MUSCULOSKELETAL SURGERY最新文献

Rotator cuff (RC) tears affect 22% of the population, increasing with age. While 48.4% are asymptomatic, 25% require surgery. Annually, over 400,000 RC repairs (RCRs) are performed in the USA, costing over $50,000 each. However, retear rates remain high (10-40%), with clinical outcomes stagnating since 1980. Platelet-rich plasma (PRP) has emerged as a potential adjunct to RCR, with its growth factors and regenerative properties offering promise for enhancing tendon healing and improving postoperative outcomes. A comprehensive search across four major databases selected studies utilising PRP in RCR. Out of 2709 studies initially identified, 22 were included, with 13 undergoing meta-analysis. The primary outcome measures were pain and functional scores, with secondary outcomes including patient-reported outcome measures (PROMs) and retear rates. PRP significantly reduced VAS scores, as a proxy of pain reduction at 6 months (MD = 0.34 [0.10, 0.59]) and at 12 months (MD = 0.24 [0.03, 0.44]) post-RCR. UCLA score improvements were significant at 3 months (MD = 2.98 [1.55, 4.40]), 6 months (MD = 1.96 [1.09, 2.83]) and 12 months (MD = 1.26 [0.39, 2.13]). Additionally, PRP significantly reduced retear rates at 24 months, with a mean risk reduction of 15.03%, indicating a substantial improvement in tendon healing. PRP offers substantial benefits in RCR, particularly in reducing pain and retear rates. However, further research is necessary due to observed heterogeneity and study biases. Future efforts should focus on incorporating PRP into clinical practice and guidelines.

Antibiotic-loaded spacers are widely used in the two-stage revision protocol for managing periprosthetic joint infections (PJIs) of the knee, offering effective local antibiotic delivery while maintaining joint space and soft tissue tension. However, despite their clinical benefits, complications such as extensor mechanism rupture remain under-recognized and can severely compromise functional outcomes. This retrospective case series presents consecutive patients treated between 2014 and 2022 by a single orthopedic team at our institution. All patients were diagnosed with knee PJI and experienced extensor mechanism rupture following the implantation of either static or dynamic antibiotic-loaded spacers. The analysis highlights the multifactorial etiology of this complication, including factors such as severe bone loss, suboptimal spacer positioning or design, repeated debridements, and individual patient risks such as obesity and previous surgical history. Dynamic spacers, while allowing partial joint mobility, were associated with a higher risk of mechanical overload, whereas static spacers posed risks related to rigidity and stress transmission. Surgical management in all cases involved radical debridement, assessment of bone loss and femoral canal diameter, and careful selection of spacer type. Awareness of the potential for extensor mechanism injury should inform both surgical technique and postoperative care strategies.

Purpose: Distal tibia nonunion poses a serious therapeutic challenge for orthopedic surgeons. Bone loss and soft tissue damage is relatively common. The aim of this study was to compare the healing rate and related functional outcomes between two retrospective series of distal tibia nonunion cases treated with internal fixation via the posterolateral approach and those managed with Ilizarov external fixation.

Methods: This retrospective cohort study included 47 affected by distal tibia nonunion. The subjects had undergone internal fixation with inter-tibiofibular graft through the posterolateral approach (Group A, n = 24) and Ilizarov method associated or not with bone transport procedures and osteotomies (Group B, n = 23). Results were assessed at a minimum 24 months after surgery. Consolidation rate, radiographic healing time of nonunion, the American Orthopedic Foot and Ankle Society (AOFAS), the short form health survey (SF-12) and Visual Analog Scale (VAS) scores (pain, ability to work and treatment satisfaction) were compared between the groups. Complications and reoperations were also recorded.

Results: The nonunion healing rate was 75% (18/24) in the group A and 91% in the group B (21/23)(p = 0.001). Consolidation was observed, on average, 5.7 months after surgery (range, 4-9) in the group A and 10.7 months in the B group (range, 5-24) (p = 0.001). All patients recovered have had good functional outcomes with no significant differences between the groups. At final follow-up, AOFAS scores in the A group were 74 (range 52-94), while in the B group it was 79 (range 57-100). Group A showed a better perception of mental health status (SF-12-MCS 46 vs. 45, p = 0.36) and a better satisfaction with the treatment received, but a worse perception of their physical health status (SF-12-PCS 49 vs. 50, p = 0.52) with a lower mean score on working ability.

Conclusion: Distal tibial nonunion can be successfully treated with the posterolateral approach, or external Ilizarov fixation. There are not significative outcomes differences when patients undergoing internal or external fixation. Although healing times are faster with internal fixation via the posterolateral approach, healing rates are higher with the Ilizarov method.

Background: Hallux valgus is a common pathology in the orthopedic daily practice. More than 100 techniques of surgical correction are currently described in the literature, mostly focused on osteotomies. Procedures based on soft tissues balancing are actually less described.

Materials and methods: Between May and October 2019, 20 patients, 16 females and 4 males, underwent surgery using mini TightRope® system. All were addressed to preoperative radiological and clinical assessment through the AOFAS-hallux scale and radiographs. Follow-up was performed postoperatively with weight-bearing radiographs and AOFAS-hallux score at 5 weeks, 3 months and 6 months. All patients were postoperatively allowed to immediately full weight-bear wearing a stiff sole orthopedic shoe (Donjoy, Podalux™).

Results: The results showed an improvement in the functional score (average AOFAS from 53.5 to 87 at 6 months) and a decrease in IMA and HVA in the direct postoperative with 9.2° and 28.3°, respectively. The reductions were maintained through 6 months and compared with the preoperative condition a reduction of 6.0° and 7.3°, respectively, were observed.

Conclusions: Correction of hallux valgus with the modified osteodesis procedure with the mini TightRope system with Full Weight-Bearing can be considered effective, safe and reliable.

Purpose: The assessment of functional outcomes after pelvic ring fracture remains a controversial topic. The Majeed pelvic score (MPS) is the most commonly used pelvic-specific questionnaire in the literature. The aim of this study is translation, cross-cultural adaptation and validation of the Italian version of MPS.

Methods: The study was articulated in two phases. Phase 1 consisted in translation and cross-cultural adaptation of MPS, from English into Italian. The psychometric properties were tested on 52 Italian patients (Phase 2). Construct validity was assessed by correlation with Short-Form 12 (SF-12). 33 patients repeated the questionnaire after 14 days to assess its reproducibility. All data were subsequently analyzed (descriptive statistics, multitrait analysis, reliability and construct validity assessment).

Results: The questionnaire was clear and easily understood (no missing data). A ceiling effect was detected for all items of the scale. Multitrait analysis showed good results for each outcome measure, except for the item "walking distance" that showed poor item discriminant validity. A significant correlation between the MPS and the physical component summary (PCS) of the SF-12 was found, while there was a weak correlation with the mental component summary (MCS). The questionnaire showed high internal consistency (Cronbach's alpha: 0.91-0.99) and very good test-retest reliability (intraclass correlation coefficients: 0.92-0.96).

Conclusions: The Italian version of the MPS has demonstrated to be reliable and valid in the evaluation of patients with pelvic ring fractures. There is still however a need for an instrument capable of evaluating the mental component in these types of injuries.

Background: This study aims to evaluate the incidence of clinically significant heterotopic ossification (HO) in primary total hip arthroplasty (THA), comparing outcomes with and without the adoption of an HO prophylactic protocol in male patients under 70 years of age.

Methods: The prophylactic protocol involved the administration of 50 mg of Indomethacin twice daily for 3 weeks. HO presence was classified according to the Brooker classification system, considering "severe" clinically significant HO (Brooker grade 3 and 4).

Results: Two hundred and seventy-nine patients were included in our study, and an overall HO rate of 68.2% versus a rate of 61.5% was found respectively in patients not subjected and subjected to prophylactic protocol, without significant difference (PR 0.062). However, patients not subjected to the HO prophylactic protocol exhibited a severe HO rate of 22.4% compared to 7.7% in the prophylactic group, with a statistically significant difference (P = 0.008).

Conclusions: Our study demonstrated that prophylactic protocol adoption is significantly associated with lower rate of severe HO in male patients under 70 years of age. Currently, there are no orthopedic guidelines for the prevention and management of HO after THA, but in the absence of contraindications, the adoption of a prophylactic protocol for HO should always be considered in high-risk patients.

The selection of graft type for anterior cruciate ligament reconstruction remains a topic of debate, taking into consideration patient characteristics, as well as the type and level of sports involvement. The aim of this scoping review was to investigate patient characteristics that might influence the selection of graft type for anterior cruciate ligament reconstruction. PubMed and Scopus were searched to identify articles for inclusion. All included studies focused on one or more patient characteristics involved in the decision-making process regarding anterior cruciate ligament reconstruction autograft, including the hamstrings tendon (HT), patellar tendon (BPTB) and quadriceps tendon (QT). Out of the 1,977 initial studies, 27 studies were included in this review. The BPTB graft seems to be the preferred choice in young patients, females, and athletes-especially those engaged in pivoting sports. The HT graft seems to be the preferred choice in less active and older patients, along with those involved in sports where knee extensors are vital. The HT graft is not preferable in patients with a small body height and graft diameter. Moreover, surgeon preferences were also of importance for graft selection. The success of a specific graft type in anterior cruciate ligament reconstruction is highly dependent on the patient's characteristics and type of sport. Patient characteristics such as age, gender, body height, graft diameter, and the patient's activity level should all be considered when choosing the appropriate graft type.

Little evidences are available in the literature concerning the outcomes of total knee replacement (TKR) in poliomyelitis patients with severe knee deformities or degeneration. Encouraging results have been reported concerning the use of constrained implants, i.e., rotating hinge knee prosthesis (RHK), compared to less constrained ones. The purpose of this paper is to report our experience with rotating hinge total knee replacement, using only RHK prosthesis, to determine functional results, complications, and survival of TKR in poliomyelitis patients. We performed a retrospective chart review of 14 patients with a history of knee osteoarthritis following poliomyelitis that underwent primary TKR, for a total of 15 surgical procedure (one bilateral case). Preoperative and postoperative clinical measurements have been conducted for all patients using the Knee Society Score (KSS). Hip-knee angle, recurvatum knee angle, and Insall-Salvati index were evaluated with full weight-bearing panoramic view X-ray preoperatively and postoperatively. The 2-year postoperative clinical KSS significantly improved from the preoperative scores. The average clinical KSS improved from 32,9 (range 3-48) preoperatively to 77,4 (range 60-88) postoperatively (P value < 0.005). The average functional KSS improved from 32,5 (range 10-60) preoperatively to 59,4 (range 30-95) postoperatively (P value < 0.005). TKR is a successful treatment in improving knee function and patient's quality of life. Using constrained implants, especially rotating hinge implants in polio patients with a quadriceps muscle weakness, could be a good alternative to maintain a physiological kinematics and reducing the revision rate due to knee instability.

With the advanced arthroscopic technique, arthroscopic-assisted reduction and internal fixation (ARIF) is gaining popularity for Glenoid fractures with and without scapular involvement. ARIF offers a complete view of the articular surfaces and diagnoses and treats other associated injuries. ARIF provides less soft tissue trauma than open reduction internal fixation (ORIF). The aim of this systemic review is to look at the functional outcomes and complications of ARIF. A systematic review of the PubMed, Embase, and Scopus databases was performed. The search terms included "glenoid fracture" OR "scapula fracture" AND "arthroscopic fixation" OR "arthroscopy" OR "arthroscopic-assisted reduction and internal fixation". Studies were limited to English publications with reported functional outcome measures and complications. Patient demographic characteristics, clinical outcomes including range of motion, outcome performance scores including ROWE score, visual analogue scale and American shoulder and elbow surgeons score and complications were extracted. Five studies met the inclusion criteria. The participants ranged in age from 41 to 48, and the mean length of follow-up ranged from 12 to 41 months postoperatively. The mean ROWE scores for the ARIF group were significantly better postoperatively. ARIF allows accurate diagnosis of the fracture pattern and associated injuries, in addition to representing a safe option to treat glenoid fractures with or without scapular fractures with fewer complications compared to ORIF. Level of Evidence: Level IV, Systematic review.