Journal of Experimental Orthopaedics最新文献

Purpose

The aim of this retrospective study was to assess the clinical outcomes for osteochondral lesions of the talus (OLT) treated with all arthroscopic autologous collagen-induced chondrogenesis (ACIC) technique using an injectable collagen scaffold combined with microfractures.

Methods

Between 2020 and 2023, 21 patients with Hepple Grade II–IV OLTs underwent arthroscopic ACIC technique using an injectable collagen scaffold combined with microfractures. Concomitant intra-articular pathologies identified during arthroscopy were addressed simultaneously. Clinical outcomes, including Visual Analogue Scale (VAS), Foot Functional Index (FFI) and Foot and Ankle Ability Measure–Sports subscale (FAAM-SS), were assessed preoperatively and at the latest follow-up. Patient expectations, complications and return-to-activity times were also recorded at final follow-up.

Results

The mean follow-up was 37.4 ± 20.7 (range, 13–68) months. The mean defect size was 76.6 ± 33.6 mm² (range, 35–135 mm²). All clinical scores significantly improved compared with preoperative values (p < 0.05): VAS improved from 3.17 ± 1.82 (95% confidence interval [CI]: 2.34–4.00) to 0.27 ± 0.48 (95% CI 0.05–0.49), FFI from 40.90 ± 25.42 (95% CI: 29.33–52.47) to 4.02 ± 3.86 (95% CI: 2.26–5.78) and FAAM-SS from 37.81 ± 28.51 (95% CI: 24.83–50.79) to 86.11 ± 13.75 (95% CI: 79.85–92.37). All patients reported that their expectations were met or exceeded regarding pain relief, functional recovery and return to daily activities. Associated intra-articular pathologies were identified in all patients; in 17 patients (80.9%), a concomitant lateral ligament injury was observed and treated with arthroscopic repair. No major complications or revision surgeries occurred.

Conclusions

Arthroscopic ACIC with an injectable atelocollagen scaffold was feasible and safe in this series of Hepple II–IV OLT, yielding improvements in patient‑reported outcomes at a mean 37.4‑month follow‑up. Due to design limitations and frequent concomitant ligament stabilization, these findings should be considered hypothesis‑generating rather than definitive evidence of cartilage regeneration.

Level of Evidence

Level IV, retrospective case series.

Purpose

Subacromial impingement syndrome (SAIS) causes shoulder pain and limitations. While corticosteroid injections are common, concerns about side effects lead to exploring alternatives like ketorolac. This trial compared the short-term effectiveness of subacromial ketorolac versus corticosteroids in SAIS patients.

Methods

This double-blind, randomised controlled trial enrolled 120 patients with clinically diagnosed SAIS. Participants were randomly assigned to receive a single ultrasound-guided subacromial injection of either ketorolac (30 mg) or methylprednisolone acetate (40 mg). The primary outcome was change in active shoulder forward flexion at 3 months. Secondary outcomes included other shoulder range-of-motion measures, shoulder abduction strength, the simple shoulder test (SST) and the Oxford shoulder score (OSS). Between-group comparisons were performed using baseline-adjusted analyses of covariance, with a noninferiority margin of −10° prespecified for the primary outcome.

Results

A total of 118 patients completed the 3-month follow-up and were included in the final analysis (two dropouts). Both groups demonstrated statistically significant improvements from baseline in shoulder range of motion, strength and patient-reported outcomes (p < 0.001). The adjusted mean difference in forward flexion between the ketorolac and corticosteroid groups was 0.07° (95% CI, −4.40° to 4.26°), meeting the prespecified criterion for noninferiority. No clinically meaningful between-group differences were observed for secondary outcomes. No injection-related adverse events were reported during follow-up.

Conclusion

Subacromial ketorolac injection produced short-term improvements comparable to those of corticosteroid injection in patients with SAIS. Ketorolac was non-inferior to corticosteroids for shoulder forward flexion at 3 months. Longer-term studies are needed to confirm these findings.

Level of Evidence

Level I.

Purpose

Reliable gait analysis is essential for clinical assessment and research. Wearable technologies such as the WalkinSense system (WSS), a wireless instrumented insole system equipped with an inertial measurement unit, enable the measurement of spatiotemporal and kinematic gait parameters in real-world settings. The accuracy of the WSS has been previously validated. This study aims to evaluate the test–retest reliability of the WSS in healthy adults walking and running under various speed and slope conditions.

Methods

Forty-nine healthy adults completed two sessions one week apart, walking and running at 3, 4.5 (−3°, −6°, +3°, +6°), 6 and 9 km/h on a treadmill. Spatiotemporal variables, including stance time, swing time, stride time, stride length, single and double support time, as well as kinematic variables such as foot ground angle at initial contact and toe-off, were recorded using the WSS. Relative reliability was assessed using intraclass correlation coefficients (ICC_2,1), while absolute reliability was evaluated using the standard error of measurement (SEM), minimal detectable change (MDC) and their percentage values (SEM%, MDC%). Bland-Altman plots were used to detect systematic bias and visualise agreement.

Results

Results demonstrated good to excellent reliability for most spatiotemporal parameters across all conditions, with ICC values ranging from 0.76–0.95, while the foot ground angles exhibited lower reliability (ICC: 0.71–0.86). SEM% and MDC% were generally below 10% for spatiotemporal measures (SEM%: 1.63–6.63; MDC%: 3.44–18.36), reflecting both low measurement error and high sensitivity to detect real changes beyond random variation. Bland-Altman analyses revealed no relevant heteroscedasticity.

Conclusion

These findings support the WSS as a reliable tool for assessing spatiotemporal variables in healthy adults across diverse walking and running conditions, underscoring its potential for use in both clinical and research environments. However, clinical studies are needed to fully establish its utility in patient assessment.

Level of Evidence

Level II, diagnostic studies.

Anterior glenoid bone loss is a critical factor in the surgical management of recurrent shoulder instability. In cases where bone loss exceeds the threshold for soft-tissue repair, bony augmentation is necessary to restore joint stability and prevent recurrence. However, there remains considerable debate regarding the optimal surgical technique and graft selection to maximise clinical outcomes and ensure long-term graft survival. The Latarjet procedure is widely performed and associated with high success rates. Nevertheless, it is not without limitations, particularly the potential for postoperative complications and inconsistent graft resorption rates. Distal tibial allograft (DTA) has emerged as a biomechanically favourable alternative. Its osteochondral surface offers a strong anatomical match for the glenoid and has shown promising clinical results. Despite its growing adoption, critical questions remain regarding long-term graft incorporation, structural remodelling, and recurrence rates. This review summarises the current evidence surrounding anterior glenoid bone augmentation techniques for shoulder instability, with a focus on graft selection, graft behaviour, and radiographic assessment. Special attention is given to the development and optimisation of DTA based on clinical outcomes and experience. Resorption patterns of the most common techniques and grafts employed, both auto- and allografts are discussed, and remodelling is defined. Understanding these remodelling patterns has practical implications for graft selection, fixation strategy, and postoperative management to optimise healing and long-term stability.

Level of Evidence

Level V.

Rotator cuff tears (RCTs) are a highly prevalent source of pain and disability. Despite advances in surgical repair techniques, high retear rates remain concerning. Biological augmentation using synthetic membranes has emerged as a promising strategy to enhance tendon regeneration and reduce the risk of repair failure. The purpose of this study is to present the currently available evidence regarding new bioinductive membranes. A narrative review of the literature was performed to identify commercially available bioinductive membranes for rotator cuff augmentation and to summarize the evidence supporting their use. Currently, there are four implants commercially available: Regeneten® (Smith & Nephew, Biobrace® (Conmed), Tapestry® (Zimmer Biomet) and Integrity® (Anika Therapeutics). These scaffolds act as bioinductive matrices, promoting new tendon-like tissue formation, intending to support the healing process and enhance the quality of the degenerative tendon, and reducing the risk of both failures at the tendon-to-bone interface and the occurrence of medial retears adjacent to the repair construct. All devices can be placed arthroscopically, although their fixation methods differ. Regeneten® has the most robust published evidence, whereas data on Biobrace® and Integrity® evidence remain limited, and no published outcomes are available for Tapestry®. Although complications are uncommon, cases of stiffness, inflammation and implant migration have been reported. Biologic augmentation with the new synthetic membranes is a promising technology that requires further attention. The use of the Regeneten implant seems to provide functional improvements in patients with partial tears and helps to avoid retears in full-thickness RCTs. The evidence for the other membranes is limited at best today.

Level of Evidence

Level V, expert opinion.

Purpose

The purpose of this study was to determine the impact of (1) healthy versus arthritic knees and (2) partial versus complete release of the superficial medial collateral ligament (sMCL) on tibiofemoral compartment pressures at varying mechanical axis alignments following medial open-wedge high tibial osteotomy (MOW-HTO).

Methods

Contact pressure (CP) was measured in seven cadaver knees (four healthy; three arthritic) under 1000 N axial load. Tests were conducted at constitutional alignment and MOW-HTO alignment corrections to 50%, 55%, 60% and 65% of the tibial plateau width (TPW) with the sMCL intact and repeated at each alignment following a partial and complete sMCL release. Linear mixed-effects models assessed differences in tibiofemoral CP with factors (1) arthritic status and alignment and (2) alignment and sMCL condition. Main effects were assessed for each factor followed by pairwise comparisons when significant.

Results

Medial CP in healthy and arthritic knees did not differ in response to varying alignment corrections (p = 0.103). The interaction of alignment and sMCL condition was not significant (p = 0.61). With the sMCL intact, altering alignment was found to significantly impact medial CP (p = 0.01). Medial CP significantly decreased from constitutional alignment to 55% and 60% of TPW by 19.0% and 13.9%, respectively (p = 0.02; p = 0.02). Additionally, medial CP at 55% of TPW was found to be 6.6% lower than at 50% of TPW (p = 0.046) and 10.4% lower than at 65% TPW (p = 0.03). sMCL release did not impact medial CP (p = 0.24) but significantly increased lateral CP by 10.8% when completely released (p < 0.001).

Conclusion

The presence of medial compartment arthritis may not be a significant factor in the loading biomechanics of cadaver knees secondary to MOW-HTO corrections. MOW-HTO correction to 55% of TPW was most effective in decreasing medial CP. sMCL release did not impact medial CP; however, it significantly increased lateral CP when the sMCL was completely released.

Level of Evidence

NA, cadaveric study.

An injury to the anterior cruciate ligament (ACL) can be sustained in sports participation during situations such as offensive cutting, landing from a jump, or defensive pressing. Despite treatment with surgical reconstruction and/or rehabilitation, only 55%–84% of patients return to sport (RTS) after treatment, and second ACL injury rates remain as high as 25% in young athletes. To reduce the risk of second ACL injury, clinicians commonly use muscle strength tests, hop tests, and patient-reported outcomes (PROs) to evaluate readiness for RTS. These tools have become central in clinical decision-making, yet significant challenges remain. Current tests typically rely on limb symmetry index (LSI) thresholds, with ≥90% LSI commonly recommended as a clearance criterion for RTS. However, these cut-offs have shown poor predictive value for second ACL injury risk and may be misleading. The LSI also fails to account for pre-injury strength, bilateral deficits, or compensatory movement strategies. Hop tests provide additional insights into explosiveness and load absorption but emphasise distance or repetitions rather than movement quality, missing key biomechanical risk factors. Similarly, while PROs aim to capture the psychological dimension of recovery, they cannot be used in isolation to determine readiness for RTS. Collectively, these evaluation tools provide only snapshots of recovery and do not adequately reflect the chaotic, multidimensional demands of sport. The research gap lies not in the absence of tests, but in their limited transferability, standardisation, and contextual relevance. Current tests should not be viewed as a simple pass-or-fail clearance point, but as guidance for informed decision-making in rehabilitation. Continuous evaluation across physical and psychological domains can help clinicians tailor progression, motivate patients, and support safer transitions toward sport. This narrative review explores the current state, limitations, and future directions of RTS testing in order the bridge the gap between clinical measures and the chaotic, high-demand realities of sport.

Level of Evidence

Level III.

Purpose

This study evaluated the comparative efficacy of two guiding devices in positioning the femoral tunnel in the ‘Isometric, Direct insertion, Eccentrically located, Anatomical, Low tension’ (I.D.E.A.L.) zone during anterior cruciate ligament reconstruction.

Methods

A retrospective analysis was conducted on 64 patients. Group A (32 cases) used traditional tools, while Group B (32 cases) used the modified locator. Postoperative three-dimensional computed tomography reconstructions of the femoral condyle were performed, and tunnel position (using the quadrant method) and the distance from the tunnel's posterior edge to the lateral condyle posterior wall were measured. Statistical analysis was performed to compare the differences between the two groups.

Results

The mean femoral tunnel centre positions were 30.3% ± 4.5% (deep–shallow) and 25.5% ± 9.6% (high–low) in Group A, and 25.9% ± 3.9% (deep–shallow) and 26.6% ± 5.8% (high–low) in Group B. The ideal I.D.E.A.L. tunnel centre was defined at (28.4, 22.2). No significant difference in dispersion was observed between the two groups. But the tunnel centre in Group B is more concentrated near the posterior region of the femoral footprint. The distance from the posterior tunnel edge to the posterior wall was 3.5 ± 1.7 mm in Group A and 2.2 ± 1.0 mm in Group B, showing a significant difference. Each group had 1 case of the posterior wall rupture; the rupture rate did not differ significantly between the groups.

Conclusion

The modified locator facilitates femoral tunnel placement closer to the posterior wall, which promotes the biomechanical conditions required for optimal graft isometry and low tension.

Level of Evidence

Level IV and V, retrospective study.