical discectomy and fusion, corpectomy, disc replacement, and posterior decompression and fusion. Implant placements were accurate, with no neurological deficits or reoperations. Surgical parameters were comparable to standard techniques.

Discussion: Robotic assistance offers accurate implant placement and reduced radiation exposure. Challenges such as vertebra segmentation and surgical approach were addressed. Further research and instrument development are needed for wider adoption.

Conclusion: Robotic navigation in cervical spine surgeries enhances precision and safety. Continued advancements in technology and technique are essential for broader implementation.

Purpose: Poland syndrome is a congenital malformation characterized by agenesis or hypoplasia of pectoralis muscles. There is a limited literature on how the anatomic anomalies of PS may impact the movement of the shoulder. This study analyzes the effects of absence of the pectoralis muscles on the shoulder kinematic.

Methods: Clinical evaluation was performed analyzing range of motion (RoM), stability, cuff disease and internal rotation strength. In all patients, we used inertial sensors to analyze scapular motion in three degrees of freedom: medium-lateral rotation, posterior tilting and protraction-retraction. The same analysis was performed by dividing the patients into two groups by age to evaluate the presence of age-related alterations.

Results: No differences in RoM between pathological and healthy side were observed. All patients were positive for posterior instability. No significant differences in strength in internal rotation were observed with average + 6,91% (s = 2,14) on the healthy side's strength. Kinematic analysis showed higher values of scapular medium-lateral rotation and anticipation of retraction of the pathological side during flexion and abduction. Reduced scapular tilt in under 18 years old was found.

Conclusions: The absence of the pectoralis muscles seems not to affect the RoM. The increased scapular rotation on the medium-lateral axis is probably due to the absence of humeral insertion of the pectoralis major and the absence of the scapular insertion of the pectoralis minor. The increased retraction in abduction it can be explained by a hypercontraction of the scapular stabilizers. The reduced tilt in under 18 years old is influenced by the lack of adaptation by the muscle groups involved.

Introduction: Irreparable rotator cuff tears (IRCTs) are large tears that can't be surgically repaired due to poor tissue quality, degeneration, or severe tendon retraction. These tears often involve multiple tendons and lead to fatty infiltration, humeral head migration, and tendon retraction. Patients with IRCTs typically present with pseudoparalysis, muscle atrophy, or anterosuperior escape. While various surgical options exist, outcomes are often inconsistent. This case series presents a novel technique for managing massive IRCTs, showing excellent, consistent results and offering a promising advancement for treating these challenging cases.

Methodology: Our case series involved 20 patients with massive irreparable rotator cuff tears, presenting clinically with pseudoparalysis and radiographically with signs of fatty infiltration, anterosuperior escape, and tendon retraction. The outcomes of interest included the Western Ontario Rotator Cuff Index (WORI), Oxford Shoulder Score (OSS), and range of motion arc (forward flexion and abduction), measured both preoperatively and postoperatively.

Results: The mean age of our patient cohort was 53.6 years, with a mean follow-up time of 40 months. The mean preoperative WORI score was 155.3, which improved to 54.2 postoperatively, showing an improvement of 101 points from the baseline. The mean preoperative OSS was 34.4, improving to 10.5 postoperatively, with a gain of 23.8 points. The mean preoperative range of motion for forward flexion was 67.0°, which improved to 164° postoperatively, resulting in a mean gain of 97°. The mean preoperative abduction was 57°, which improved to 166° postoperatively, with a mean gain of 109°. All these findings were statistically significant (p < 0.05).

Conclusion: In our surgical technique, all patients demonstrated clinically and statistically significant improvements in both range of motion and patient-reported outcomes. This makes our approach a novel, robust, and reliable technique for managing massive irreparable tears, particularly in young adult patients.

Level of evidence: Case Series, Level IV.

Background: Isolated distal fibula fractures (DFF) are usually treated with open reduction and internal fixation (ORIF) and non-weight-bearing protocols. The study assessed the outcomes of immediate weight-bearing on DFF healing and stability after lateral locking plating.

Materials and methods: For this study, 49 patients affected by isolated DFF were enrolled. They underwent ORIF with a lateral polyaxial locking plate and were allowed immediate weight-bearing with crutches postoperatively. Clinical and radiographic evaluations were performed at 2, 6, and 12 weeks using the AOFAS (American Orthopedic Foot and Ankle Society) score and X-rays evaluations..

Results: Immediate weight-bearing yielded positive outcomes, with a significant increase of the AOFAS score during the clinical re-evaluations. All patients tolerated early and progressive full weight-bearing without complications. Radiographic findings at 12 weeks showed complete bone healing in all cases.

Conclusions: The immediate weight-bearing protocol combined with lateral locking plating resulted in favorable clinical outcomes, accelerated recovery, and successful bone healing for stable DFF cases.

Spontaneous osteonecrosis of the knee (SONK) was first described by Ahlbäck et al. in 1968. However, subsequent studies revealed that subchondral fractures, rather than necrosis, are the most common histopathological finding in bone samples from patients diagnosed with SONK. This has led to ongoing debate regarding the accuracy of the term "SONK." Therefore, SONK is an inappropriate definition for this condition since the absence of necrosis in most histopathological samples of patients with such diagnosis. A PRISMA-compliant scoping review was conducted using PubMed, Scopus, and Cochrane databases. All original research studies reporting histological analyses of bone samples from patients who underwent surgery following a diagnosis of SONK were considered for inclusion. Extracted data included general study characteristics, radiographic and magnetic resonance imaging (MRI) findings, time elapsed between arthroscopy and histological sampling, and the results of histological examinations of bone samples. Eight articles met the inclusion criteria, comprising 90 patients (91 knees), of which 87 bone samples were analyzed histologically. Of these, 7 showed undetermined outcomes. Among the remaining 80 samples, necrosis was identified in 35 cases and absent in 45. Subchondral insufficiency fractures (SIFs) were detected in 41 cases, with 19 of these also showing necrosis. The histopathological evidence suggests that the term "SONK" is inappropriate, as SIFs, rather than necrosis, are the predominant finding. We therefore recommend adopting "SIF" as a more accurate descriptor for this condition.

Purpose: Magnetic resonance imaging (MRI) is often used to evaluate patients with patellar dislocations to facilitate diagnosis and management strategies. Many radiological parameters have been described in the literature. The aim of this study was to assess the significance of tibial-tubercle trochlear groove distance (TT-TG) distance and other MRI measurements in patients with and without patellar instability.

Methods: This case-control study included 41 patients with recurrent patellar instability and 50 patients with stable knees, all of whom underwent MRI scans. A total of 19 radiological parameters were measured in both groups.

Results: All measured MRI parameters had statistically significant differences between both groups (p < 0.05) apart from trochlear cartilage length. TT-TG distance. 20 mm had the strongest association with patellar instability (OR 53.3, p = 0.006, 95%CI [3.1- 927.4]) and the highest specificity (100%) but had the lowest sensitivity (34%) out of all the measured parameters. TT-TG. 13 mm had a higher sensitivity (68%) but lower specificity (72%) and weaker association with patellar instability (OR 5.5, p < 0.001, 95%CI [2.2. 13.7]). TT-TG/trochlear articular cartilage width ratio also had a strong association with patellar instability (OR 14.7, p < 0.001, 95%CI [4.5. 48.5]) with high specificity (92%) but lower sensitivity (56%).

Conclusion: The cut-off values for TT-TG distance at 13 mm and 20 mm both had advantages and disadvantages which supports the concept of using patient-individualised ratios. Patellar instability is associated with many radiological abnormalities demonstrated on MRI scans. Selection of the most appropriate measurement is dependent on the philosophy and preference of the treating clinician.

Post-surgical rehabilitation advice after ankle fracture surgery, particularly regarding weight-bearing, varies significantly, leading to patient frustration and inconsistent recovery outcomes. This study aimed to establish a consensus for ankle fracture rehabilitation advice and identify content and implementation options for future interventions through consultation with healthcare professionals (HCPs). This study was part of the weight-bearing in ankle fractures (WAX) trial, a multicentre, randomised controlled trial. Using the behaviour change wheel (BCW) framework, three online workshops with HCPs were conducted between April 25, 2022, to May 4, 2022, to generate consensus on rehabilitation interventions. Participants completed pre-workshop tasks, and data were collected using an adapted nominal group technique (NGT). Workshop data were collated to create a survey with indicative statements about rehabilitation preferences. An online survey was subsequently disseminated to surgeons and physiotherapists between May 5, 2022, and July 13, 2022. Respondents were asked to indicate how strongly they agreed with various statements by ranking statements on a 5-point Likert scale from "strongly disagree" to "strongly agree"; 75% was used as a threshold for consensus agreement. Eight HCPs participated in the workshops, and 79 HCPs responded to the survey, representing 38 different NHS hospital trusts. Consensus was achieved on several key aspects: Patients could rest their foot on the floor while seated during non-weight-bearing periods and gradually increase weight-bearing based on comfort. It was agreed that orthotic boots are for comfort, and patients can discontinue use as early as two weeks post-operatively if weight-bearing is permitted. Guidelines for wound management, including when to get wounds wet and how to handle numbness, were also established. This study established a consensus for ankle fracture rehabilitation, emphasising patient autonomy and clear, standardised advice. The findings support the development of a tailored, patient-centred rehabilitation interventions, potentially delivered through digital platforms, to enhance recovery outcomes.