Orthopedics最新文献

Background: There is a high correlation between hallux valgus and pes planus deformity. We sought to evaluate the outcomes of simultaneous Scarf osteotomy and extraosseous talotarsal stabilization (EOTTS) for correcting adult hallux valgus with flexible pes planus deformity.

Materials and methods: This retrospective study enrolled patients who had hallux valgus deformity with flexible pes planus and underwent combined Scarf osteotomy and EOTTS from January 2018 to October 2021. The hallux valgus angle (HVA), intermetatarsal angle (IMA), Meary's angle, calcaneal pitch, and lateral talocalcaneal angles were assessed preoperatively and at 1-year follow-up. Clinical outcomes were evaluated using the visual analog scale (VAS) score for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score, and the Maryland foot score (MFS). Complications were recorded.

Results: This study included 25 patients, 19 women and 6 men, with a mean age of 44.3 years. The mean follow-up period was 14.6 months. The mean HVA, IMA, Meary's angle, calcaneal pitch, and lateral talocalcaneal angles improved significantly at 1-year follow-up (P<.001). The mean VAS score decreased from 5.8 to 1.0, whereas the mean AOFAS forefoot score and MFS increased from 52.3 to 88.9 and 61.2 to 89.3, respectively, at 1-year follow-up (P<.001). Two patients had arthroereisis implant removal as a consequence of sinus tarsi pain. No other complications were seen during the follow-up.

Conclusion: Management of hallux valgus with flexible pes planus deformity with combined Scarf osteotomy and EOTTS can achieve satisfactory clinical and radiologic results with low complication and recurrence rates. [Orthopedics. 2025;48(1):37-43.].

Background: The purpose of this study was to evaluate changes in open carpal tunnel release (OCTR) and endoscopic carpal tunnel release (ECTR) utilization, reimbursement, and patient demographics in the Medicare population from 2013 to 2021 at national and regional levels.

Materials and methods: The Medicare Physician & Other Practitioners database from 2013 to 2021 was queried to extract all instances of OCTR and ECTR. Utilization per 10,000 beneficiaries, inflation-adjusted reimbursement, and patient characteristics were extracted for OCTR and ECTR each year. Data were stratified by region based on US Census guidelines. Kruskal-Wallis tests and multivariable linear regressions were performed.

Results: From 2013 to 2021, national utilization per 10,000 beneficiaries increased by 6% for OCTR and by 50% for ECTR. In 2021, the Midwest had the greatest utilization of OCTR (29 of 10,000) and the lowest utilization of ECTR (7 of 10,000). Inflation-adjusted reimbursement declined for both OCTR and ECTR during the study period (10.3% and 11.8%, respectively), with the South having the lowest reimbursement for both procedures. The severity of patient comorbidity profiles and dual Medicare-Medicaid enrollees decreased for both procedures as well.

Conclusion: Both OCTR and ECTR utilization have increased, while inflation-adjusted reimbursement has decreased. Patient populations encompassed fewer dual Medicare-Medicaid enrollees, indicating surgeons may be more selective in operative indications. These findings should be addressed to ensure the economic sustainability of carpal tunnel release procedures and equitable access to quality hand care for all patients with Medicare. [Orthopedics. 2025;48(1):e45-e51.].

Background: Despite most patients reporting optimal knee function after anterior cruciate ligament reconstruction (ACLR), not all return to their pre-injury level of sport, often due to psychological factors. The ACL-Return to Sport after Injury Scale (ACL-RSI) was developed to measure the emotions, confidence in performance, and risk appraisal among athletes returning to sport. The purpose of this study was to determine the Patient Acceptable Symptom State (PASS) threshold for the ACL-RSI in patients undergoing ACLR.

Materials and methods: Patients with an ACL injury that required surgical reconstruction were included in this prospective study. All patients underwent ACLR with a bone-patellar tendon-bone autograft and completed the ACL-RSI 12 months postoperatively. An anchor-based approach was used to generate a receiver operating characteristic curve and establish the PASS threshold. Multivariable regression analyses were used to evaluate the effect of age, sex, and baseline score on likelihood of achieving PASS.

Results: A total of 113 patients (37% female) with a mean age of 28.1±8.2 years and a mean body mass index of 24.7±3.5 kg/m² were included. At 12 months postoperatively, the threshold value for the PASS of the ACL-RSI was 40 (robust area under the curve: 0.89; sensitivity: 81%; specificity: 85%). Baseline score, sex, and age had no significant influence on achieving PASS at 12 months postoperatively.

Conclusion: In a group of patients undergoing ACLR with bone-patellar tendon-bone autograft, the PASS threshold value was 40 for the ACL-RSI at 12 months postoperatively. The PASS value for the ACL-RSI established from this study can be useful for designing future clinical trials. [Orthopedics. 2025;48(1):20-24.].

Background: Unilateral biportal endoscopic laminotomy (UBE) and percutaneous endoscopic laminotomy (PEL) are minimally invasive spinal surgery (MISS) techniques used for unilateral and dual-channel endoscopic laminectomy. However, limited research has been conducted on lumbosacral multifidus muscle injuries in elderly individuals undergoing MISS for lumbar spinal canal stenosis. The objective of this study was to investigate the impact of single-channel and double-channel MISS on the multifidus muscle in elderly patients.

Materials and methods: A total of 107 patients who underwent MISS were stratified into two cohorts: group A (<65 years) and group B (≥65 years). Preoperative imaging data, including magnetic resonance imaging, were gathered to classify the degree of stenosis based on the nerve root compression. The extent of multifidus muscle atrophy and fat infiltration was assessed by calculating the fat-free cross-sectional area (FCSA)/cross-sectional area (CSA) ratio before and after surgery through measurements of CSA and FCSA. Total cross-sectional area/FCSA were calculated using MRI cross-sectional T2WI.

Results: The degree of atrophy and fat infiltration did not change between procedures in group A (P>.05), but changed significantly in group B (P<.05).

Conclusion: Unilateral single-channel and double-channel surgery had no significant effect on the degree of multifidus muscle atrophy and fat infiltration in patients younger than 65 years. However, in patients 65 years and older, the degree of multifidus muscle atrophy and fat infiltration significantly increased with the increasing incidence of lateral recess stenosis, which was positively correlated with the duration of surgery. [Orthopedics. 2025;48(1):12-19.].

Background: Most olecranon fractures are intra-articular, affecting the extensor mechanism of the elbow, and are treated surgically with dorsal plate fixation or tension band. Due to shortcomings of dorsal plates related to prominence, insufficient fixation of sagittal fracture lines, and difficulty matching proximal ulna dorsal angulation (PUDA), dual medial and lateral plating (DP) has been developed. We hypothesized that olecranon fractures treated with DP would have low complication rates and low incidence of hardware removal compared with those treated with traditional methods of fixation.

Materials and methods: The database of a single institution was reviewed for the period January 2017 to April 2023 for adults with olecranon fractures receiving DP fixation. Open fractures, fracture dislocations, previous elbow injuries, and pathologic fractures were excluded. Demographics, pre- and postoperative imaging, reoperations, and range of motion were collected. PUDA and varus angulation measurements, intra-articular step off, and fracture distraction were recorded.

Results: A total of 42 fractures in 41 patients were reviewed. Mean follow-up was 8.7 months (range, 3-36 months). One patient reported symptomatic hardware at 6 weeks that had resolved by 3 months, and 1 reported persistent symptomatic hardware not bothersome enough to warrant removal. Five patients (11.9%) had at least 1 postoperative complication. The hardware removal rate was 2.4%.

Conclusion: DP for olecranon fractures represents a valuable strategy in fracture treatment. We report a low hardware removal rate of 2.4%, with removal being done for infection, not symptomatic hardware. DP provides a reliable method of fixation, helps re-create native anatomy, and has a low complication rate compared with standard dorsal plating. [Orthopedics. 2025;48(1):30-36.].

Background: This study sought to characterize the incidence of, timing of, predictive factors for, and reasons for emergency department (ED) visits within 90 days of single-level posterior cervical foraminotomy (PCF). These visits, after PCF, have received limited attention.

Materials and methods: The 2010-2022 M161 PearlDiver database was queried for elective single-level PCFs, excluding multilevel procedures, midline laminectomies, fusions, or other posterior/anterior procedures, as well as indications of trauma, infection, or neoplasm. Patient age, sex, Elixhauser Comorbidity Index (ECI), insurance, and region were extracted. Weekly ED use after PCF was calculated. Multivariate analyses were used to identify predictive factors for ED use, and primary ED diagnoses were categorized.

Results: Of 10,588 PCF patients, 9.09% (n=962) visited the ED within 90 days after surgery, mostly in the first 4 weeks. Multivariate analysis identified that predictors included younger age (odds ratio [OR], 1.02 per decade decrease), female sex (OR, 1.19), higher ECI (OR, 1.28 for ECI 1-2; OR, 1.41 for ECI 3-4; OR, 1.51 for ECI ≥5), Midwest (OR, 1.16) or Northeast (OR, 1.19) region, and Medicare (OR, 1.09) or Medicaid (OR, 1.57) coverage. In the first 4 weeks, 69.9% of ED visits were related to the surgical site; this decreased to 27.1% thereafter.

Conclusion: Almost one-tenth of PCF patients visited the ED within 90 days after surgery. Specific patient characteristics were associated with ED visits, with surgical site-related diagnoses predominating in the acute postoperative period. Tailoring health care interventions based on timing of, risk factors for, and causes of ED visits may enhance outcomes and reduce costs. [Orthopedics. 2025;48(1):51-56.].

Background: Failure after rotator cuff repair is typically due to a loss of integrity of the bone-tendon interface. The BioWick anchor (Zimmer-Biomet) is an interpositional scaffold-anchor that was developed to improve tendon-bone healing. The purpose of this study was to determine the clinical efficacy of this novel anchor compared with a standard anchor with respect to retear rates and patient outcomes.

Materials and methods: We enrolled 99 patients in a double-anonymized, prospective, randomized controlled trial who underwent rotator cuff repair. Fifty patients were randomized to the novel anchor group and 49 patients were randomized to the standard anchor group. The primary outcome was rotator cuff repair integrity assessed via ultrasound at 6 months postoperatively. Secondary outcomes included visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), strength, and active range of motion (AROM) assessed preoperatively and postoperatively at 3 and 6 months.

Results: There were no statistically significant differences in demographic data, mean rotator cuff tear size, tobacco use, workers' compensation status, or operative side between the groups. At 6-month follow-up, the retear rate was 22% (n=9) for the novel anchor group vs 23% (n=10) for the standard anchor group (P=.8864). Secondary outcomes, including VAS pain score, ASES score, SST, strength, and AROM measurements, did not differ significantly between the groups at 3- or 6-month follow-up. There were no complications identified in either group.

Conclusion: This study did not demonstrate superior clinical improvements or decreased retear rates with the use of this novel anchor compared with a standard anchor. [Orthopedics. 2025;48(1):e33-e39.].

Background: Prior work has demonstrated that telemedicine in orthopedic surgery is cost-effective and can yield good clinical outcomes with high patient satisfaction. However, few studies have investigated the use of telemedicine in orthopedic oncology. In this study, we assessed the effect of telemedicine on (1) potential cost savings for orthopedic oncologic patients and (2) clinical outcomes as measured by unexpected in-person clinic visits and missed complications.

Materials and methods: A total of 308 patients who had 528 telemedicine visits in the orthopedic oncology clinic from May 2020 to August 2023 were identified. Demographic and clinical information, travel distance/time to clinic, complications, and instances where a telemedicine visit prompted an in-person evaluation were collected and reported with descriptive statistics. Cost savings were calculated based on travel distance and lost productivity. Patients with and without a complication or an unexpected in-person clinic visit were compared to identify risk factors for these clinical outcomes.

Results: Cost analysis demonstrated that telemedicine offers patients a potential cost savings of up to $475.2±$242.9 per visit. For 4.5% of the patients, a telehealth visit prompted an in-person evaluation. A complication was experienced by 5.5% of the patients. No complications were missed because of telemedicine. A diagnosis of a malignant tumor was associated with a higher rate of complications (P=.01) and unexpected in-person clinic visits (P=.03).

Conclusion: Telemedicine can reduce the financial burden of treatment for orthopedic oncologic patients without negatively impacting clinical outcomes. Care should be taken when considering telehealth for patients with malignant tumors given their higher risk for adverse outcomes. [Orthopedics. 2025;48(1):e27-e32.].

Background: Given the significant morbidity and mortality associated with primary bone cancer, provision of high-quality end-of-life care concordant with patient preferences is critical. This study aimed to evaluate trends in use of dedicated end-of-life care settings and investigate sociodemographic disparities in location of death among individuals with primary bone cancer.

Materials and methods: A retrospective, population-based review of patients who died of primary bone cancer-related causes was performed using the Underlying Cause of Death public use record from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (WONDER) database for the years 2003 through 2019. A total of 24,557 patients were included.

Results: Over the study period, the proportion of primary bone cancer-related deaths occurring at home and in hospice increased, whereas those occurring in hospital, nursing home, and outpatient medical facility/emergency department settings decreased. Several sociodemographic factors were found to be associated with location of death, including age, marital status, and level of education. Moreover, patients of racial and ethnic minority groups were at significantly lower risk of experiencing death at home or in outpatient medical facility/emergency department settings relative to a hospital compared with White patients.

Conclusion: Although rates of in-hospital death from primary bone cancer are decreasing, marked racial and ethnic disparities in use of dedicated end-of-life care settings exist. These gaps must be addressed to ensure all patients with primary bone cancer have equitable access to high-quality end-of-life care regardless of racial, ethnic, or socioeconomic status. [Orthopedics. 2025;48(1):44-50.].