Journal of Experimental Orthopaedics最新文献

Purpose

Hip arthroscopy (HAS) evidence has expanded rapidly, but methodological quality and conclusions vary. This umbrella review of contemporary meta-analyses published January 2020–October 2025 aimed to (i) identify eligible reviews, (ii) appraise methodological quality (AMSTAR 2) and review-level risk of bias (ROBIS), (iii) quantify evidence overlap (corrected covered area, CCA) and (iv) map concordance of conclusions.

Methods

We searched PubMed/MEDLINE, Embase and Epistemonikos (2020–2025) for human HAS meta-analyses with quantitative synthesis on clinical effectiveness and safety. Two reviewers independently screened records and extracted data (consensus/third-reviewer adjudication). Quality was assessed with AMSTAR 2, risk of bias with ROBIS, and evidence overlap with CCA. No re-pooling of primary data.

Results

From 5940 records, 44 meta-analyses were included. AMSTAR 2 confidence was predominantly weak (≈7% high, 5% moderate; most critically low); ROBIS was low risk in just over half. Overlap was slight (low redundancy). Across randomised/comparative syntheses, HAS yielded superior short-term improvements versus best-practice nonoperative care—most consistently for iHOT-33 at ~8–12 months—attenuating by ~24 months and not uniformly meeting MCIDs. Limited long-term data suggest less radiographic osteoarthritis progression versus nonoperative care. Versus open procedures, functional outcomes were similar with fewer complications after HAS. Return-to-work was ~71% at ~115 days, return-to-sport was high (elite ~94% at ~6–7 months; broader cohorts ~89%). More recent evidence increasingly favours capsular closure and labral repair. Preoperative intra-articular injection ≤3 months before HAS was associated with higher infection risk.

Conclusion

Evidence supports short-term benefits and a good safety profile for HAS, yet certainty remains limited. Prioritise patient selection and standardised rehab; high-quality long-term studies are needed.

Level of Evidence

Level I, systematic umbrella review of meta-analyses on hip arthroscopy.

Purpose

To investigate the association between anterior cruciate ligament (ACL) remnant morphology, classified by Crain, and preoperative rotational knee instability after adjusting for preoperative and anatomical factors including time from injury to surgery and meniscal status. It was hypothesised that remnant morphology would be associated with rotational knee instability.

Methods

This retrospective multicenter cohort study was conducted between October 2022 and June 2025. Arthroscopic assessment categorised ACL remnants according to the Crain classification. Under anaesthesia, the Lachman and pivot-shift tests were graded and dichotomised as high-grade or low-grade. Univariate comparisons were performed using the chi-square test. Multivariate logistic regression identified predictors of high-grade Lachman (L-HG) and pivot-shift (PS-HG), adjusting for age, sex, body mass index, time from injury to surgery, mechanism of injury, Tegner Activity Scale (TAS) score, and medial and lateral meniscal tears, with Crain Type 4 as the reference.

Results

Among 304 patients, Crain types were as follows: Type 1 (16.8%), Type 2 (40.8%), Type 3 (27.6%) and Type 4 (14.8%). Overall, L-HG and PS-HG occurred in 36.8% and 39.8% of patients, respectively. L-HG did not differ among the Crain groups (p = 0.081), whereas PS-HG did (p = 0.016). In multivariate analysis, TAS score (odds ratio [OR] per unit, 0.83; 95% confidence interval [CI], 0.70–0.98; p = 0.028) and lateral meniscal tear (OR, 2.16; 95% CI, 1.31–3.58; p = 0.003) were significant predictors of L-HG. For PS-HG, Crain Type 3 had lower odds compared with Type 4 (OR, 0.43; 95% CI, 0.19–0.99; p = 0.048).

Conclusions

Crain remnant morphology was associated with rotational instability, with Type 3 demonstrating lower odds of high-grade pivot shift than Type 4. These findings suggest that ACL remnant morphology may play a role in rotational instability.

Level of Evidence

Level IV, cohort study.

Purpose

Traumatic open book injuries of the pubic symphysis require stable fixation while minimizing surgical morbidity. Traditional symphyseal plating is associated with complications such as implant failure and infections. This study aims to evaluate the biomechanical performance of a novel minimally invasive technique using an internal fixator (IF) compared to conventional plating (symphyseal locking dynamic compression plate [SLDCP]) in human cadaveric pelvises.

Methods

Ten human cadaveric pelvises were assigned to two groups (n = 5 each). After anatomical reduction, either SLDCP or IF stabilization was applied. Intrasymphyseal compression forces, contact area and interfragmentary motion were assessed using pressure-sensitive sensor films and an optical tracking system under incrementally applied axial loads up to 600 N. Bone density and symphyseal dimensions were measured and were comparable across both groups.

Results

At key loading stages (400 and 600 N), the IF group demonstrated significantly higher intrasymphyseal compression forces (IF 61.78 ± 31.98 N vs. SLDCP 15.98 ± 8.2 N at 400 N and IF 42.82 ± 25.2 N vs. SLDCP 9.42 ± 5.81 N at 600 N) and larger contact areas (IF 453 ± 137.6 mm² vs. SLDCP 216 ± 135 mm² at 400 N and IF 337.6 ± 168.45 mm² vs. SLDCP 154 ± 59.73 mm² at 600 N), with more homogeneous segmental force and area distributions. Higher compression forces, particularly in the caudal symphyseal region (IF 23.68 ± 18.69 N vs. SLDCP 13.78 ± 10.1 N), were achieved. Three-dimensional analysis showed reduced fragment displacement in the IF group under load.

Conclusion

The proposed technique using an internal fixator provided superior biomechanical stability compared to standard plating, offering a promising minimally invasive alternative for managing open book injuries. The technique facilitates uniform force transmission and improved contact conditions, which may enhance healing and reduce complications.

Level of Evidence

N/A.

The integration of artificial intelligence (AI), the rise of mega-journals, and the manipulation of impact factors present challenges to scientific integrity. These trends threaten the core principles of objectivity, reproducibility, and transparency. This editorial highlights two categories of threats: (1) external pressures, such as AI misuse and metric-driven publishing models, and (2) internal systemic flaws, including the ‘publish or perish’ culture and methodological fragility. Mega-journals, characterized by high-volume publishing and broad interdisciplinary scopes, improve accessibility and accelerate dissemination. However, the emphasis on publication volume might weaken the rigor of peer review. To navigate these challenges, the authors propose a balanced approach that harnesses innovation without compromising scientific integrity. Proposed solutions include mandating AI transparency through frameworks like CONSORT-AI, and redefining impact metrics to emphasize reproducibility, mentorship, and societal impact alongside citations. Scientific journals should promote career opportunities less on publication quantity and more on quality. Global cooperation, via initiatives like the San Francisco Declaration on Research Assessment (DORA) and the Committee on Publication Ethics (COPE), is essential to standardize ethics and address resource disparities. This editorial proposes solutions for researchers, journals, and policymakers to realign academic incentives and uphold the ethical foundation of the science. By fostering transparency, accountability, and equity, the scientific community can preserve its ethical foundations while embracing transformative tools—ultimately advancing knowledge and serving society.

Level of Evidence

Level V.

Purpose

Anterior cruciate ligament (ACL) injuries have consistently been linked to specific kinetic and kinematic patterns, including elevated vertical ground reaction forces, increased knee abduction angle and moment (dynamic valgus), reduced knee flexion during landing and excessive hip adduction/internal rotation. However, the relationship between motor competence as a factor affecting athletes' performance and kinetic and kinematic variables has not yet been investigated.

Methods

A total of 112 elite athletes (66 males and 46 females; mean age = 19.4 ± 1.1 years) from basketball, volleyball and handball were assessed. Motor competence was evaluated using the short form of the Bruininks–Oseretsky Test of Motor Proficiency. Biomechanical data were collected during a single-leg drop landing task using a three-dimensional motion analysis system (Vicon) and a force plate. Pearson correlation coefficients and multiple linear regression (Enter method) were used to analyse relationships between motor competence and kinetic/kinematic variables.

Results

All biomechanical variables showed significant correlations with motor competence (p < 0.001). Notably, knee flexion angle (r = 0.613) and knee abduction angle (r = −0.576) demonstrated strong associations. Regression analysis identified several biomechanical variables that were statistically associated with motor competence, explaining 69.6% of its variance.

Conclusion

Motor competence was related to several kinetic and kinematic variables previously linked to ACL injury risk. However, due to the cross-sectional design, these associations should not be interpreted as causal, and further longitudinal or interventional studies are warranted.

Level of Evidence

Level IV, cross-sectional study.

Purpose

To explore the results of a fluoroscopic-guided intra-osseous (IO) and intra-articular (IA) injection of expanded adipose-derived stromal cells (ASCs) in athletes with bone marrow lesions (BML) associated with knee osteoarthritis (OA).

Methods

A prospective study was conducted on 16 athletes (9 males, 7 females; mean age 30.5 ± 2.8 years), including two with bilateral knee involvement. All had Kellgren-Lawrence grades 2–4 and received IA and IO injections of 24.3 ± 2.1 million and 23.4 ± 1.9 million ASCs, respectively. Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Numeric Pain Rating Scale (NPRS), and Tegner activity scale at baseline, 6 months, and 12 months. Radiological changes were evaluated using Magnetic Resonance Imaging Osteoarthritis Knee Scores (MOAKS) at baseline and 12 months.

Results

Significant improvements were observed in NPRS, Tegner, and all KOOS subscales at 6 months and 12 months with respect to baseline (p < 0.05). At 12 months, NPRS decreased from 6.6 ± 0.9 to 2.4 ± 0.5, and Tegner increased from 4.4 ± 1.8 to 7.8 ± 1.1. All KOOS subscale scores improved at 12 months. Symptoms: 49.3 ± 6.4 to 74.1 ± 4.9; pain: 49.4 ± 4.3 to 75.8 ± 3.2; sport and recreation: 30.6 ± 6.2 to 67.8 ± 4.3; activities of daily living: 57.6 ± 3.6 to 79.9 ± 4.8; and quality of life: 35.4 ± 10.3 to 66.3 ± 5.3. A mild decline yet significant in the KOOS sport and recreation subscale was noted between 6 and 12 months (p = 0.02), but remained significantly improved from baseline. MOAKS analysis showed improvement in 12 of 27 evaluated regions. No major complications occurred.

Conclusions

Combined IA and IO ASC injections are a safe and effective treatment for OA-BMLs in athletes, offering sustained clinical and radiological benefits over 12 months.

Level of Evidence

Level III.

Purpose

To evaluate whether a high lateral distal femoral angle (LDFA) contributes to undercorrection of lower-limb alignment following medial open wedge high tibial osteotomy (MOWHTO), and to determine the LDFA threshold above which tibial correction alone may be insufficient.

Methods

This retrospective study analysed 68 patients who underwent MOWHTO at our hospital between 2020 and 2022. Based on their postoperative mechanical axis (MA), patients were categorised into two groups: the acceptable correction group (A-group; MA 57%–67%) and the undercorrection group (U-group; MA ≤ 56%). Radiographic parameters before and after surgery were compared between the two groups. Simple and multiple regression analyses were used to identify factors affecting postoperative MA. A receiver operating characteristic (ROC) curve was utilised to identify the LDFA cut-off value associated with undercorrection.

Results

A total of 54 patients met the inclusion criteria (A-group, n = 35; U-group, n = 19). The U-group demonstrated a significantly higher preoperative mechanical LDFA (89.5° vs. 87.6°, p = 0.001) and a lower medial proximal tibial angle (mMPTA) (84° vs. 86°, p = 0.014) than that in the A-group. Both mLDFA (p = 0.006) and mMPTA (p = 0.010) were independent predictors of postoperative MA in multiple regression analysis. The ROC analysis identified an LDFA cut-off of 89.2° for predicting undercorrection (area under the curve = 0.78; sensitivity, 36.8%; specificity, 88.6%). Patients with an LDFA ≥ 89.2° had significantly higher body mass index, joint line convergence angle, varus stress angle, percentage condylar tibial translation and preoperative knee joint line obliquity.

Conclusions

A high LDFA (≥89.2°) is associated with an increased risk of undercorrection after MOWHTO, despite accurate tibial correction. These findings suggest that in cases with significant distal femoral varus, isolated tibial osteotomy may be insufficient. Double-level osteotomy, including femoral correction, should be considered in such cases to achieve optimal alignment.

Level of Evidence

Level Ⅳ, retrospective comparative study.

Purpose

The primary aim was to study the impact of joint line obliquity (JLO) on clinical outcomes and survivorship in patients undergoing total knee arthroplasty (TKA) after a previous high tibial osteotomy (HTO). The secondary aim was to study how maintaining neutral JLO at both HTO and TKA affected clinical outcomes of TKA.

Methods

A retrospective review of patients undergoing TKA following valgus-producing HTO, having a minimum 1-year follow-up, was performed. Using the coronal plane alignment of the knee (CPAK) classification, three groups of JLO were formed: distal JLO (<177°), neutral JLO (177–183°) and proximal JLO (>183°). Clinical outcomes were assessed using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). The level of significance was 0.05.

Results

The study included 110 TKA (mean follow-up: 5.8 years). Prevalence of a proximal JLO post-TKA was higher (p < 0.05) in those with a proximal JLO pre-TKA (40%) as compared to those with a neutral JLO pre-TKA (13%). The odds ratio of having a proximal JLO post-TKA was 4 (95% confidence interval: 1.4–11.1, p < 0.05) in those having a proximal JLO pre-TKA. Revision rate in the proximal JLO post-TKA, neutral JLO post-TKA and distal JLO post-TKA groups was 20%, 8% and 4% respectively, with no statistical difference (p > 0.05). Post-TKA, the stiffness, function and total WOMAC were significantly better (p < 0.05) in patients with a neutral JLO pre-TKA and neutral JLO post-TKA as compared to those with a proximal JLO pre-TKA and proximal JLO post-TKA or a proximal JLO pre-TKA and neutral JLO post-TKA.

Conclusion

While a proximal JLO after conversion TKA did not show a statistically higher revision rate, maintaining a neutral JLO during HTO and at the time of subsequent TKA was associated with higher post-operative clinical scores. However, further research in different and larger populations is needed to confirm these findings.

Level of Evidence

Level IV.

Purpose

To assess the mid- to long-term clinical and functional outcomes and return to sports following derotational distal femoral osteotomy (DDFO) for the treatment of recurrent patellofemoral instability and associated increased femoral antetorsion.

Methods

Patients who underwent DDFO as well as concomitant procedures between 2007 and 2016 were eligible for inclusion. Recurrent instability, complications, revision surgery and return to sports rates were evaluated after a minimum follow-up of 5 years. Kaplan–Meier survival analysis was performed for the risk of recurrent instability or undergoing further surgery other than hardware removal. Patient-reported outcome measures (PROMs; Visual Analog Scale [VAS] for pain, Tegner Activity Scale [TAS], Kujala score, Banff Patellofemoral Instability Instrument [BPII] 2.0 and Patellofemoral Instability-Return to Sport after Injury [PFI-RSI] scale) were recorded.

Results

Of 44 knees in 42 patients eligible for inclusion, 25 knees in 24 patients (64% female) with a mean age of 27.3 ± 9.0 years at the time of surgery were available for follow-up at a mean of 8.7 ± 2.7 years (follow-up: 57%). Two patients (5%) underwent early revision surgery due to loss of osteosynthesis at the distal femur. Three patients (12%) reported subjective recurrent instability at a median of 3.9 (3.5–7.0) years post-operatively. The Kaplan–Meier estimator showed a survival probability free of recurrent instability and revision (except hardware removal) of 87% (95%-confidence interval 76%–100%) at 5 years. At final follow-up, patients reported good knee function (Kujala score: 78.5 ± 16.6), knee-related quality of life (BPII: 68.3 ± 22.3), psychological readiness to return to sport (PFI-RSI: 73.3 [43.8–90.0]), and moderate activity levels (TAS: 4.0 [3.0–4.0]). The majority of patients returned to sports (84%).

Conclusion

DDFO provided effective treatment for recurrent patellofemoral instability associated with increased femoral antetorsion. Favourable clinical and functional outcomes as well as high return to sport rates were observed at a mid- to long-term follow-up.

Level of Evidence

Level IV, retrospective case series.