Bastian Mester, Tobias Ohmann, Christine Seelmann, Anne Terschluse, Claas Güthoff, Christian Gerach, Nikolaus Brinkmann, Marcel Dudda
Purpose
Postoperative pain remains a major obstacle to early mobilisation following total knee arthroplasty (TKA) and is particularly challenging in patients with posttraumatic arthritis due to prior injury, scarring, and complex surgeries. While various analgesic strategies have been evaluated in degenerative TKA, evidence in posttraumatic cases is lacking. This study is the first to compare patient-controlled intravenous analgesia (PCIA), continuous femoral/sciatic nerve block (cFNB/cSNB), and continuous local infiltration analgesia (cLIA) in this specific population.
Methods
In this prospective, monocentric, randomised controlled trial, 92 patients undergoing TKA for posttraumatic arthritis were allocated to PCIA (n = 31), cFNB/cSNB (n = 30) or cLIA (n = 31). Postoperative pain was assessed using the numeric rating scale (NRS) from day 1 (t1) to discharge (t6). Secondary outcomes included range of motion (ROM), rescue analgesic use, Knee Society Score (KSS) and patient satisfaction. Statistical comparisons between groups were performed using adjusted pairwise tests.
Results
At t1, patients in cFNB/cSNB reported significantly lower pain scores compared to cLIA (p = 0.039). cLIA required significantly more rescue analgesics at t1/t2 (both p < 0.05). Active/passive knee flexion was consistently higher in cFNB/cSNB from t1 to t6 (all p < 0.05). No differences were observed in postoperative mobility, KSS or satisfaction. All groups showed significant improvement in pain and ROM over time.
Conclusions
In patients undergoing TKA for posttraumatic arthritis, cFNB/cSNB provided superior early postoperative pain control and functional recovery compared to PCIA and cLIA. The findings suggest that standard fast-track protocols may not be fully applicable in this complex patient population, highlighting the need for individualised analgesic strategies.
{"title":"Postoperative analgesia in total knee arthroplasty for posttraumatic arthritis: A randomised controlled trial comparing patient-controlled intravenous analgesia, continuous femoral/sciatic nerve block and continuous local infiltration analgesia","authors":"Bastian Mester, Tobias Ohmann, Christine Seelmann, Anne Terschluse, Claas Güthoff, Christian Gerach, Nikolaus Brinkmann, Marcel Dudda","doi":"10.1002/jeo2.70599","DOIUrl":"10.1002/jeo2.70599","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Postoperative pain remains a major obstacle to early mobilisation following total knee arthroplasty (TKA) and is particularly challenging in patients with posttraumatic arthritis due to prior injury, scarring, and complex surgeries. While various analgesic strategies have been evaluated in degenerative TKA, evidence in posttraumatic cases is lacking. This study is the first to compare patient-controlled intravenous analgesia (PCIA), continuous femoral/sciatic nerve block (cFNB/cSNB), and continuous local infiltration analgesia (cLIA) in this specific population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective, monocentric, randomised controlled trial, 92 patients undergoing TKA for posttraumatic arthritis were allocated to PCIA (<i>n</i> = 31), cFNB/cSNB (<i>n</i> = 30) or cLIA (<i>n</i> = 31). Postoperative pain was assessed using the numeric rating scale (NRS) from day 1 (t1) to discharge (t6). Secondary outcomes included range of motion (ROM), rescue analgesic use, Knee Society Score (KSS) and patient satisfaction. Statistical comparisons between groups were performed using adjusted pairwise tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At t1, patients in cFNB/cSNB reported significantly lower pain scores compared to cLIA (<i>p</i> = 0.039). cLIA required significantly more rescue analgesics at t1/t2 (both <i>p</i> < 0.05). Active/passive knee flexion was consistently higher in cFNB/cSNB from t1 to t6 (all <i>p</i> < 0.05). No differences were observed in postoperative mobility, KSS or satisfaction. All groups showed significant improvement in pain and ROM over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In patients undergoing TKA for posttraumatic arthritis, cFNB/cSNB provided superior early postoperative pain control and functional recovery compared to PCIA and cLIA. The findings suggest that standard fast-track protocols may not be fully applicable in this complex patient population, highlighting the need for individualised analgesic strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level I.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12745048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pietro Cimatti, Martina Rocchi, Benedetta Dallari, Nicolandrea Del Piccolo, Alessandro Mazzotta, Dante Dallari
Purpose
Total hip arthroplasty (THA) is a widely performed surgery with growing demand globally. This study aims to evaluate the effectiveness of a fast track (FT) protocol compared to standard care (SC) in patients undergoing THA.
Methods
Ninety patients aged 18–70 years with primary unilateral hip osteoarthritis, American Society of Anesthesiologists (ASA) score <3, body mass index (BMI) ≤ 32 and no cognitive or psychiatric disorders were prospectively enrolled from March 2018 to January 2020. All patients provided informed consent and were randomised to the FT or SC groups. The FT protocol consisted of preoperative education, oral analgesic pain management and early intensive rehabilitation. Functional autonomy was assessed on postoperative Day 3 using the Iowa Level of Assistance (ILOA) scale. Follow-up assessments at 6 weeks, 3, 6, 12 and 60 months included the Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).
Results
Forty-six patients were assigned to the FT group. Both groups were comparable in baseline demographics. The FT group showed significantly faster early functional recovery, with lower ILOA scores on postoperative Day 3 (9.60 ± 5.2 vs. 11.7 ± 3.4; p = 0.024), and a shorter hospital stay (3.54 ± 1.25 vs. 6.39 ± 1.59 days; p < 0.0001). WOMAC scores were significantly better in the FT group at 6 weeks (10.38 ± 9.18 vs. 14.21 ± 8.76; p = 0.035) and remained superior at 60 months (0 ± 0 vs. 0.27 ± 0.81; p = 0.027). Although baseline HHS was higher in the FT group, greater improvements from baseline were seen in the SC group at later follow-ups, likely due to a ceiling effect.
Conclusions
The FT protocol enhances early postoperative recovery and significantly reduces hospital stay after THA without compromising safety. Long-term functional outcomes favour the FT approach, supporting its implementation to improve recovery in appropriately selected patients undergoing hip arthroplasty.
{"title":"Improved early recovery and shorter hospital stay with fast track protocol versus standard care in total hip arthroplasty: 5-year results from a prospective randomised controlled study","authors":"Pietro Cimatti, Martina Rocchi, Benedetta Dallari, Nicolandrea Del Piccolo, Alessandro Mazzotta, Dante Dallari","doi":"10.1002/jeo2.70528","DOIUrl":"10.1002/jeo2.70528","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Total hip arthroplasty (THA) is a widely performed surgery with growing demand globally. This study aims to evaluate the effectiveness of a fast track (FT) protocol compared to standard care (SC) in patients undergoing THA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Ninety patients aged 18–70 years with primary unilateral hip osteoarthritis, American Society of Anesthesiologists (ASA) score <3, body mass index (BMI) ≤ 32 and no cognitive or psychiatric disorders were prospectively enrolled from March 2018 to January 2020. All patients provided informed consent and were randomised to the FT or SC groups. The FT protocol consisted of preoperative education, oral analgesic pain management and early intensive rehabilitation. Functional autonomy was assessed on postoperative Day 3 using the Iowa Level of Assistance (ILOA) scale. Follow-up assessments at 6 weeks, 3, 6, 12 and 60 months included the Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-six patients were assigned to the FT group. Both groups were comparable in baseline demographics. The FT group showed significantly faster early functional recovery, with lower ILOA scores on postoperative Day 3 (9.60 ± 5.2 vs. 11.7 ± 3.4; <i>p</i> = 0.024), and a shorter hospital stay (3.54 ± 1.25 vs. 6.39 ± 1.59 days; <i>p</i> < 0.0001). WOMAC scores were significantly better in the FT group at 6 weeks (10.38 ± 9.18 vs. 14.21 ± 8.76; <i>p</i> = 0.035) and remained superior at 60 months (0 ± 0 vs. 0.27 ± 0.81; <i>p</i> = 0.027). Although baseline HHS was higher in the FT group, greater improvements from baseline were seen in the SC group at later follow-ups, likely due to a ceiling effect.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The FT protocol enhances early postoperative recovery and significantly reduces hospital stay after THA without compromising safety. Long-term functional outcomes favour the FT approach, supporting its implementation to improve recovery in appropriately selected patients undergoing hip arthroplasty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level II.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12745168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Condylar lift-off is the phenomenon in which the femoral component lifts off from the polyethylene insert. In some cases, the mechanical hip–knee–ankle angle (mHKAA) appears more varus than the arithmetic hip–knee–ankle angle (aHKAA) in a standing position, which is thought to be related to lift-off. This study analyzed factors influencing the difference between postoperative aHKAA and mHKAA in bi-cruciate-stabilized total knee arthroplasty (BCS-TKA).
Methods
This study included 100 knees that underwent BCS-TKA. Full-length standing radiographs of both lower extremities were obtained preoperatively and 1-year postoperatively. The mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and mHKAA were measured and aHKAA (mMPTA−mLDFA) was calculated. The difference between postoperative aHKAA (post-aHKAA) and post-mHKAA was defined as post-ΔHKAA (post-mHKAA−post-aHKAA). Correlations between post-ΔHKAA and the measured parameters were analyzed, and multivariable linear regression analyses were performed to identify independent predictors of post-ΔHKAA.
Results
Post-ΔHKAA was significantly correlated with preoperative mLDFA (pre-mLDFA, r = −0.30, p < 0.001), pre-aHKAA (r = 0.22, p = 0.02), pre-mHKAA (r = 0.21, p = 0.03) and post-mMPTA (r = −0.29, p = 0.004). Multivariable linear regression analyses revealed that pre-mLDFA (β = −0.20, p = 0.02) and post-mMPTA (β = −0.32, p = 0.01) were independently associated with post-ΔHKAA. These results indicate that performing TKA in cases with severe femoral varus alignment and placing the tibial implant in valgus relative to the original joint surface leads to increased postoperative coronal varus alignment in the standing position.
Conclusion
In BCS-type TKA, postoperative condylar lift-off in standing positions is more likely to occur in cases with severe preoperative femoral varus alignment or with valgus tibial implant placement.
Level of Evidence
Level Ⅳ.
目的：髁突抬起是指股骨假体从聚乙烯假体上抬起的现象。在某些情况下，站立时机械髋关节-膝关节-踝关节角（mHKAA）比算术髋关节-膝关节-踝关节角（aHKAA）更容易内翻，这被认为与起跳有关。本研究分析双十字稳定全膝关节置换术（BCS-TKA）术后aHKAA和mHKAA差异的影响因素。方法：本研究纳入100例行BCS-TKA的膝关节。术前和术后1年分别获得双下肢站立x线片。测量股骨机械外侧远端角（mLDFA）、胫骨机械内侧近端角（mMPTA）和mHKAA，计算aHKAA （mMPTA-mLDFA）。术后aHKAA （post-aHKAA）与mhkaa后的差异定义为-ΔHKAA后（post- mhkaa -post-aHKAA）。分析-ΔHKAA岗位与测量参数之间的相关性，并进行多变量线性回归分析，确定-ΔHKAA岗位的独立预测因子。结果：-ΔHKAA后与术前mLDFA （pre-mLDFA, r = -0.30, pr = 0.22, p = 0.02）、mhkaa前（r = 0.21, p = 0.03）、mmpta后（r = -0.29, p = 0.004）显著相关。多变量线性回归分析显示，mldfa前（β = -0.20, p = 0.02）和mmpta后（β = -0.32, p = 0.01）与-ΔHKAA后独立相关。这些结果表明，在严重股骨内翻对准的病例中进行TKA，并将胫骨植入物放置在相对于原始关节表面的外翻位置，可增加站立位置的术后冠状内翻对准。结论：在bcs型TKA中，术前股骨内翻对准严重或胫骨外翻植入的情况下，更容易发生站立位髁突上升。证据等级：Ⅳ级。
{"title":"Preoperative coronal alignment and tibial implant positioning affect condylar lift-off in BCS-TKA","authors":"Kento Harada, Masayuki Kamimura, Yu Mori, Takashi Aki, Shunsuke Utsumi, Tomokazu Tanita, Toshiya Uehara, Toshimi Aizawa","doi":"10.1002/jeo2.70609","DOIUrl":"10.1002/jeo2.70609","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Condylar lift-off is the phenomenon in which the femoral component lifts off from the polyethylene insert. In some cases, the mechanical hip–knee–ankle angle (mHKAA) appears more varus than the arithmetic hip–knee–ankle angle (aHKAA) in a standing position, which is thought to be related to lift-off. This study analyzed factors influencing the difference between postoperative aHKAA and mHKAA in bi-cruciate-stabilized total knee arthroplasty (BCS-TKA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study included 100 knees that underwent BCS-TKA. Full-length standing radiographs of both lower extremities were obtained preoperatively and 1-year postoperatively. The mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and mHKAA were measured and aHKAA (mMPTA−mLDFA) was calculated. The difference between postoperative aHKAA (post-aHKAA) and post-mHKAA was defined as post-ΔHKAA (post-mHKAA−post-aHKAA). Correlations between post-ΔHKAA and the measured parameters were analyzed, and multivariable linear regression analyses were performed to identify independent predictors of post-ΔHKAA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Post-ΔHKAA was significantly correlated with preoperative mLDFA (pre-mLDFA, <i>r</i> = −0.30, <i>p</i> < 0.001), pre-aHKAA (<i>r</i> = 0.22, <i>p</i> = 0.02), pre-mHKAA (<i>r</i> = 0.21, <i>p</i> = 0.03) and post-mMPTA (<i>r</i> = −0.29, <i>p</i> = 0.004). Multivariable linear regression analyses revealed that pre-mLDFA (<i>β</i> = −0.20, <i>p</i> = 0.02) and post-mMPTA (<i>β</i> = −0.32, <i>p </i>= 0.01) were independently associated with post-ΔHKAA. These results indicate that performing TKA in cases with severe femoral varus alignment and placing the tibial implant in valgus relative to the original joint surface leads to increased postoperative coronal varus alignment in the standing position.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In BCS-type TKA, postoperative condylar lift-off in standing positions is more likely to occur in cases with severe preoperative femoral varus alignment or with valgus tibial implant placement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level Ⅳ.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12745164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Annika Babette Ito, Maria Christine van der Steen, Robin Nicolaas Julian Voskuilen, Rob Paulus Augustinus Janssen, Martijn Dietvorst
Purpose
The aim of this study was to investigate the prevalence of the deep lateral femoral notch sign (DLFNS) in skeletally immature patients with anterior cruciate ligament (ACL) injuries and its potential association with trauma-related and clinical factors.
Methods
A total of 87 skeletally immature patients with ACL injuries and a minimum follow-up of 1 year were included and matched based on sex and skeletal age with 44 controls. The presence of the DLFNS, defined as a notch depth of >1.5 mm, was assessed on MRI. Intra- and inter-observer reliability were calculated, and prevalence was determined. Associations between the DLFNS and trauma mechanism, trauma-related bone lesions, concomitant injuries, clinical instability, and treatment at both baseline and follow-up were assessed using Fisher's exact tests.
Results
The prevalence of DLFNS was 11.5% (10/87) among skeletally immature patients with ACL injuries compared to 0% (0/44) in controls (p = 0.02). DLFNS depth demonstrated excellent intra- and inter-observer reliability (ICC > 0.90). Furthermore, a significant positive association was identified between the DLFNS and overall concomitant knee injuries (p = 0.02), including ligamentous, meniscus, and cartilage injuries. Further subgroup analysis did not reveal any statistically significant associations with individual injury types. All patients presenting with a DLFNS ultimately received operative treatment, either during initial management or follow-up. This revealed a significant positive association between the DLFNS and primary operative treatment (p = 0.02).
Conclusion
The prevalence of the DLFNS in skeletally immature patients with ACL injuries was 11.5%. When present, the DLFNS was associated with overall concomitant knee injuries and primary ACL reconstruction. The DLFNS may therefore be an important sign to take into consideration on the primary MRI in skeletally immature patients with ACL injuries.
{"title":"The deep lateral femoral notch sign (DLFNS) is associated with concomitant knee injuries in skeletally immature patients with anterior cruciate ligament injuries","authors":"Annika Babette Ito, Maria Christine van der Steen, Robin Nicolaas Julian Voskuilen, Rob Paulus Augustinus Janssen, Martijn Dietvorst","doi":"10.1002/jeo2.70595","DOIUrl":"10.1002/jeo2.70595","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The aim of this study was to investigate the prevalence of the deep lateral femoral notch sign (DLFNS) in skeletally immature patients with anterior cruciate ligament (ACL) injuries and its potential association with trauma-related and clinical factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 87 skeletally immature patients with ACL injuries and a minimum follow-up of 1 year were included and matched based on sex and skeletal age with 44 controls. The presence of the DLFNS, defined as a notch depth of >1.5 mm, was assessed on MRI. Intra- and inter-observer reliability were calculated, and prevalence was determined. Associations between the DLFNS and trauma mechanism, trauma-related bone lesions, concomitant injuries, clinical instability, and treatment at both baseline and follow-up were assessed using Fisher's exact tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The prevalence of DLFNS was 11.5% (10/87) among skeletally immature patients with ACL injuries compared to 0% (0/44) in controls (<i>p</i> = 0.02). DLFNS depth demonstrated excellent intra- and inter-observer reliability (ICC > 0.90). Furthermore, a significant positive association was identified between the DLFNS and overall concomitant knee injuries (<i>p</i> = 0.02), including ligamentous, meniscus, and cartilage injuries. Further subgroup analysis did not reveal any statistically significant associations with individual injury types. All patients presenting with a DLFNS ultimately received operative treatment, either during initial management or follow-up. This revealed a significant positive association between the DLFNS and primary operative treatment (<i>p</i> = 0.02).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The prevalence of the DLFNS in skeletally immature patients with ACL injuries was 11.5%. When present, the DLFNS was associated with overall concomitant knee injuries and primary ACL reconstruction. The DLFNS may therefore be an important sign to take into consideration on the primary MRI in skeletally immature patients with ACL injuries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12745167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fernanda Teixeira Furlan Chico, Ana Caroline Barbosa Retameiro, Aline Reginato, Rafaela Rambo Bremm, Bruna Menegat, Mustafa Munir Mustafa Dahleh, Marina Prigol, Gustavo Petri Guerra, Gladson Ricardo Flor Bertolini, Lucinéia de Fátima Chasko Ribeiro
Purpose
Here we analysed the effects of treatment with therapeutic ultrasound, passive mobilisation and their synergically effects on hind paw' functionality, histomorphometric and immunological aspects in the musculoskeletal tissue in an experimental immobilisation model.
Methods
Forty male Wistar rats, aged 10 weeks were divided into (n = 8): Immobilised Group, Free remobilisation, Passive Mobilisation, Therapeutic Ultrasound and Passive Mobilisation and Therapeutic Ultrasound. The animals were immobilised, for 21 consecutive days, with a plaster cast orthosis. Therapeutic Ultrasound with frequency of 1.0 MHZ and intensity of 0.5 w/cm2 and Passive Mobilisation using degree IV, were performed as treatment. Generalised mixed models and analysis of variance were used for statistical analysis, p-value was set as 0.05. The Immobilised Group had loss in motor function and increase in nociceptive threshold.
Results
Histomorphometry revealed hypotrophy and fibrosis in the muscular tissue, with changes in the muscle fibres, connective tissue and muscle spindles (p < 0.0001). Animals that underwent both treatments had the best recovery in those aspects. In the inflammatory tests, the immobilisation caused greater amount of tumour necrosis factor alpha, nuclear factor kappa beta and interleukin-10 (p < 0.05).
Conclusion
Treatments synergistically restored motor function, histomorphometric integrity, and immunological balance in the musculoskeletal tissue of the rats after immobilisation. This may indicate that in humans there should be integration of therapies in post-immobilisation periods.
{"title":"Therapeutic ultrasound and passive mobilisation improve motor function and reduce inflammation in skeletal muscle of immobilised Wistar rats","authors":"Fernanda Teixeira Furlan Chico, Ana Caroline Barbosa Retameiro, Aline Reginato, Rafaela Rambo Bremm, Bruna Menegat, Mustafa Munir Mustafa Dahleh, Marina Prigol, Gustavo Petri Guerra, Gladson Ricardo Flor Bertolini, Lucinéia de Fátima Chasko Ribeiro","doi":"10.1002/jeo2.70505","DOIUrl":"10.1002/jeo2.70505","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Here we analysed the effects of treatment with therapeutic ultrasound, passive mobilisation and their synergically effects on hind paw' functionality, histomorphometric and immunological aspects in the musculoskeletal tissue in an experimental immobilisation model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Forty male Wistar rats, aged 10 weeks were divided into (<i>n</i> = 8): Immobilised Group, Free remobilisation, Passive Mobilisation, Therapeutic Ultrasound and Passive Mobilisation and Therapeutic Ultrasound. The animals were immobilised, for 21 consecutive days, with a plaster cast orthosis. Therapeutic Ultrasound with frequency of 1.0 MHZ and intensity of 0.5 w/cm<sup>2</sup> and Passive Mobilisation using degree IV, were performed as treatment. Generalised mixed models and analysis of variance were used for statistical analysis, <i>p</i>-value was set as 0.05. The Immobilised Group had loss in motor function and increase in nociceptive threshold.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Histomorphometry revealed hypotrophy and fibrosis in the muscular tissue, with changes in the muscle fibres, connective tissue and muscle spindles (<i>p</i> < 0.0001). Animals that underwent both treatments had the best recovery in those aspects. In the inflammatory tests, the immobilisation caused greater amount of tumour necrosis factor alpha, nuclear factor kappa beta and interleukin-10 (<i>p</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Treatments synergistically restored motor function, histomorphometric integrity, and immunological balance in the musculoskeletal tissue of the rats after immobilisation. This may indicate that in humans there should be integration of therapies in post-immobilisation periods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>N/A.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12745041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vicente Sanchis-Alfonso, Cristina Ramírez-Fuentes, Jose Yañez-Rodríguez, Laura Parra-Calabuig, Marcos López-Vega, Julio Domenech-Fernandez
Purpose
To perform a segmental analysis of tibial torsion in females with refractory anterior knee pain (AKP) and investigate the relationship between external tibial torsion (ETT) and the position of the tibial tubercle (TT).
Methods
All disabling AKP patient refractory to adequate physical therapy, that presented to our clinic between January 2013 and December 2024 were retrospectively reviewed. Inclusion criteria: (1) females, (2) ≥18 years old, (3) torsional CT scan performed for strictly clinical reasons. Patients were classified into three groups according to ETT: normal (≤30°), moderate (31°–40°), and severe (>40°). ETT was measured proximally and distally to the TT, and the contribution of distal tibial torsion (DTT) to total tibial torsion (TTT) was calculated. TT lateralisation (TTL) relative to the tibial plateau′s maximum transverse diameter was measured. Statistical analysis for comparisons was conducted using one-way ANOVA with Bonferroni correction and Student′s t-test. Correlations were assessed with Pearson′s coefficient. To evaluate the association between TTT and the percentage of DTT, a linear regression analysis was performed. Inter-observer reproducibility was evaluated using the intraclass correlation coefficient. Statistical significance was set at p < 0.05.
Results
A total of 197 tibial CT scans from 101 AKP females were analysed. The percentage of contribution of DTT to TTT was significantly higher in the severe group (35.2%, SD 11.5) compared to the moderate (22.1%, SD 12.1) and normal (18.2%, SD 16.7) groups (p < 0.01). A moderate correlation between TTT and DTT contribution was identified (R = 0.540, p < 0.001). Linear regression analysis indicated that ETT was a significant predictor of DTT contribution (p < 0.001). No significant correlation was found between TTL and ETT severity.
Conclusion
The infratuberositary contribution to pathological ETT increases with the severity of the torsion. Moreover, the degree of ETT does not affect TTL.
Level of Evidence
Level IV.
目的：对难治性膝前痛（AKP）女性患者的胫骨扭转进行节段性分析，探讨胫骨外扭转（ETT）与胫骨结节（TT）位置的关系。方法：回顾性分析2013年1月至2024年12月间我院收治的所有难以进行适当物理治疗的致残性AKP患者。纳入标准：(1)女性；(2)年龄≥18岁；(3)严格出于临床原因进行扭转CT扫描。根据ETT水平将患者分为正常（≤30°）、中度（31°-40°）和重度（>40°）三组。测量近端和远端胫骨扭转（ETT），计算胫骨远端扭转（DTT）对胫骨总扭转（TT）的贡献。测量相对于胫骨平台最大横向直径的TT侧化（TTL）。比较的统计分析采用Bonferroni校正的单因素方差分析和学生t检验。用Pearson系数评估相关性。为了评估TTT与DTT百分比之间的关系，进行了线性回归分析。用类内相关系数评价观察者间的可重复性。结果：对101例AKP女性的197张胫骨CT扫描图进行分析。重度组DTT对TTT的贡献比例（35.2%,SD 11.5）明显高于中度组（22.1%,SD 12.1）和正常组（18.2%,SD 16.7） （p R = 0.540, p p）。结论：随着扭转的严重程度，肺下动脉对病理性ETT的贡献增加。此外，ETT的程度不影响TTL。证据等级：四级。
{"title":"In females with anterior knee pain, the infratuberositary contribution to external tibial torsion increases with torsion severity and does not correlate with tibial tubercle lateralisation","authors":"Vicente Sanchis-Alfonso, Cristina Ramírez-Fuentes, Jose Yañez-Rodríguez, Laura Parra-Calabuig, Marcos López-Vega, Julio Domenech-Fernandez","doi":"10.1002/jeo2.70603","DOIUrl":"10.1002/jeo2.70603","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To perform a segmental analysis of tibial torsion in females with refractory anterior knee pain (AKP) and investigate the relationship between external tibial torsion (ETT) and the position of the tibial tubercle (TT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All disabling AKP patient refractory to adequate physical therapy, that presented to our clinic between January 2013 and December 2024 were retrospectively reviewed. Inclusion criteria: (1) females, (2) ≥18 years old, (3) torsional CT scan performed for strictly clinical reasons. Patients were classified into three groups according to ETT: normal (≤30°), moderate (31°–40°), and severe (>40°). ETT was measured proximally and distally to the TT, and the contribution of distal tibial torsion (DTT) to total tibial torsion (TTT) was calculated. TT lateralisation (TTL) relative to the tibial plateau′s maximum transverse diameter was measured. Statistical analysis for comparisons was conducted using one-way ANOVA with Bonferroni correction and Student′s <i>t</i>-test. Correlations were assessed with Pearson′s coefficient. To evaluate the association between TTT and the percentage of DTT, a linear regression analysis was performed. Inter-observer reproducibility was evaluated using the intraclass correlation coefficient. Statistical significance was set at <i>p</i> < 0.05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 197 tibial CT scans from 101 AKP females were analysed. The percentage of contribution of DTT to TTT was significantly higher in the severe group (35.2%, SD 11.5) compared to the moderate (22.1%, SD 12.1) and normal (18.2%, SD 16.7) groups (<i>p</i> < 0.01). A moderate correlation between TTT and DTT contribution was identified (<i>R</i> = 0.540, <i>p</i> < 0.001). Linear regression analysis indicated that ETT was a significant predictor of DTT contribution (<i>p</i> < 0.001). No significant correlation was found between TTL and ETT severity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The infratuberositary contribution to pathological ETT increases with the severity of the torsion. Moreover, the degree of ETT does not affect TTL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12745182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marco Zaffagnini, Federico Raggi, Eleonora Carillo, Luca Andriolo, Angelo Boffa, Carola Cavallo, Luca Cattini, Stefano Zaffagnini, Giuseppe Filardo
Purpose
Micro-fragmented adipose tissue (MFAT) has been proposed as a promising option for hip osteoarthritis (OA). The aim of this prospective study was to evaluate clinical outcomes of MFAT injections in patients with hip OA.
Methods
Thirty patients (19 men and 11 women, 55.7 ± 8.2 years) with symptomatic hip OA (Tönnis Grade 1–2) were treated with a single ultrasound-guided MFAT injection. Patients were evaluated at baseline and 1–3–6–12 months of follow-up with the Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Harris Hip Score (HHS). Adverse events were also documented. MFAT samples were evaluated for cell analysis and characterization.
Results
No major complications were reported, and only three patients failed. The total WOMAC score significantly improved from baseline (31.2 ± 16.4) only at 1 month (21.0 ± 14.3, p = 0.015) and 3 months (19.3 ± 15.8, p = 0.012), while VAS and HHS scores showed a significant improvement from baseline to all follow-ups. The minimal clinically important difference (MCID) for the total WOMAC score was achieved in 56.7% of patients at 6 and 12 months. Better clinical improvement and MCID achievement were observed in mild compared to moderate hip OA. A total of 300.000 cells derived from MFAT produced small colonies from Day 10 (89.9 ± 61.2), increasing by Day 20 (129.9 ± 47.9).
Conclusions
A single ultrasound-guided intra-articular MFAT injection represents a safe and promising option for hip OA treatment. However, the clinical benefit was partial, and better outcomes were observed in mild compared to moderate hip OA.
{"title":"Micro-fragmented adipose tissue for the treatment of hip osteoarthritis: A prospective pilot study at 1-year follow-up","authors":"Marco Zaffagnini, Federico Raggi, Eleonora Carillo, Luca Andriolo, Angelo Boffa, Carola Cavallo, Luca Cattini, Stefano Zaffagnini, Giuseppe Filardo","doi":"10.1002/jeo2.70579","DOIUrl":"10.1002/jeo2.70579","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Micro-fragmented adipose tissue (MFAT) has been proposed as a promising option for hip osteoarthritis (OA). The aim of this prospective study was to evaluate clinical outcomes of MFAT injections in patients with hip OA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Thirty patients (19 men and 11 women, 55.7 ± 8.2 years) with symptomatic hip OA (Tönnis Grade 1–2) were treated with a single ultrasound-guided MFAT injection. Patients were evaluated at baseline and 1–3–6–12 months of follow-up with the Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Harris Hip Score (HHS). Adverse events were also documented. MFAT samples were evaluated for cell analysis and characterization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No major complications were reported, and only three patients failed. The total WOMAC score significantly improved from baseline (31.2 ± 16.4) only at 1 month (21.0 ± 14.3, <i>p</i> = 0.015) and 3 months (19.3 ± 15.8, <i>p</i> = 0.012), while VAS and HHS scores showed a significant improvement from baseline to all follow-ups. The minimal clinically important difference (MCID) for the total WOMAC score was achieved in 56.7% of patients at 6 and 12 months. Better clinical improvement and MCID achievement were observed in mild compared to moderate hip OA. A total of 300.000 cells derived from MFAT produced small colonies from Day 10 (89.9 ± 61.2), increasing by Day 20 (129.9 ± 47.9).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A single ultrasound-guided intra-articular MFAT injection represents a safe and promising option for hip OA treatment. However, the clinical benefit was partial, and better outcomes were observed in mild compared to moderate hip OA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12745173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145864862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Miguel Angel Ruiz Ibán, Rosa Vega, Raquel Ruiz Díaz, Cristina Delgado, Umile Giuseppe Longo, Jorge Diaz Heredia
Purpose
To evaluate whether the use of polyetheretherketone (PEEK) or biocomposite vented anchors has any impact on bony ingrowth inside the anchor or implant-related osteolysis after implantation during remplissage for Hill-Sachs defects (HSD) in patients with shoulder instability.
Methods
Prospective cohort study with a minimum of 24 months follow-up (mean follow-up 3.11[SD = 0.67] years). Forty-nine subjects (43 males and 6 females; mean age 27.6[SD:9.22] years) with HSD undergoing remplissage were evaluated with a CT performed at a mean of 14.7[4,4] months after surgery. The procedures were performed in two cohorts: in the first, 44 anchors (4.5 mm Healicoil PEEK) were used in 26 subjects. In the second, 41 anchors (4.75 mm Healicoil Regenesorb biocomposite) were used in 21 subjects. A computed tomography evaluation of the volume of the bone defects and the degree of bony ingrowth was made.
Results
Preoperatively both cohorts were homogenous. The biocomposite anchors showed better bony ingrowth than the PEEK anchors (p = 0.0014): full bony ingrowth in 18/41(44%) in biocomposite versus 13/44(30%) in PEEK; clear ossification with a thin lucent rim in 15/41(37%) biocomposite versus 7/44(30%) PEEK; discontinuous ossification in 6/41(15%) biocomposite versus 7/44(16%) PEEK; and no ossification in 2/41(5%) biocomposite versus 17/44(39%) PEEK. The biocomposite anchors showed smaller bone defects than the PEEK anchors (p = 0.0217): no bone defect in 18/41(44%) biocomposite versus 13/44(30%) PEEK, partial bone defects in 20/41(49%) biocomposite versus 17/44(39%) PEEK; and bone defects larger than the insertion hole in 2/41(5%) biocomposite versus 13/44(30%) PEEK. One anchor in each group caused a bone defect larger than twice the size of the hole (2%). At the latest follow-up no differences in clinical outcomes between the groups were found.
Conclusion
Biocomposite vented anchors for remplissage favours bony ingrowth and lower the incidence of osteolysis and defect formation when compared to PEEK anchors with similar clinical outcomes.
Level of Evidence
Level II, prospective cohort study.
目的：评价聚醚醚酮（PEEK）或生物复合通气锚对肩关节不稳定患者Hill-Sachs缺陷（HSD）复发期间植入后锚内骨长入或植入后植入物相关骨溶解是否有影响。方法：前瞻性队列研究，随访至少24个月（平均随访3.11[SD = 0.67]年）。49例HSD患者（男性43例，女性6例，平均年龄27.6岁[SD:9.22]岁）手术后平均14.7[4,4]个月行CT检查。该手术在两个队列中进行：第一组，26名受试者使用44个锚（4.5 mm Healicoil PEEK）。在第二项研究中，21名受试者使用41个锚（4.75 mm Healicoil Regenesorb生物复合材料）。计算机断层扫描评估骨缺损的体积和骨长入的程度。结果：术前两组均为同质性。生物复合材料锚钉比PEEK锚钉表现出更好的骨长入（p = 0.0014）：生物复合材料锚钉的骨长入率为18/41(44%)，PEEK锚钉的骨长入率为13/44(30%)；15/41（37%）生物复合材料与7/44(30%)PEEK具有清晰的骨化和透明的边缘；6/41（15%）生物复合材料与7/44(16%)PEEK的不连续骨化；2/41（5%）生物复合材料与17/44(39%)PEEK无骨化。生物复合材料锚钉比PEEK锚钉显示更小的骨缺损（p = 0.0217）： 18/41（44%）生物复合材料与13/44(30%)PEEK相比无骨缺损；20/41（49%）生物复合材料与17/44(39%)PEEK相比有部分骨缺损；2/41（5%）生物复合材料和13/44(30%)PEEK的骨缺损大于插入孔。每组1个锚钉造成的骨缺损大于孔大小的2倍（2%）。在最近的随访中，两组之间的临床结果没有发现差异。结论：与具有相似临床结果的PEEK锚钉相比，生物复合通气锚钉可促进骨长入，降低骨溶解和缺损形成的发生率。证据等级：II级，前瞻性队列研究。
{"title":"The use of biocomposite vented anchors for arthroscopic remplissage allows for better bony ingrowth than peek vented anchors: A volumetric CT study of 85 anchors","authors":"Miguel Angel Ruiz Ibán, Rosa Vega, Raquel Ruiz Díaz, Cristina Delgado, Umile Giuseppe Longo, Jorge Diaz Heredia","doi":"10.1002/jeo2.70605","DOIUrl":"10.1002/jeo2.70605","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To evaluate whether the use of polyetheretherketone (PEEK) or biocomposite vented anchors has any impact on bony ingrowth inside the anchor or implant-related osteolysis after implantation during remplissage for Hill-Sachs defects (HSD) in patients with shoulder instability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Prospective cohort study with a minimum of 24 months follow-up (mean follow-up 3.11[SD = 0.67] years). Forty-nine subjects (43 males and 6 females; mean age 27.6[SD:9.22] years) with HSD undergoing remplissage were evaluated with a CT performed at a mean of 14.7[4,4] months after surgery. The procedures were performed in two cohorts: in the first, 44 anchors (4.5 mm Healicoil PEEK) were used in 26 subjects. In the second, 41 anchors (4.75 mm Healicoil Regenesorb biocomposite) were used in 21 subjects. A computed tomography evaluation of the volume of the bone defects and the degree of bony ingrowth was made.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Preoperatively both cohorts were homogenous. The biocomposite anchors showed better bony ingrowth than the PEEK anchors (<i>p</i> = 0.0014): full bony ingrowth in 18/41(44%) in biocomposite versus 13/44(30%) in PEEK; clear ossification with a thin lucent rim in 15/41(37%) biocomposite versus 7/44(30%) PEEK; discontinuous ossification in 6/41(15%) biocomposite versus 7/44(16%) PEEK; and no ossification in 2/41(5%) biocomposite versus 17/44(39%) PEEK. The biocomposite anchors showed smaller bone defects than the PEEK anchors (<i>p</i> = 0.0217): no bone defect in 18/41(44%) biocomposite versus 13/44(30%) PEEK, partial bone defects in 20/41(49%) biocomposite versus 17/44(39%) PEEK; and bone defects larger than the insertion hole in 2/41(5%) biocomposite versus 13/44(30%) PEEK. One anchor in each group caused a bone defect larger than twice the size of the hole (2%). At the latest follow-up no differences in clinical outcomes between the groups were found.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Biocomposite vented anchors for remplissage favours bony ingrowth and lower the incidence of osteolysis and defect formation when compared to PEEK anchors with similar clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level II, prospective cohort study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12745165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Angelo V. Vasiliadis, Vasileios Giovanoulis, Theodorakys Marín Fermín, Luca Macchiarola, Nicholas Colyvas
<p>In recent years, there has been growing interest in preservation-focused approach to the management of meniscal tears. An increasing number of surgeons now advocate for the ‘Save the Meniscus’ philosophy, expanding the envelope of what is considered repairable [<span>1-3</span>]. While it is acknowledged that not every tear is amenable to repair, and not all surgeons possess the same level of expertise, ongoing education and skill development can enable surgeons to turn seemingly unrepairable tears into viable repair candidates. In this editorial, we support this evolving mindset and introduce the ‘Iceberg’ concept in the surgical management of meniscal tears (Figure 1), a metaphor that illustrates how the visible, commonly addressed cases represent only a small portion of the true repairable potential.</p><p>The meniscus acts as a vital anatomical part of the knee joint and plays a fundamental role in its function. It helps distribute loads, absorb forces, stabilize the joint, facilitate lubrication and contribute to the nutrition of the knee joint [<span>2</span>]. Traditionally, meniscectomy (partial or total) was routinely performed as the gold standard treatment to alleviate symptoms in the short term. However, it is now well known that the absence or tear of the meniscus has dramatic and irreversible consequences for the joint cartilage in the long term, including the early onset of osteoarthritis [<span>2, 4, 5</span>]. Since LaPrade first introduced the principle of ‘Save the Meniscus’ in 2007 [<span>6</span>], and it was later reinforced by Lubowitz in 2011 [<span>7</span>], there has been a significant shift in the surgical management of meniscal tears. In this regard, a majority of orthopaedic surgeons feel that the future of meniscus management should focus on meniscal preservation principles [<span>8</span>].</p><p>Today, the surgical treatment of meniscal tears has evolved, with a significant increase in arthroscopic meniscal repair and a substantial reduction in partial meniscectomy (Figure 1) [<span>4, 8-11</span>]. Meniscal repair has become one of the fastest-growing areas in sports medicine, where the global proportion of arthroscopic meniscal repair is increasing by 11.4% to as much as 370% over the last two decades [<span>4, 8-14</span>]. In contrast, arthroscopic meniscectomy has shown a global reduction by 21%–72% over the same study period [<span>4, 8-11</span>]. Interestingly, studies from Brazil and Korea have presented increases in both meniscectomy and meniscal repair, with the proportion of meniscal repair being higher [<span>13, 14</span>]. This confirms that while meniscal surgical volume may be increasing overall, there is a growing preference for meniscal repair when possible. These findings also highlight that meniscal surgeries remain among the most commonly performed procedures in orthopaedics. Interestingly, two large-scale studies from the United States [<span>10, 12</span>], covering the period from 2005
{"title":"The ‘Save the Meniscus’ philosophy and the ‘Iceberg’ concept","authors":"Angelo V. Vasiliadis, Vasileios Giovanoulis, Theodorakys Marín Fermín, Luca Macchiarola, Nicholas Colyvas","doi":"10.1002/jeo2.70596","DOIUrl":"10.1002/jeo2.70596","url":null,"abstract":"<p>In recent years, there has been growing interest in preservation-focused approach to the management of meniscal tears. An increasing number of surgeons now advocate for the ‘Save the Meniscus’ philosophy, expanding the envelope of what is considered repairable [<span>1-3</span>]. While it is acknowledged that not every tear is amenable to repair, and not all surgeons possess the same level of expertise, ongoing education and skill development can enable surgeons to turn seemingly unrepairable tears into viable repair candidates. In this editorial, we support this evolving mindset and introduce the ‘Iceberg’ concept in the surgical management of meniscal tears (Figure 1), a metaphor that illustrates how the visible, commonly addressed cases represent only a small portion of the true repairable potential.</p><p>The meniscus acts as a vital anatomical part of the knee joint and plays a fundamental role in its function. It helps distribute loads, absorb forces, stabilize the joint, facilitate lubrication and contribute to the nutrition of the knee joint [<span>2</span>]. Traditionally, meniscectomy (partial or total) was routinely performed as the gold standard treatment to alleviate symptoms in the short term. However, it is now well known that the absence or tear of the meniscus has dramatic and irreversible consequences for the joint cartilage in the long term, including the early onset of osteoarthritis [<span>2, 4, 5</span>]. Since LaPrade first introduced the principle of ‘Save the Meniscus’ in 2007 [<span>6</span>], and it was later reinforced by Lubowitz in 2011 [<span>7</span>], there has been a significant shift in the surgical management of meniscal tears. In this regard, a majority of orthopaedic surgeons feel that the future of meniscus management should focus on meniscal preservation principles [<span>8</span>].</p><p>Today, the surgical treatment of meniscal tears has evolved, with a significant increase in arthroscopic meniscal repair and a substantial reduction in partial meniscectomy (Figure 1) [<span>4, 8-11</span>]. Meniscal repair has become one of the fastest-growing areas in sports medicine, where the global proportion of arthroscopic meniscal repair is increasing by 11.4% to as much as 370% over the last two decades [<span>4, 8-14</span>]. In contrast, arthroscopic meniscectomy has shown a global reduction by 21%–72% over the same study period [<span>4, 8-11</span>]. Interestingly, studies from Brazil and Korea have presented increases in both meniscectomy and meniscal repair, with the proportion of meniscal repair being higher [<span>13, 14</span>]. This confirms that while meniscal surgical volume may be increasing overall, there is a growing preference for meniscal repair when possible. These findings also highlight that meniscal surgeries remain among the most commonly performed procedures in orthopaedics. Interestingly, two large-scale studies from the United States [<span>10, 12</span>], covering the period from 2005 ","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12745179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emmanuel Marchetti, Loïc Laurendon, ReSurg, Antoine Combes, Roger Badet
Purpose
The purpose was to compare intraoperative versus postoperative coronal, sagittal and axial alignment in total knee arthroplasty (TKA) performed using augmented reality (AR) navigation, and determine whether imperfect implant positioning affects postoperative alignment.
Methods
A retrospective assessment was conducted on a study cohort of 70 patients (70 knees), who received unrestricted kinematic aligned TKA using AR navigation between February 2022 and April 2023. Implant positioning was assessed on postoperative frontal (divergence between the proximal tibial resection and baseplate) and sagittal radiographs (gaps between the distal femoral resection and implant) to distinguish between knees with adequate and imperfect implant positioning. The deviation between intraoperative and postoperative alignment measurements (lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), hip knee ankle angle (HKA), posterior tibial slope (PTS) and femoral rotation) was assessed, and the number of outliers calculated using thresholds of 1° and 3°.
Results
There were considerable proportions of knees with deviations between intraoperative and postoperative LDFA (>1°, 43 [61%]; >3°,14 [20%]), MPTA (>1°, 42 [60%]; >3°, 5 [7%]), HKA angle (>1°, 42 [60%]; >3°, 17 [24%]), and PTS (>1°, 47 [67%]; >3°, 15 [21%]). It is worth noting, however, that most of the relevant deviations were observed in knees that had imperfectly positioned implants (19 of 70, 27%), where the femoral component was inadequately impacted during surgery (15 of 19, 79%) and/or the tibial baseplate had an uneven cement distribution (8 of 19, 42%).
Conclusion
The use of AR facilitates precise bone resections during TKA, yet it may not reduce deviations between intraoperative and postoperative LDFA, MPTA, HKA angle or PTS. As with any assistive technology, accurate bone resections alone are not sufficient to grant adequate implant positioning during TKA, which requires meticulous attention from surgeons to ensure sufficient component impaction and uniform cement distributions.
{"title":"Augmented reality navigation improves intraoperative resection accuracy but may not prevent alignment deviations in total knee arthroplasty","authors":"Emmanuel Marchetti, Loïc Laurendon, ReSurg, Antoine Combes, Roger Badet","doi":"10.1002/jeo2.70570","DOIUrl":"https://doi.org/10.1002/jeo2.70570","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The purpose was to compare intraoperative versus postoperative coronal, sagittal and axial alignment in total knee arthroplasty (TKA) performed using augmented reality (AR) navigation, and determine whether imperfect implant positioning affects postoperative alignment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective assessment was conducted on a study cohort of 70 patients (70 knees), who received unrestricted kinematic aligned TKA using AR navigation between February 2022 and April 2023. Implant positioning was assessed on postoperative frontal (divergence between the proximal tibial resection and baseplate) and sagittal radiographs (gaps between the distal femoral resection and implant) to distinguish between knees with adequate and imperfect implant positioning. The deviation between intraoperative and postoperative alignment measurements (lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), hip knee ankle angle (HKA), posterior tibial slope (PTS) and femoral rotation) was assessed, and the number of outliers calculated using thresholds of 1° and 3°.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were considerable proportions of knees with deviations between intraoperative and postoperative LDFA (>1°, 43 [61%]; >3°,14 [20%]), MPTA (>1°, 42 [60%]; >3°, 5 [7%]), HKA angle (>1°, 42 [60%]; >3°, 17 [24%]), and PTS (>1°, 47 [67%]; >3°, 15 [21%]). It is worth noting, however, that most of the relevant deviations were observed in knees that had imperfectly positioned implants (19 of 70, 27%), where the femoral component was inadequately impacted during surgery (15 of 19, 79%) and/or the tibial baseplate had an uneven cement distribution (8 of 19, 42%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The use of AR facilitates precise bone resections during TKA, yet it may not reduce deviations between intraoperative and postoperative LDFA, MPTA, HKA angle or PTS. As with any assistive technology, accurate bone resections alone are not sufficient to grant adequate implant positioning during TKA, which requires meticulous attention from surgeons to ensure sufficient component impaction and uniform cement distributions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>IV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70570","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145824820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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