Journal of Experimental Orthopaedics最新文献_第8页

Forecasting the value of innovation in total knee arthroplasty care: A headroom approach 预测全膝关节置换术护理创新的价值：一种净空方法。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-12-18 DOI: 10.1002/jeo2.70096

Thomas M. Otten, Sabine E. Grimm, Bram Ramaekers, Alex Roth, Pieter Emans, Tim Boymans, Maarten Janssen, Ralph Jeuken, Manuela A. Joore

Purpose

Total knee arthroplasty (TKA) is the standard treatment of end-stage osteoarthritis. TKA is often used and, therefore, poses a healthcare and societal burden, which is likely to increase further. Headroom analyses evaluate a technology under development by making assumptions about its effectiveness. This article applies a headroom approach to forecast the potential value of innovations that improve TKA-related care in the Netherlands in terms of cost-effectiveness and surgeries avoided.

Methods

A state-transition model estimating lifetime direct health effects, healthcare- and societal costs and percentage of avoide d surgeries was developed. The model compared care as usual to five hypothetical interventions to calculate the headroom associated with (1) preventing the need for TKAs, (2) preventing the need for all TKA revisions, (3) postponing TKAs without quality-of-life loss, (4) preventing periprosthetic joint infections (PJIs) and (5) improving patient satisfaction.

Results

Preventing the need for all TKAs amounted to €43,076 of headroom. Preventing the need for TKA revisions amounted to €2276 (5.8% of surgeries avoided), postponing TKAs by 5 years amounted to €7634 (32.4% of surgeries avoided), preventing PJIs amounted to €1187 (1.4% of surgeries avoided) and improving patient satisfaction amounted to €16,622 (0% of surgeries avoided). The headroom of each hypothetical intervention was highest in younger populations (<50 years of age).

Conclusion

There is a headroom for improving TKA-related care. Innovations to avoid or postpone TKA (i.e., joint-preserving treatments) as well as those that improve patient satisfaction can be effective in maximizing the value for money and avoiding surgeries. Due to the decreasing average patient age, innovations to reduce revision rates and PJIs will become more valuable as these are most effective in younger patients. It is currently unclear how cost-effectiveness considerations should be traded off against the prevention of surgery to reduce the increasing burden on the healthcare system.

Level of Evidence

Level III economic evaluation/decision-analytic model.

目的：全膝关节置换术是治疗终末期骨关节炎的标准方法。TKA经常被使用，因此造成了医疗保健和社会负担，这种负担可能会进一步增加。净空分析通过对一项正在开发的技术的有效性做出假设来评估该技术。这篇文章应用一个净空的方法来预测创新的潜在价值，提高tka相关的护理在荷兰的成本效益和手术避免方面。方法：建立了一个状态转换模型，估计终生直接健康影响、医疗保健和社会成本以及避免手术的百分比。该模型将常规护理与五种假设干预措施进行比较，以计算以下方面相关的剩余空间：(1)防止TKA的需要，(2)防止所有TKA修改的需要，(3)在不影响生活质量的情况下推迟TKA，(4)防止假体周围关节感染（PJIs）和(5)提高患者满意度。结果：预防所有tka所需的净空量为43,076欧元。预防TKA修订的需要达2276欧元（避免手术的5.8%），推迟TKA 5年达7634欧元（避免手术的32.4%），预防pji达1187欧元（避免手术的1.4%），提高患者满意度达16,622欧元（避免手术的0%）。在年轻人群中，每种假设干预的净空空间最高(结论：tka相关护理的改善仍有净空空间。避免或推迟TKA（即关节保留治疗）的创新以及提高患者满意度的创新可以有效地最大化物有所值并避免手术。由于患者平均年龄的下降，降低翻修率和pji的创新将变得更有价值，因为它们在年轻患者中最有效。目前尚不清楚如何权衡成本效益与预防手术之间的关系，以减轻医疗保健系统日益增加的负担。证据等级：三级经济评价/决策分析模型。

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引用次数: 0

Effectiveness of a large language model for clinical information retrieval regarding shoulder arthroplasty 大型语言模型对肩关节置换术临床信息检索的有效性。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-12-17 DOI: 10.1002/jeo2.70114

Jacob F. Oeding, Amy Z. Lu, Michael Mazzucco, Michael C. Fu, David M. Dines, Russell F. Warren, Lawrence V. Gulotta, Joshua S. Dines, Kyle N. Kunze

Purpose

To determine the scope and accuracy of medical information provided by ChatGPT-4 in response to clinical queries concerning total shoulder arthroplasty (TSA), and to compare these results to those of the Google search engine.

Methods

A patient-replicated query for ‘total shoulder replacement’ was performed using both Google Web Search (the most frequently used search engine worldwide) and ChatGPT-4. The top 10 frequently asked questions (FAQs), answers, and associated sources were extracted. This search was performed again independently to identify the top 10 FAQs necessitating numerical responses such that the concordance of answers could be compared between Google and ChatGPT-4. The clinical relevance and accuracy of the provided information were graded by two blinded orthopaedic shoulder surgeons.

Results

Concerning FAQs with numeric responses, 8 out of 10 (80%) had identical answers or substantial overlap between ChatGPT-4 and Google. Accuracy of information was not significantly different (p = 0.32). Google sources included 40% medical practices, 30% academic, 20% single-surgeon practice, and 10% social media, while ChatGPT-4 used 100% academic sources, representing a statistically significant difference (p = 0.001). Only 3 out of 10 (30%) FAQs with open-ended answers were identical between ChatGPT-4 and Google. The clinical relevance of FAQs was not significantly different (p = 0.18). Google sources for open-ended questions included academic (60%), social media (20%), medical practice (10%) and single-surgeon practice (10%), while 100% of sources for ChatGPT-4 were academic, representing a statistically significant difference (p = 0.0025).

Conclusion

ChatGPT-4 provided trustworthy academic sources for medical information retrieval concerning TSA, while sources used by Google were heterogeneous. Accuracy and clinical relevance of information were not significantly different between ChatGPT-4 and Google.

Level of Evidence

Level IV cross-sectional.

目的：确定ChatGPT-4在回应全肩关节置换术（TSA）临床查询时提供的医疗信息的范围和准确性，并将这些结果与谷歌搜索引擎的结果进行比较。方法：使用谷歌Web Search（全球最常用的搜索引擎）和ChatGPT-4对“全肩关节置换术”进行患者复制查询。提取了前10个常见问题（FAQs）、答案和相关来源。该搜索再次独立执行，以确定需要数字回答的前10个常见问题，以便可以比较谷歌和chatggt -4之间答案的一致性。两位盲法骨科肩部外科医生对所提供信息的临床相关性和准确性进行了评分。结果：在带有数字回答的常见问题中，ChatGPT-4和谷歌有80%的答案相同或有大量重叠。信息准确性差异无统计学意义（p = 0.32）。谷歌来源包括40%的医疗实践，30%的学术，20%的单一外科医生实践和10%的社交媒体，而ChatGPT-4使用100%的学术来源，代表统计学上显著差异（p = 0.001）。在ChatGPT-4和谷歌之间，只有3 / 10（30%）带有开放式答案的常见问题是相同的。常见问题的临床相关性无显著性差异（p = 0.18）。谷歌开放式问题的来源包括学术（60%）、社交媒体（20%）、医疗实践（10%）和单外科医生实践（10%），而ChatGPT-4的来源100%为学术，差异有统计学意义（p = 0.0025）。结论：ChatGPT-4为TSA医学信息检索提供了可靠的学术来源，而谷歌使用的来源具有异质性。ChatGPT-4和谷歌对信息的准确性和临床相关性无显著差异。证据等级：横截面ⅳ级。

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引用次数: 0

Medial opening low tibial osteotomy shifts the load laterally not only at the ankle joint but also at the knee joint 内侧开孔胫骨低位截骨术不仅在踝关节，而且在膝关节也使负荷向外侧移位。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-12-17 DOI: 10.1002/jeo2.70029

Yoshihiro Wanezaki, Hiroaki Kurokawa, Yuki Ueno, Adrian Tablante, Nan Mei, Li Yinghao, Akira Taniguchi, Akemi Suzuki, Yuya Takakubo, Michiaki Takagi, Yasuhito Tanaka

Purpose

The purpose of this study was to determine the effects of medial opening low tibial osteotomy (LTO) on lower limb alignment, including the knee joint, 1 year after low tibial osteotomy.

Methods

This study included 20 legs of 20 patients (mean age, 66.8 ± 5.4 years) who underwent LTO for medial ankle osteoarthritis and evaluated the changes in the hip–knee–ankle angle (HKA), percentage hip-to-ankle line (%HA), percentage hip-to-calcaneal line (%HC), medial proximal tibial angle (MPTA), knee joint line convergence angle (K-JLCA), tibio-calcaneal angle (TCA), tibial anterior surface angle (TAS), tibio-plafond inclination (TPI), talar inclination (TI), ankle joint line convergence angle (A-JLCA), mechanical ankle joint axis point (MAJAP) on radiographs and the Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale before and 1 year after low tibial osteotomy.

Results

The mean preoperative/postoperative measured values showed the following: HKA (degrees) of 1.0 ± 3.7/−0.8 ± 3.7; %HC of 38.8 ± 10.0/53.8 ± 16.1; MPTA (degrees) of 85.6 ± 2.4/87.6 ± 2.1; and A-JLCA (degrees) of 4.2 ± 2.9/1.1 ± 2.3 respectively. Including other measurements, a significant increase in the %HA, %HC, MPTA, TCA, TAS, MAJAP and JSSF ankle/hindfoot scale was observed postoperatively, whereas a significant decrease in the HKA, TPA, TI and A-JLCA was observed postoperatively (p < 0.05). With the numbers available, no significant differences were observed between the preoperative and postoperative values of K-JLCA (n.s.).

Conclusion

After LTO, the entire lower limb alignment became valgus, and the loading points of the knee and ankle joints shifted laterally. These changes must be considered when performing LTO, especially in patients with lateral knee OA.

Level of Evidence

Ⅳ

目的：本研究的目的是确定内侧开口胫骨低位截骨术（LTO）对胫骨低位截骨1年后包括膝关节在内的下肢对齐的影响。方法:本研究纳入20例（平均年龄66.8±5.4岁）因踝关节内侧骨性关节炎行LTO治疗的患者20条腿，评估髋关节-膝关节-踝关节角（HKA）、髋关节-踝关节线百分比（%HA）、髋关节-跟骨线百分比（%HC）、胫骨内侧近端角（MPTA）、膝关节线会聚角（K-JLCA）、胫骨-跟骨角（TCA）、胫骨前表面角（TAS）、胫骨平台倾角（TPI）、距骨倾角（TI）、膝关节内侧角（TPI）、膝关节内侧角（TPI）、膝关节内侧角（TI）、膝关节内侧角（TPI）、膝关节内侧角（TI）的变化。胫骨低位截骨前和术后1年的踝关节线会聚角（A-JLCA）、机械踝关节轴点（MAJAP）和日本足外科学会（JSSF）踝关节/后足量表。结果：术前/术后平均测量值：HKA（度）1.0±3.7/-0.8±3.7；%HC为38.8±10.0/53.8±16.1；MPTA（度）为85.6±2.4/87.6±2.1；A-JLCA（度）分别为4.2±2.9/1.1±2.3。包括其他测量在内，术后观察到%HA、%HC、MPTA、TCA、TAS、MAJAP和JSSF踝关节/后足量表显著升高，而术后观察到HKA、TPA、TI和a - jlca显著降低(p结论：LTO后，整个下肢直线外翻，膝关节和踝关节负荷点外侧移位。在进行LTO手术时必须考虑到这些变化，特别是对于侧膝OA患者。证据级别：Ⅳ。

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引用次数: 0

Mobile bearing total knee arthroplasty does not lead to better joint awareness compared to fixed bearing design: A systematic review and meta-analysis 与固定支座设计相比，移动支座全膝关节置换术并不会带来更好的关节知觉：系统回顾和荟萃分析。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-12-15 DOI: 10.1002/jeo2.70110

Mohammad Poursalehian, Yeganeh Pakbaz, Seyed Mohammad Javad Mortazavi

Purpose

Mobile-bearing total knee arthroplasty (MB-TKA) and fixed-bearing (FB) TKA are both widely used, with MB-TKA theoretically offering better functional outcomes due to its natural kinematics. This systematic review and meta-analysis aimed to compare joint awareness between MB-TKA and FB-TKA, as measured by Forgotten Joint Score-12 (FJS-12), to provide insights into patient-perceived outcomes.

Methods

A comprehensive literature search was conducted across major databases following PRISMA guidelines, without date or language restrictions. Studies focusing on TKA with MB or FB as the intervention and control groups, respectively, and reporting on FJS-12 were included. The selection process involved two independent reviewers. Data extraction was carried out using a structured checklist and assessed for quality using the Newcastle–Ottawa Scale (NOS). The meta-analysis employed Hedge's g method to compare FJS-12 and assessed publication bias using Egger's test and funnel plot analyses.

Results

Six studies, including two randomized clinical trials and four cohort studies with 731 participants and mean follow-up of 5.4 years, met the inclusion criteria. The meta-analysis revealed no significant difference in FJS-12 between MB and FB TKA (pooled difference = 0.132, 95% confidence interval: −0.103 to 0.367, p = 0.271), with moderate heterogeneity observed (I² = 53.5%). Publication bias assessment indicated no significant bias. Meta-regression did not identify factors contributing to heterogeneity.

Conclusion

MB-TKA does not provide superior patient-perceived outcomes in terms of joint awareness compared to FB-TKA. This suggests that the clinical advantage of MB-TKA in terms of joint awareness is likely negligible. Therefore, the choice between MB and FB TKA should be based on other considerations, such as surgeon preference, implant cost and individual patient needs.

Level of Evidence

Level III.

目的：活动轴承全膝关节置换术（MB-TKA）和固定轴承全膝关节置换术（FB）均被广泛应用，MB-TKA由于其天然的运动学特性，理论上具有更好的功能效果。本系统综述和荟萃分析旨在比较MB-TKA和FB-TKA之间的关节意识，以遗忘关节评分-12 （FJS-12）衡量，以提供患者感知结果的见解。方法：根据PRISMA指南在主要数据库中进行全面的文献检索，没有日期或语言限制。纳入以MB或FB分别作为干预组和对照组的TKA研究，并报道FJS-12。评选过程由两名独立评审员参与。使用结构化检查表进行数据提取，并使用纽卡斯尔-渥太华量表（NOS）评估质量。meta分析采用Hedge’s g方法比较FJS-12，采用Egger检验和漏斗图分析评估发表偏倚。结果：6项研究符合纳入标准，包括2项随机临床试验和4项队列研究，共731名受试者，平均随访5.4年。meta分析显示，MB和FB TKA的FJS-12无显著差异（合并差异= 0.132,95%可信区间：-0.103 ~ 0.367,p = 0.271），存在中等异质性（i2 = 53.5%）。发表偏倚评估显示无显著偏倚。meta回归没有确定导致异质性的因素。结论：与FB-TKA相比，MB-TKA在关节意识方面没有提供更好的患者感知结果。这表明MB-TKA在关节意识方面的临床优势可能可以忽略不计。因此，在MB和FB TKA之间的选择应基于其他考虑因素，如外科医生的偏好、植入物的成本和患者的个体需求。证据等级：三级。

{"title":"Mobile bearing total knee arthroplasty does not lead to better joint awareness compared to fixed bearing design: A systematic review and meta-analysis","authors":"Mohammad Poursalehian, Yeganeh Pakbaz, Seyed Mohammad Javad Mortazavi","doi":"10.1002/jeo2.70110","DOIUrl":"10.1002/jeo2.70110","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Mobile-bearing total knee arthroplasty (MB-TKA) and fixed-bearing (FB) TKA are both widely used, with MB-TKA theoretically offering better functional outcomes due to its natural kinematics. This systematic review and meta-analysis aimed to compare joint awareness between MB-TKA and FB-TKA, as measured by Forgotten Joint Score-12 (FJS-12), to provide insights into patient-perceived outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive literature search was conducted across major databases following PRISMA guidelines, without date or language restrictions. Studies focusing on TKA with MB or FB as the intervention and control groups, respectively, and reporting on FJS-12 were included. The selection process involved two independent reviewers. Data extraction was carried out using a structured checklist and assessed for quality using the Newcastle–Ottawa Scale (NOS). The meta-analysis employed Hedge's <i>g</i> method to compare FJS-12 and assessed publication bias using Egger's test and funnel plot analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six studies, including two randomized clinical trials and four cohort studies with 731 participants and mean follow-up of 5.4 years, met the inclusion criteria. The meta-analysis revealed no significant difference in FJS-12 between MB and FB TKA (pooled difference = 0.132, 95% confidence interval: −0.103 to 0.367, <i>p</i> = 0.271), with moderate heterogeneity observed (<i>I</i><sup>2</sup> = 53.5%). Publication bias assessment indicated no significant bias. Meta-regression did not identify factors contributing to heterogeneity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>MB-TKA does not provide superior patient-perceived outcomes in terms of joint awareness compared to FB-TKA. This suggests that the clinical advantage of MB-TKA in terms of joint awareness is likely negligible. Therefore, the choice between MB and FB TKA should be based on other considerations, such as surgeon preference, implant cost and individual patient needs.</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":"11 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11646548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830141","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}

引用次数: 0

A novel minimally invasive nonanatomical single-bundle medial collateral ligament reconstruction technique with a short isometric construct Achilles tendon allograft: A surgical description with clinical and radiological outcomes in multiligament knee injury patients 一种新型的微创非解剖单束内侧副韧带重建技术与短等距构造跟腱异体移植：多韧带膝关节损伤患者的临床和放射学结果的外科描述。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-12-15 DOI: 10.1002/jeo2.70076

Mohammadreza Minator Sajjadi, Alireza Mirahmadi, Vahid Alizad, Mohammedhasan Dabis, Ali Saeidi, Mohammad Movahedinia

Purpose

Multiligament knee injuries (MLKIs) involve various ligaments in the knee. Current double-bundle anatomical reconstructions of the medial collateral ligament (MCL) increase the level of technical complexity, often resulting in the establishment of numerous bone tunnels and different fixation points with additional hardware. To overcome these limitations, we proposed a novel minimally invasive nonanatomical MCL reconstruction with one tibial tunnel in the metaphysis using Achilles allograft in the MLKI setting.

Methods

In a retrospective study, we enroled 24 patients with MLKIs who underwent a new single-strand short isometric construct (SIC) nonanatomical MCL reconstruction during 2020 and 2021. We fixed an Achilles allograft in one tunnel in the distal femur on the medial epicondyle and one tunnel in the metaphyseal part of the tibia using interference screws at 2 cm below the joint line between the anatomical insertion of the superficial MCL and the posterior oblique ligament. The patients underwent clinical and radiological assessment at the last follow-up, 1–2 years after the operation, including valgus stress radiographs, range of motion (ROM), Lysholm and International Knee Documentation Committee (IKDC) scores.

Results

The mean postoperative IKDC score was 77.8 (range, 50.1–86.6). The mean Lysholm score was 84.1 ± 11.9 (range, 96–59). The medial knee widening difference (i.e., mean side-to-side difference under valgus stress x-ray) was measured to be 1.2 mm on average. Only two patients (8%) had ROM limitation of 20° in knee flexion, one of which had surgery failure. Results showed a significant statistical difference between the patients' outcomes according to the number of involved ligaments.

Conclusions

This novel SIC-like technique with a single tibial metaphyseal tunnel demonstrated satisfactory patient-reported outcome measures, valgus stress radiographs, ROM and a low rate of knee stiffness and graft failure. While the number of injured ligaments in MLKI patients significantly influenced the outcomes, the results remained acceptable across all patients.

Level of Evidence

Level IV.

目的：膝关节多韧带损伤（MLKIs）涉及膝关节的各种韧带。目前的内侧副韧带（MCL）双束解剖重建增加了技术的复杂性，往往导致建立许多骨隧道和使用额外硬件的不同固定点。为了克服这些局限性，我们提出了一种新颖的微创非解剖 MCL 重建方法，即在 MLKI 环境下使用跟腱异体移植物在干骺端建立一个胫骨隧道：在一项回顾性研究中，我们招募了24名MLKI患者，他们在2020年和2021年期间接受了新的单股短等长结构（SIC）非解剖MCL重建术。我们在股骨远端内上髁上的一个隧道和胫骨干骺端上的一个隧道中使用过盈螺钉固定了跟腱异体移植物，过盈螺钉位于 MCL 浅层解剖插入部和后斜韧带之间的关节线下 2 厘米处。患者在术后1-2年的最后一次随访中接受了临床和放射学评估，包括外翻应力X光片、活动范围（ROM）、Lysholm和国际膝关节文献委员会（IKDC）评分：术后IKDC平均评分为77.8分（范围为50.1-86.6分）。Lysholm 评分的平均值为 84.1 ± 11.9（范围为 96-59）。经测量，膝关节内侧增宽差（即外翻应力X光片下的平均侧对侧差值）平均为1.2毫米。只有两名患者（8%）膝关节屈曲活动度受限达20°，其中一名患者手术失败。结果显示，根据受累韧带的数量，患者的治疗效果存在明显的统计学差异：结论：这种采用单一胫骨骺隧道的新型 SIC 类技术在患者报告结果、外翻应力X光片、膝关节活动度、膝关节僵硬率和移植物失败率方面均令人满意。虽然MLKI患者受伤韧带的数量对结果有很大影响，但所有患者的结果都是可以接受的：证据等级：IV 级。

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引用次数: 0

Three-dimensional computerized tomography reconstruction-based morphologic assessment of the coracoid process in an Asian population: Clinical implications for shoulder surgery 亚洲人群中基于三维计算机断层重建的喙突形态学评估：肩关节手术的临床意义。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-12-15 DOI: 10.1002/jeo2.70109

Tongyue Ji, Su Yan, Chao Lu, Hao Shu, Luning Sun

<div> <section> <h3> Purpose</h3> <p>To assess coracoid process morphology in an Asian population using three-dimensional (3D) computed tomography (CT) reconstruction and provide reference values for surgical treatment.</p> </section> <section> <h3> Methods</h3> <p>Data on demographic and shoulder CT characteristics were collected from 142 patients for 3D-CT-based scapular reconstruction. Ten coracoid morphological indicators and the glenoid width were measured. The morphology of the superior pillar and its undersurface were classified into common shapes. Statistical analyses included intraclass correlation coefficient (ICC) analysis, Cohen's <i>κ</i> value, independent samples <i>t</i> test, Welch's <i>t</i> test, Mann–Whitney <i>U</i> test, Kruskal–Wallis test, Spearman and Pearson correlations, receiver operating characteristic (ROC) curves and area under the curve (AUC) values. Relationships among the measured indicators, patient demographics (i.e., sex, age, height and weight) and superior pillar morphology were ascertained.</p> </section> <section> <h3> Results</h3> <p>The intraobserver and interobserver ICC values were 0.924–0.980 and 0.906–0.962, respectively. For intraobserver and interobserver agreement, Cohen's <i>κ</i> values were 0.927–0.950 and 0.901–0.937, respectively. Significant sex differences in coracoid measurements were noted. Correlations were observed between the coracoid indicators and glenoid width, sex, height and weight (<i>p</i> < 0.05). ROC curve analysis identified height as a significant predictor of safe distance, with cutoff values of 160.5 and 170.5 cm (AUC = 0.82 and 0.83) for women and men, respectively. The superior pillar morphologies included violin (24.65%), long rod (21.13%), short rod (33.80%), trapezoidal (11.97%) and wedge (8.45%) shapes, with the undersurfaces categorized as straight (16.20%), arched (76.76%) and hooked (7.04%), with significant differences in pillar widths among the different morphological types (<i>p</i> < 0.05).</p> </section> <section> <h3> Conclusion</h3> <p>Coracoid morphology is crucial in the preoperative planning of given shoulder surgeries, with height and sex serving as key predictors of coracoid graft length. Consideration of variations in the superior pillar shape and undersurface of the coracoid could minimize surgical complications associated with special shoulder surgery.</p> </section> <section> <h3> Level of Evidence</h3> <p>Level IV case series with no compariso

目的：利用三维（3D）计算机断层扫描（CT）重建亚洲人群的喙突形态，为外科治疗提供参考价值。方法：收集142例患者的人口学数据和肩部CT特征，进行基于3d -CT的肩胛骨重建。测量10项喙形形态学指标及关节盂宽度。上矿柱和下矿柱的形态被划分为常见的形态。统计分析包括类内相关系数（ICC）分析、Cohen’s κ值、独立样本t检验、Welch’st检验、Mann-Whitney U检验、Kruskal-Wallis检验、Spearman和Pearson相关性、受试者工作特征（ROC）曲线和曲线下面积（AUC）值。确定测量指标、患者人口统计学（即性别、年龄、身高和体重）和优势支柱形态之间的关系。结果：观察者内和观察者间的ICC值分别为0.924 ~ 0.980和0.906 ~ 0.962。对于观察者内部和观察者之间的一致性，Cohen’s κ值分别为0.927-0.950和0.901-0.937。在喙形测量中发现了显著的性别差异。结论：肩关节手术术前，肩关节宽度、性别、身高、体重与喙骨形态相关，而身高、性别是喙骨移植物长度的关键预测因素。考虑到上柱形状和喙下表面的变化可以最大限度地减少特殊肩部手术相关的手术并发症。证据级别：没有比较的IV级病例系列。

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引用次数: 0

Quadriceps muscle strength of the affected limb in medial meniscus posterior root tears is negatively correlated with the progression of postoperative medial joint space narrowing 内侧半月板后根撕裂患者患肢的股四头肌肌力与术后内侧关节间隙狭窄的进展呈负相关。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-12-12 DOI: 10.1002/jeo2.70057

Koki Kawada, Mikao Fukuba, Yuki Okazaki, Masanori Tamura, Yusuke Yokoyama, Toshifumi Ozaki, Takayuki Furumatsu

Purpose

The effect of quadriceps muscle strength on medial joint space (MJS) narrowing after repair for medial meniscus (MM) posterior root tears (MMPRTs) has not yet been determined. This study aimed to evaluate the effect of preoperative and postoperative quadriceps muscle strength on the change in MJS (ΔMJS) in MMPRTs.

Methods

Thirty patients who underwent pullout repair for MMPRTs were retrospectively evaluated. The MJS width using fixed-flexion view radiographs, MM extrusion (MME) using magnetic resonance imaging, quadriceps muscle strength using the Locomo Scan-II and clinical scores were measured and compared preoperatively and 1 year postoperatively. Correlations between the ΔMJS, change in MME (ΔMME), and preoperative and postoperative quadriceps muscle strength were evaluated using Spearman's rank correlation coefficient.

Results

MJS narrowing and MME progressed significantly at 1 year postoperatively (p < 0.001). Quadriceps muscle strength in MMPRT knees and all clinical scores significantly improved at 1 year postoperatively (p < 0.001). ΔMJS and ΔMME showed a significant positive correlation (0.50 ± 0.70 and 1.22 ± 0.92 mm, respectively; r = 0.516, p = 0.004). Both preoperative and postoperative quadriceps muscle strength in MMPRT knees showed significant negative correlations with ΔMJS (preoperative: r = −0.529, p = 0.003; postoperative: r = −0.477, p = 0.008) and ΔMME (preoperative: r = −0.431, p = 0.018; postoperative: r = −0.443, p = 0.014).

Conclusions

In pullout repair for MMPRTs, preoperative and postoperative quadriceps muscle strength in MMPRT knees was negatively correlated with the progression of MJS narrowing and MME. Rehabilitation with a focus on quadriceps muscle strengthening, including preoperative rehabilitation, may delay knee-osteoarthritis progression after pullout repair for MMPRTs.

Level of Evidence

Level IV.

目的：股四头肌力量对内侧半月板（MM）后根撕裂（MMPRTs）修复后内侧关节间隙（MJS）狭窄的影响尚未确定。本研究旨在评估术前和术后股四头肌力量对MMPRTs中MJS变化的影响（ΔMJS）。方法：对30例MMPRTs拔牙修复患者进行回顾性分析。采用固定屈曲透视片测量MJS宽度，采用磁共振成像测量MM挤压（MME），采用Locomo Scan-II测量股四头肌力量和临床评分，并对术前和术后1年进行比较。使用Spearman等级相关系数评估ΔMJS、MME变化（ΔMME）与术前和术后股四头肌肌力之间的相关性。结果：术后1年MJS变窄和MME进展明显（p pr = 0.516, p = 0.004）。MMPRT膝关节术前和术后股四头肌肌力与ΔMJS呈显著负相关(术前：r = -0.529, p = 0.003；术后：r = -0.477, p = 0.008)和ΔMME(术前：r = -0.431, p = 0.018；术后：r = -0.443, p = 0.014)。结论：在MMPRT拔除修复中，术前和术后MMPRT膝关节的股四头肌肌力与MJS变窄和mme的进展呈负相关。康复以股四头肌肌肉强化为重点，包括术前康复，可能会延迟MMPRT拔除修复后膝关节骨性关节炎的进展。证据等级：四级。

{"title":"Quadriceps muscle strength of the affected limb in medial meniscus posterior root tears is negatively correlated with the progression of postoperative medial joint space narrowing","authors":"Koki Kawada, Mikao Fukuba, Yuki Okazaki, Masanori Tamura, Yusuke Yokoyama, Toshifumi Ozaki, Takayuki Furumatsu","doi":"10.1002/jeo2.70057","DOIUrl":"10.1002/jeo2.70057","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The effect of quadriceps muscle strength on medial joint space (MJS) narrowing after repair for medial meniscus (MM) posterior root tears (MMPRTs) has not yet been determined. This study aimed to evaluate the effect of preoperative and postoperative quadriceps muscle strength on the change in MJS (ΔMJS) in MMPRTs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Thirty patients who underwent pullout repair for MMPRTs were retrospectively evaluated. The MJS width using fixed-flexion view radiographs, MM extrusion (MME) using magnetic resonance imaging, quadriceps muscle strength using the Locomo Scan-II and clinical scores were measured and compared preoperatively and 1 year postoperatively. Correlations between the ΔMJS, change in MME (ΔMME), and preoperative and postoperative quadriceps muscle strength were evaluated using Spearman's rank correlation coefficient.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>MJS narrowing and MME progressed significantly at 1 year postoperatively (<i>p</i> < 0.001). Quadriceps muscle strength in MMPRT knees and all clinical scores significantly improved at 1 year postoperatively (<i>p</i> < 0.001). ΔMJS and ΔMME showed a significant positive correlation (0.50 ± 0.70 and 1.22 ± 0.92 mm, respectively; <i>r</i> = 0.516, <i>p</i> = 0.004). Both preoperative and postoperative quadriceps muscle strength in MMPRT knees showed significant negative correlations with ΔMJS (preoperative: <i>r</i> = −0.529, <i>p</i> = 0.003; postoperative: <i>r</i> = −0.477, <i>p</i> = 0.008) and ΔMME (preoperative: <i>r</i> = −0.431, <i>p</i> = 0.018; postoperative: <i>r</i> = −0.443, <i>p</i> = 0.014).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In pullout repair for MMPRTs, preoperative and postoperative quadriceps muscle strength in MMPRT knees was negatively correlated with the progression of MJS narrowing and MME. Rehabilitation with a focus on quadriceps muscle strengthening, including preoperative rehabilitation, may delay knee-osteoarthritis progression after pullout repair for MMPRTs.</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":"11 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11638345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830151","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}

引用次数: 0

Arthroscopic meniscal surgery in Norway from 2010 to 2020: A paradigmatic shift 从2010年到2020年，挪威的关节镜半月板手术：一个典型的转变。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-12-12 DOI: 10.1002/jeo2.70113

Karoline Nysted Nilsen, Frank-David Øhrn, Asbjørn Årøen, Tor Åge Myklebust, Tommy Frøseth Aae

Purpose

Meniscal injuries in the knee are usually treated surgically with arthroscopic partial resection (APR) or arthroscopic repair (AR). APR has been shown to increase the risk of osteoarthritis and the focus has shifted to repairing the meniscus with AR. The extent of this shift is yet to be established and an analysis of incidence rates (IR) of APR and AR for meniscal injuries could highlight this.

Methods

Data from the Norwegian Patient Registry (NPR) and Statistics Norway (SN) from 2010 to 2020 were collected. The number of procedures, demographics and facilities providing meniscal surgery were obtained from NPR, while population size and catchment area were collected from SN. IR of APR and AR and APR/AR rate ratios were estimated and compared.

Results

A total of 119,528 knee arthroscopies were performed, 89.6% of which were APR. The number of APR performed nationally decreased by 72%, while AR procedures increased by 178%. The national IR of APR decreased from 298 to 82/100,000 inhabitants (p < 0.001). For AR, the national IR increased annually from 13/100,000 inhabitants to a peak in 2019 of 32/100,000 inhabitants (p < 0.001). The APR/AR rate ratio decreased from 22 to below five and the APR/AR trend curves showed a statistically significant decrease (p < 0.001).

Conclusion

Surgical treatment of meniscal injuries has changed, with a substantial reduction in APR and a strong increase in AR. The reduction in APR, especially in older patients, suggests that meniscal surgery in Norway has undergone a paradigmatic shift, in line with recent literature.

Level of Evidence

Level IV.

目的：膝关节半月板损伤通常采用关节镜部分切除（APR）或关节镜修复（AR）手术治疗。APR已被证明会增加骨关节炎的风险，并且焦点已经转移到用AR修复半月板上。这种转移的程度尚未确定，对半月板损伤的APR和AR的发病率（IR）的分析可以突出这一点。方法：收集2010 - 2020年挪威患者登记处（NPR）和挪威统计局（SN）的数据。提供半月板手术的手术数量、人口统计数据和设施来自NPR，而人口规模和集水区面积来自SN。估算并比较了APR和AR的IR以及APR/AR比率。结果：共进行膝关节镜检查119,528例，其中APR手术占89.6%，全国APR手术数量下降72%，而AR手术数量增加178%。结论：半月板损伤的手术治疗发生了变化，APR大幅降低，AR大幅增加。APR的降低，特别是在老年患者中，表明挪威的半月板手术经历了一个典型的转变，与最近的文献一致。证据等级：四级。

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引用次数: 0

Leveraging transfer learning for predicting total knee arthroplasty failure from post-operative radiographs 利用迁移学习从术后x线片预测全膝关节置换术失败。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-12-11 DOI: 10.1002/jeo2.70097

Anna Corti, Sarah Galante, Rebecca Rauch, Katia Chiappetta, Valentina Corino, Mattia Loppini

Purpose

The incidence of both primary and revision total knee arthroplasty (TKA) is expected to rise, making early recognition of TKA failure crucial to prevent extensive revision surgeries. This study aims to develop a deep learning (DL) model to predict TKA failure using radiographic images.

Methods

Two patient cohorts who underwent primary TKA were retrospectively collected: one was used for the model development and the other for the external validation. Each cohort encompassed failed and non-failed subjects, according to the need for TKA revision surgery. Moreover, for each patient, one anteroposterior and one lateral radiographic view obtained during routine TKA follow-up, were considered. A transfer learning fine-tuning approach was employed. After pre-processing, the images were analyzed using a convolutional neuronal network (CNN) that was originally developed for predicting hip prosthesis failure and was based on the Densenet169 pre-trained on Imagenet. The model was tested on 20% of the images of the first cohort and externally validated on the images of the second cohort. Metrics, such as accuracy, sensitivity, specificity and area under the receiving operating characteristic curve (AUC), were calculated for the final assessment.

Results

The trained model correctly classified 108 out of 127 images in the test set, providing a classification accuracy of 0.85, sensitivity of 0.80, specificity of 0.89 and AUC of 0.86. Moreover, the model correctly classified 1547 out of 1937 in the external validation set, providing a balanced accuracy of 0.79, sensitivity of 0.80, specificity of 0.78 and AUC of 0.86.

Conclusions

The present DL model predicts TKA failure with moderate accuracy, regardless of the cause of revision surgery. Additionally, the effectiveness of the transfer learning fine-tuning approach, leveraging a previously developed DL model for hip prosthesis failure, has been successfully demonstrated.

Level of Evidence

Level III, diagnostic study.

目的：原发性和翻修性全膝关节置换术（TKA）的发生率预计会上升，因此早期识别TKA失败对于防止广泛翻修手术至关重要。本研究旨在开发一种深度学习（DL）模型，利用放射影像预测TKA失效。方法：回顾性收集两组接受原发性TKA的患者：一组用于模型开发，另一组用于外部验证。根据TKA翻修手术的需要，每个队列包括失败和未失败的受试者。此外，考虑到每个患者在常规TKA随访期间获得的一个正位和一个侧位x线片。采用迁移学习微调方法。预处理后，使用卷积神经网络（CNN）对图像进行分析，该网络最初是用于预测髋关节假体失效，并基于在Imagenet上预训练的Densenet169。该模型在第一组的20%的图像上进行了测试，并在第二组的图像上进行了外部验证。计算准确度、灵敏度、特异性和接收工作特征曲线下面积等指标，以进行最终评估。结果：训练后的模型对测试集中127张图像中的108张进行了正确分类，分类精度为0.85，灵敏度为0.80，特异性为0.89，AUC为0.86。此外，该模型在外部验证集中正确分类了1937个样本中的1547个，平衡精度为0.79，灵敏度为0.80，特异性为0.78，AUC为0.86。结论：目前的DL模型预测TKA失败具有中等准确度，与翻修手术的原因无关。此外，迁移学习微调方法的有效性，利用先前开发的髋关节假体失败的DL模型，已被成功证明。证据等级：III级，诊断性研究。

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引用次数: 0

Limited evidence for the usage of renin–angiotensin–aldosterone pathway blockers to prevent arthrofibrosis after total knee arthroplasty. A systematic review of clinical evidence 使用肾素-血管紧张素-醛固酮途径阻滞剂预防全膝关节置换术后关节纤维化的证据有限。临床证据的系统回顾。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-12-11 DOI: 10.1002/jeo2.70089

Giuseppe Anzillotti, Andreas H. Gomoll, Pietro Conte, Alberto Bulgarelli, Paolo Queirazza, Maurilio Marcacci, Elizaveta Kon, Berardo Di Matteo

Purpose

Despite advances in surgical techniques and rehabilitation protocols, arthrofibrosis following total knee arthroplasty (TKA) still has poor outcomes. In the last decade, attention has been focused on the pathogenesis and cascade of events leading to the development of fibrosis. Currently, one of the most promising approaches consists in the indirect antagonisation of transforming growth factor beta 1 (TGF-beta 1) through the downregulation of the renin–angiotensin–aldosterone system (RAAS). This systematic review aims to analyse the available evidence regarding the use of angiotensin receptor blockers (ARBs)/angiotensin-converting-enzyme inhibitors (ACEi) in order to prevent post-operative knee arthrofibrosis following TKA.

Methods

Extensive research on the PubMed, Cochrane, and Google Scholar databases was performed on 8 July 2024, using keywords related to ARBs, ACE inhibitors and arthrofibrosis. Inclusion criteria included: (1) clinical trials of any level of evidence; (2) written in English; (3) studies conducted on humans; and (4) evaluating the antifibrotic effects of ACE inhibitors or ARBs administered for TKA surgeries. Exclusion criteria were articles written in other languages; preclinical studies; expert opinions; reviews and trials evaluating the effects of ACEi/ARBs not related to their antifibrotic effect after TKA.

Results

A total of six studies met the inclusion criteria and were analysed. All studies were retrospective and involved a total of 158,310 patients. Time of administration varied among the studies as well as the dosage, which fell within the range for cardiological use. Four out of six studies focused exclusively on losartan. Three studies reported a clear, significant correlation between the use of ARBs and/or ACEi and a reduced likelihood of developing arthrofibrosis.

Conclusions

The RAAS antagonism could have potential for stiffness prevention after TKA. However, given the side effects and the limited evidence available, the use of ACEi/sartans for the sole purpose of avoiding arthrofibrosis after TKA is not currently recommended.

Level of Evidence

Level III.

目的：尽管手术技术和康复方案取得了进步，但全膝关节置换术（TKA）后关节纤维化的预后仍然很差。在过去的十年中，人们的注意力一直集中在导致纤维化发展的发病机制和级联事件上。目前，最有希望的方法之一是通过下调肾素-血管紧张素-醛固酮系统（RAAS）间接拮抗转化生长因子β 1 （tgf - β 1）。本系统综述旨在分析血管紧张素受体阻滞剂(ARBs)/血管紧张素转换酶抑制剂（ACEi）用于预防TKA术后膝关节纤维化的现有证据。方法：于2024年7月8日对PubMed、Cochrane和谷歌Scholar数据库进行广泛研究，使用与arb、ACE抑制剂和关节纤维化相关的关键词。纳入标准包括：(1)任何证据水平的临床试验；（二）用英文书写的；（三）人体研究；(4)评估TKA手术中ACE抑制剂或arb的抗纤维化作用。排除标准是用其他语言写的文章；临床前研究;专家意见;评价与TKA后抗纤维化作用无关的ACEi/ arb效果的综述和试验。结果：共有6项研究符合纳入标准并进行了分析。所有研究均为回顾性研究，共涉及158,310例患者。在不同的研究中，给药时间和剂量各不相同，但都在心脏病学使用的范围内。六项研究中有四项专门针对氯沙坦。三项研究报告了使用arb和/或ACEi与降低发生关节纤维化的可能性之间明确且显著的相关性。结论：RAAS拮抗剂可能具有预防TKA术后僵硬的作用。然而，考虑到副作用和现有证据有限，目前不推荐将ACEi/sartans作为TKA后避免关节纤维化的唯一目的。证据等级：三级。

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引用次数: 0