Journal of Experimental Orthopaedics最新文献

Purpose

To evaluate the validity and reliability of the French version of the Quick Foot and Ankle Ability Measure (Q‑FAAM‑F) in French‑speaking patients with chronic lateral ankle instability (CLAI).

Methods

We conducted a prospective observational cohort in a sports surgery centre with repeated assessments preoperatively, and at 3 and 6 months postoperatively; the primary analysis was cross‑sectional at 6 months. Consecutive CLAI patients undergoing anatomic lateral ankle ligament reconstruction (AALR) were included. Patients completed the Q‑FAAM‑F (12 items derived from the validated French FAAM) alongside the full FAAM, FAOS, ALR‑RSI, CAIT and VAS‑pain. Internal consistency (Cronbach's α), item–total and inter‑item correlations, and construct validity (Pearson's r) were calculated. Discriminant validity used ROC analyses for CLAI status (CAIT < 24) and return to sport (RTS), defined on the RTS continuum as return to the pre‑injury sport at any level at 6 months and treated as an external clinical variable.

Results

Among 275 patients (56% male; median age 32 years), Q‑FAAM‑F showed excellent internal consistency (α = 0.96) and strong item–total correlations (mean r ≈ 0.65). Convergent validity was strong with the FAAM (r = 0.95) and with FAOS and ALR‑RSI; divergent validity was supported by the absence of correlation with CAIT of the nonoperated limb. ROC AUC for CLAI status and RTS were high; optimal cut‑offs were 78.1/100 (CLAI: sensitivity 81.3%, specificity 85.4%) and 80.2/100 (RTS: sensitivity 75.4%, specificity 87.9%).

Conclusion

The Q‑FAAM‑F is a valid and reliable PROM for French‑speaking CLAI patients, suitable for clinical practice and research. Precise AUC‑based thresholds may support clinical decision‑making at 6 months.

Level of Evidence

Level III.

Purpose

Multiple revision total knee arthroplasty (rTKA) remains highly challenging due to severe bone defects, which often render standard implants unsuitable. This study aimed to evaluate the clinical outcomes, survivorship and complication rates of customised knee implants used in aseptic one-stage rTKA for patients with severe bone defects.

Methods

This study included 16 patients who underwent 18 one-stage rTKAs using custom-made implants due to aseptic loosening between 2016 and 2023. Conventional revision systems failed to provide appropriate femoral or tibial fixation due to severe conical longitudinal bone defects classified as Anderson Orthopaedic Research Institute (AORI) type III. Clinical outcomes were assessed using the knee injury and osteoarthritis outcome score (KOOS), Oxford knee score (OKS), visual analogue scale (VAS) for pain, range of motion (ROM), walking time and procedure-related complications. Implant costs were compared between customised and standard implants.

Results

Mean follow-up was 51 months (range, 24–100), with patients having an average of five previous surgeries (range, 2–8). During follow-up, three patients (17%) reported complications: one periprosthetic fracture, one periprosthetic joint infection and one failure of the modular stem component. Mean KOOS improved from 31 to 80 (p < 0.001), OKS from 47–32 points (p < 0.001) and pain on the VAS decreased from 8.1 to 3.1 (p < 0.001).

Conclusions

Customised implants for one-stage rTKA present a promising cementless fit-and-fill fixation option for patients with severe longitudinal bone defects, particularly when standard knee revision implants, including cones and sleeves, are no longer suitable. Yet, these results are just midterm and small sample size-based and therefore long-term results in larger patient numbers need to be awaited before a final conclusion can be made.

Level of Evidence

Level IV.

Purpose

This study aimed to translate and cross-culturally validate a Danish version of the BPII 2.0, and assess its construct validity, internal consistency and test-retest reliability in a Danish population of patients with patellar instability.

Methods

The BPII 2.0 was translated and cross-culturally validated according to international guidelines, including 15 think-aloud interviews in patients with patellar instability. Responses from 100 patients with patellar instability were accustomed to evaluating, construct validity, floor and ceiling effect, minimal detectable change, internal consistency and test-retest reliability. Construct validity was assessed using Spearman Rho (r) comparing the BPII 2.0-DK with the Kujala-DK, the International Knee Documentation Committee (IKDC), the Victorian Institute of Sport Assessment-Patella (VISA-P) and the Tegner activity score (TAS). Structural validity was assessed using confirmatory factor analysis (CFA). Internal consistency reliability was evaluated using Cronbach's alpha. Test-rest reliability was examined using Pearson's intraclass correlation coefficient (ICC) in 57 patients who completed the BPII 2.0 twice, with a one-week interval. The study followed the COSMIN guidelines.

Results

Minor comprehensibility issues were corrected during translation, and patients found the BPII 2.0-DK relevant and comprehensive. High positive correlations were found with the Kujala-DK (r = 0.73), IKDC (r = 0.81) and VISA-P (r = 0.67), whereas only a low correlation was found with the TAS (r = 0.44). CFA demonstrated loadings ranging from 0.45 to 0.84. No ceiling or floor effects were observed, and a minimal detectable change of 15.3 points was found. Cronbach's alpha was 0.95, indicating excellent internal consistency, and ICC was 0.90 (95% CI: 0.86–0.94) for test-retest reliability.

Conclusion

The BPII 2.0-DK is a relevant, comprehensible, and comprehensive tool for patients with patellar instability. There was a high positive correlation between BPII 2.0 and Kujala-DK, IKDC and VISA-P. Furthermore, excellent internal consistency reliability and high test-retest reliability were found.

Level of Evidence

Level III.

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.