Orthopedic Reviews最新文献

Some researchs have shown a positive correlation between hand grip strength and bone mineral density(BMD), but they lack comprehensiveness. In this study, we adjusted for body mass index and analyzed the association between relative grip strength index(RGSI) and trunk bone BMD (TBBMD). # Materials and methods Of 19,931 initial participants, 5,764 adults (aged ≥20 years) with complete TBBMD, grip strength, and BMI data were analyzed. Covariates included gender, age, weight, height, BMI, marital status, family income to poverty ratio (FIR), education level, alcohol, activity, total cholesterol, vitamin D, hypertension, diabetes, cancer, smoke, and sleep status. Missing values were imputed, and RGSI was calculated. Statistical analyses included baseline characteristics, regression, and nonlinear modeling. # Results Analysis of Participants (mean age 39.006 ± 11.545 years; 52.186% male) revealed a positive RGSI-TBBMD association. TBBMD increased across RGSI quartiles (Q1:0.864±0.102 vs. Q4:0.941±0.122, P<0.001). Multiple regression confirmed strong associations in unadjusted (β=0.033, 95% CI[0.029, 0.036], P<0.00001), gender and age adjusted (β=0.013, 95% CI[0.009, 0.017], P<0.00001), and fully adjusted models (β=0.035, 95%CI[0.030, 0.041], P<0.00001). The association was stronger in women (β=0.050) than men (β=0.032). Generalized additive models revealed inverted U-shaped relationships in total variable (inflection RGSI=4.935), males (4.999), females (3.088), age≤30 (4.975), and vitamin D Q4 (4.458), with negative associations above inflection points (all P<0.05). Participants >30 had an approximately linear positive associations. # Conclusion An elevated RGSI was significantly associated with higher TBBMD levels. Collectively, this study highlights the importance of RGSI in assessing TBBMD.

This bibliometric analysis investigates global research trends in anterior cruciate ligament (ACL) injury prevention and treatment by evaluating 4,086 articles indexed in the Web of Science Core Collection from 1985 to June 18, 2025. The top funding agencies of ACL research showed governmental-linked institutions from the United States, the People's Republic of China, and Japan supporting a substantial part of ACL literature. Keyword emphasis on surgical methods was evident in the indexed literature on ACL. Continued research towards improving surgical methods will prevent retear, assist in more efficient recovery, and better long-term outcomes for the patient.

Background: Massive irreparable rotator cuff tears are a significant challenge for shoulder function, with tendon transfers emerging as potential solutions.

Objective: This systematic review aims to comprehensively evaluate the current evidence on the outcomes of lower trapezius transfer for the treatment of massive rotator cuff tears.

Methods: This systematic review examines the use of trapezius transfer in managing these tears. Following PRISMA guidelines, a search of Medline, Embase, and Cochrane was conducted through March 2024 for studies on trapezius tendon transfer.

Results: The review analyzed data from 214 patients (161 males, 53 females) with an average age of 58 years (range: 31-73 years), focusing on surgical technique, complications, follow-up duration, and outcomes. Most procedures utilized an Achilles allograft, with reported complications including retear rates of 7.5% and surgical infections in 2.3% of cases. The average follow-up was 38.4 months, with 80% to 100% of patients returning to previous activity levels.

Conclusion: This review highlights the effectiveness of lower trapezius tendon transfer, particularly using an Achilles allograft, in enhancing pain relief, shoulder mobility, and overall function. Despite some complications, the high return-to-activity rate underscores the procedure's utility in restoring normalcy and productivity for patients with massive rotator cuff tears. Future research should aim to standardize operative and postoperative protocols to optimize outcomes and reduce complications.

Anterior cruciate ligament (ACL) is vital for knee joint stability, and its rupture is a common injury, especially among athletes in high-demand sports involving pivoting and jumping. ACL reconstruction using grafts-autografts or allografts-is the standard treatment to restore knee function. However, graft healing within the bone tunnel is complex, involving coordinated molecular and cellular events across inflammatory, proliferative, and remodeling phases. During the inflammatory phase, immune cells like neutrophils, macrophages, and lymphocytes infiltrate the injury site, releasing pro-inflammatory cytokines (IL-1β, TNF-α, IL-6) that initiate the healing cascade via pathways such as NF-κB. The proliferative phase features fibroblast and mesenchymal stem cell (MSC) activity, synthesizing extracellular matrix (ECM) components like type III collagen under the influence of growth factors (TGF-β, PDGF, bFGF) and promoting angiogenesis through VEGF. In the remodeling phase, tissue maturation occurs with the replacement of type III collagen by type I collagen, enhanced by matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs), and alignment of collagen fibers facilitated by mechanotransduction pathways involving integrins and focal adhesion kinase (FAK). Early mechanical loading plays a critical role by activating mechanosensitive receptors, leading to the upregulation of anabolic growth factors (IGF-1, PGE2) and promoting cellular responses that enhance graft integration, collagen fiber alignment, and biomechanical properties. Understanding the optimal timing, intensity, and type of mechanical loading is essential for developing effective rehabilitation protocols. Personalized rehabilitation strategies that consider patient-specific factors-such as age, activity level, genetic predispositions (e.g., variations in COL1A1, COL5A1, IL-6, TNF-α genes), and graft type-can optimize healing outcomes. Integrating molecular biology insights with mechanical loading approaches holds promise for improving ACL reconstruction success rates, reducing recovery times, and minimizing complications. Future research should focus on identifying novel molecular targets and signaling pathways (e.g., Wnt/β-catenin) involved in graft healing. Combining mechanical loading with biological augmentations-such as growth factors, stem cells, or gene therapy-may lead to synergistic therapies that further enhance graft integration and functional recovery.

Background: There is relatively little literature into the cost of treating diaphyseal femur fractures in paediatric population. This study aims to determine the cost of managing paediatric diaphyseal femur fractures in a South African Academic Hospital.

Objective and methods: We conducted a retrospective study using prospectively collected data on paediatric diaphyseal femoral fracture treatment at our public academic hospital over a four-month duration. The study included patients who were between 2 years and 14 years of age and excluded those with femur fractures caused by pathological or atypical factors. The following costs were reviewed: emergency department, inpatient admission, anaesthesia and theatre, allied department, and radiology department.

Results: Data from 31 patients (80.6% males) with diaphyseal femoral fractures were included in the study; falls accounted for 64.5% of the injuries. The patients who underwent surgery had a mean hospital stay of 7.4 days (range:3 to 22 days), while the group that did not have surgery had a mean hospital stay of 24.1 days (range:17 to 34 days). The factors that had a greater impact on cost were the duration of the hospital stay, the cost of the implant, and the cost of the theatre. There was no statistically significant variation in the cost of emergency unit services among this group.

Conclusion: The data showed that orthopaedic surgeons need to be cognizant of the cost of treating paediatric diaphyseal femoral fractures in the current state of the economy.

Purpose: To systematically evaluate the effects of Tai Chi on bone mineral density (BMD) in lumbar spine, femoral greater trochanter, Ward's triangle, femoral neck, and calcaneus among middle-aged and older adults through a meta-analysis.

Methods: A comprehensive literature search was conducted across multiple databases, including CNKI, PubMed, Embase, Web of Science, and Cochrane Library, to identify randomized controlled trials (RCTs) investigating the impact of Tai Chi on BMD in middle-aged and older populations. The literature search covered the period from the establishment of each database to February 25, 2025. EndNote 20 was employed for literature management. The methodological quality of included studies was evaluated using the PEDro (Physiotherapy Evidence Database) scale. Heterogeneity analysis, bias assessment, and sensitivity analysis were performed on extracted data using RevMan 5.4 and Stata SE 15.0 software.

Results: 1. Seventeen randomized controlled trials (RCTs) with a total sample size of 1,253 participants (intervention group: n=675; control group: n=578) were included in the final analysis. The methodological quality of the included studies, as assessed by standardized evaluation criteria, demonstrated overall high robustness. The meta-analysis revealed statistically significant improvements in bone mineral density (BMD) at multiple skeletal sites following Tai Chi intervention: lumbar spine (WMD = 0.07, 95% CI: 0.04-0.11, p < 0.00001), greater trochanter (WMD = 0.04, 95% CI: 0.02-0.06, p < 0.00001), Ward's triangle (WMD = 0.03, 95% CI: 0.01-0.05, p = 0.007), femoral neck (WMD = 0.03, 95% CI: 0.02-0.05, p < 0.0001), and calcaneus (WMD = 5.52, 95% CI: 3.87-7.27, p < 0.00001).

Conclusion: Regular Tai Chi practice demonstrates significant improvements in bone mineral density (BMD) among middle-aged and older adults, particularly at the lumbar spine. Our meta-analysis suggests Tai Chi may serve as a viable non-pharmacological intervention for mitigating osteoporosis in aging populations. Notably, individuals aged ≥60 years exhibit more pronounced BMD enhancements when adhering to a structured regimen of ≥3 sessions/week over ≥6 months. However, rigorously designed randomized controlled trials (RCTs) are required to validate these observed benefits and systematically explore optimal Tai Chi exercise regimens for skeletal health promotion.

Background: The Latarjet technique is the gold standard for treatment of anterior shoulder instability with glenoid bone loss or hyperlaxity. Since its initial description by Latarjet in 1954, the procedure has undergone significant evolution. While existing literature describes each of the various advances and alterations in technique, there is no existing literature that describes the complete history of the Latarjet procedure.

Questions/purposes: The purpose of this study is to provide a comprehensive review of the evolution of the Latarjet procedure, while highlighting the underlying biomechanical principles of the technique.

Methods: This study was performed as a systematic review of literature aimed at characterizing the history and rationale of the open Latarjet procedure as well as its initial outcomes and its subsequent evolution of technique.

Results: Long-term studies of the open Latarjet procedure have consistently demonstrated low rates of recurrent instability, high patient satisfaction, and high rates of return to sport. Though a reliable procedure, complication rates have been reported between 7-35%. The arthroscopic Latarjet was first described in 2007 and combined the benefits of minimally invasive arthroscopic surgery with the reliability of the open procedure, though with an initial learning curve. Finally, Boileau et al described the utilization of low-profile cortical buttons for fixation in place of the traditional screws. Subsequent analysis has demonstrated no significant biomechanical differences in the two techniques with proposed benefits of improved graft union and positioning as well as decreased rates of neurologic injury.

Conclusion: The Latarjet procedure has remained a reliable technique to address anterior shoulder instability. The initial technique has undergone several iterations in an effort to improve outcomes, minimize complications, and capitalize on the benefits of minimally invasive techniques. As technology and techniques improve, we anticipate that the all-arthroscopic Latarjet will become more commonly performed to address anterior shoulder instability.

Background: This study aimed to evaluate the early outcomes of full-endoscopic decompression using the outside-in technique via the interlaminar approach for treating lumbar spinal stenosis in Vietnamese patients.

Methods: A retrospective review was conducted on 25 consecutive patients with lumbar spinal stenosis (16 men and 9 women; mean age ± SD: 65.80 ± 8.41 years) who underwent full-endoscopic decompression. Clinical outcomes were analyzed using the Visual Analog Scale (VAS) for back and leg pain and the Oswestry Disability Index (ODI) preoperatively, immediately postoperatively, and at a three-month follow-up. The final outcome was evaluated using the MacNab criteria.

Results: Among the 25 patients, the L4-L5 level was the most common site of stenosis (17 patients, 68%), with central canal stenosis observed in 10 patients (40%). The primary causes of stenosis were hypertrophy of the facet joints combined with ligamentum flavum thickening (9 patients, 36%) and disc herniation (11 patients, 44%). Unilateral decompression was performed in 20 patients (80%), while bilateral decompression was required in 5 patients (20%). The mean operative time was 50.96 ± 16.20 minutes, and the average hospital stay was 2.13 ± 0.52 days, with no reported complications. VAS scores for back pain decreased from 7.60 preoperatively to 1.80 at 6 months, and leg pain scores from 7.20 to 1.76. The ODI improved from 76.35 preoperatively to 10.34 at 6 months. MRI results showed a significant increase in the canal cross-sectional area, from 75.78 mm² to 155.2 mm². Based on Mac-Nab criteria, 80% of patients achieved excellent results, 16% good, and 4% fair at 6 months.

Conclusions: Full-endoscopic decompression of lumbar canal stenosis demonstrates promising early outcomes. Advances in endoscopic surgical instruments facilitate decompression procedures that can be performed as effectively, if not more so, than traditional open decompression surgery.

The widespread condition Subacromial impingement syndrome (SAIS) appears among the leading causes of shoulder pain, which restrict people in their daily routine activities and diminish their quality of life. The condition specifically relates to subacromial space reduction that leads to rotator cuff damage. # Objective The study aims to determine whether particular acromion shapes and different stages of AC joint degeneration significantly contribute to the risk of developing SAIS. # Methods The retrospective study was conducted on 608 patients who underwent shoulder MRI between the period of 2017 to 2020. The Acromion type and AC joint degeneration severity were evaluated by using T1- or T2/PD-weighted MRI sequences obtained from sagittal and coronal oblique planes. # Results Type III acromion and mild AC joint degeneration were more frequently observed in SAIS patients, but these findings were not statistically significant (P-value =0.38). Results showed that supraspinatus and infraspinatus tendon pathologies together with reduced acromiohumeral distance were strongly linked to SAIS development. # Conclusion Acromion shape together with AC joint degeneration did not produce significant effects on increasing the risk of developing SAIS. However, the rotator cuff pathologies combined with reduced subacromial space act as primary causes of SAIS, additional studies are needed further for better diagnostics and treatment strategies.

Periprosthetic femoral fractures (PFFs) are an increasingly common complication following total hip arthroplasty, especially in aging populations. This retrospective study analyzes a five-year experience at the National Scientific Center of Traumatology and Orthopedics in Astana, Kazakhstan, using a domestically developed anatomically contoured locking plate for surgical fixation. Thirty-eight patients were included, with the majority being elderly females. The most common fracture locations were the femoral shaft and distal femur. All patients underwent open reduction and internal fixation with the national plate system. No in-hospital complications, reoperations, or mortality were recorded. Clinical improvement at discharge was observed in all cases. ICU admission decreased over time, and the average hospital stay was significantly longer in patients aged ≥70 years. The plate's design enabled bicortical fixation around existing femoral stems, and the system demonstrated excellent short-term outcomes. This study supports the use of localized implant strategies in low- and middle-income countries and highlights the role of centralized surgical expertise. Further multicenter studies with long-term follow-up are recommended. Periprosthetic femoral fractures (PFFs) represent a serious complication following total hip arthroplasty (THA), particularly in elderly and osteoporotic patients. Their incidence is increasing in parallel with the global growth of primary arthroplasty procedures. In resource-limited settings, access to modular revision systems is often constrained, necessitating cost-effective and anatomically appropriate alternatives. This study aimed to evaluate the clinical characteristics, management strategies, and early outcomes of patients with PFFs treated using a domestically produced anatomically contoured locking plate at a national trauma center in Kazakhstan.