Archives of Bone and Joint Surgery-ABJS最新文献

Objectives: The aim of the current study was to investigate the inter-tester reliability of the MSI classification test items in patients with neck pain.

Methods: sixty subjects with neck pain (18-65 years) participated in this cross-sectional study. The examination of each patient, included the evaluation of signs and symptoms during posture and movement tests and the MSI diagnosis of subjects with cervical pain, was performed simultaneously by three testers in one session. Kappa and gamma values were used to determine the measure of agreement between testers for each of the test items and classification judgment.

Results: The kappa values for inter-tester reliability of the sign items ranged from 0.36 to 1. For the symptom items kappa values ranged from 0.36 to 1. The kappa values of inter-tester reliability for patients' classification judgments ranged from 0.71 to 0.73.

Conclusion: The inter-tester reliability between three testers according to the MSI approach for neck pain classification, sign and symptom was generally acceptable.

Objectives: The major emphasis of physical therapy in patient evaluation is the assessment of physical function, and the Patient-Specific Functional Scale (PSFS) is one of the most commonly used instruments for this purpose. Therefore, the present study aims to translate and cross-culturally adapt the PSFS into Persian and test its psychometric properties in patients with chronic low back pain (CLBP).

Methods: The PSFS was translated from English to Persian and cross-culturally adapted in accordance with the study by Beaton et al. Psychometric properties of 100 CLBP patients were assessed. Reliability (internal consistency and test-retest) was examined for 32 participants who completed the Persian version of the PSFS (PSFS-P) twice with one week interval. Construct validity was assessed against the Persian versions of the Oswestry Disability Index (ODI-P) and the Numerical Pain Rating Scale (NPRS-P).

Results: The PSFS-P showed excellent reliability (Cronbach's alpha=0.88, intraclass correlation coefficient [ICC _{3, 1}] =0.95, 95% CI [0.87 to 0.98]). The construct validity analysis revealed a moderate negative correlation between PSFS-P and NPRS-P (r=-0.47) and a high negative correlation between PSFS-P and ODI-P (r=-0.61). The PSFS-P showed no floor and ceiling effects.

Conclusion: The PSFS-P has adequate psychometric properties and is applicable in both clinical settings and research involving the Iranian population with CLBP.

Objectives: The aim of this study is to quantitatively investigate the accuracy of text generated by AI large language models while comparing their readability and likelihood of being accepted to a scientific compared to human-authored papers on the same topics.

Methods: The study consisted of two papers written by ChatGPT, two papers written by Assistant by scite, and two papers written by humans. A total of six independent reviewers were blinded to the authorship of each paper and assigned a grade to each subsection on a scale of 1 to 4. Additionally, each reviewer was asked to guess if the paper was written by a human or AI and explain their reasoning. The study authors also graded each AI-generated paper based on factual accuracy of the claims and citations.

Results: The human-written calcaneus fracture paper received the highest score of a 3.70/4, followed by Assistant-written calcaneus fracture paper (3.02/4), human-written ankle osteoarthritis paper (2.98/4), ChatGPT calcaneus fracture (2.89/4), ChatGPT Ankle Osteoarthritis (2.87/4), and Assistant Ankle Osteoarthritis (2.78/4). The human calcaneus fracture paper received a statistically significant higher rating than the ChatGPT calcaneus fracture paper (P = 0.028) and the Assistant calcaneus fracture paper (P = 0.043). The ChatGPT osteoarthritis review showed 100% factual accuracy, the ChatGPT calcaneus fracture review was 97.46% factually accurate, the Assistant calcaneus fracture was 95.56% accurate, and the Assistant ankle osteoarthritis was 94.98% accurate. Regarding citations, the ChatGPT ankle osteoarthritis paper was 90% accurate, the ChatGPT calcaneus fracture was 69.23% accurate, the Assistant ankle osteoarthritis was 35.14% accurate, and the Assistant calcaneus fracture was 39.68% accurate.

Conclusion: Through this paper we emphasize that while AI holds the promise of enhancing knowledge sharing, it must be used responsibly and in conjunction with comprehensive fact-checking procedures to maintain the integrity of the scientific discourse.

The objective of this paper is to carry out a review of the literature on the contemporary situation of total ankle replacement (TAR) in people with hemophilia (PWH). A search was performed in PubMed on December 29, 2024, utilizing the keywords "hemophilia" and "total ankle replacement." To date solely 8 papers (136 TARs) in 103 PWH have been reported. All published series showed improvement in preoperative pain and function. However, the complication rate was 8.8% (intra-operative fractures of the medial malleolus, delayed wound healings, hematomas). Additional surgery is required in 5.1% of the TARs implanted (ankle arthrolysis due to painful arthrofibrosis, major surgeries, revision surgeries). The estimated 10-year survival free of any TAR removal or ankle fusion (AF) is 92.2%. Regarding the controversy AF or TAR in PWH, a recent systematic review and meta-analysis have found similar clinical results and rates of adverse events between TAR and AF in PWH.

Objectives: Despite the extensive research revolving around total knee arthroplasty (TKA), the optimal steroid administration route remains unclear. This study aimed to compare the clinical efficacy of intravenous (IV) to periarticular (PA) steroid administration in TKA.

Methods: Embase, PubMed, Cochrane, and Google Scholar were searched till April 2024 for randomized controlled trials (RCT) comparing IV to PA steroids in TKA. Each trial was assessed using the Cochrane risk-of-bias tool and classified as having a High, Low, or Unclear risk of bias. The clinical outcomes of interest were post-operative pain (reported as the Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS)), vomiting, post-operative range of motion (reported as knee flexion angle), post-operative IL-6 and CRP, and glucose levels. Post-operative complications such as surgical site or deep infections, and wound dehiscence following TKA were also recorded and assessed.

Results: Five RCTs with a total of 501 patients were included in this review. There were no significant differences in pain at rest on post-operative day (POD) 1 and 2 and during activity between PA and IV administration, while pain at rest on POD 3 was lower in the PA group (I2 =38% SMD=-0.27; 95% CI: -0.5, -0.04, P=0.02). Post-operative complications, knee flexion, and laboratory values such as IL-6, CPR, and glucose showed no significant difference between the groups, while vomiting rates were significantly higher in the PA group (I2= 0% OR=2.43; 95% CI: 1.36-4.35, P=0.003).

Conclusion: PA and IV peri-operative administration of glucocorticoids in TKA have similar clinical outcomes in inflammation reduction, knee flexion function, adverse event rates, and post-operative pain at rest during the first 48 hours post-operatively and at activity, while the PA group is associated with lower pain at rest on POD 3 and a higher rate of post-operative vomiting.

Objectives: Management of acromioclavicular (AC) joint injuries remains controversial regarding ideal surgical indications and technique. While loss of reduction following AC reconstruction is common, its relationship to clinical outcomes is uncertain. The purpose of this study was to evaluate outcomes and potential predictors of suboptimal results in patients with structural failure following AC reconstruction.

Methods: Patients with structural failure following AC reconstruction from 2013-2019 were identified, defined as 50% loss of coronal AC joint reduction between immediate and final postoperative radiographs. Failures were categorized by degree of displacement and mechanism, which included traumatic reinjury versus spontaneous subsidence of AC reduction. Suboptimal clinical outcomes were defined as undergoing reoperation or postoperative American Shoulder and Elbow Surgeons (ASES) score less than 80. Bivariate analyses were performed to identify risk factors for suboptimal clinical results and compare outcomes between operative versus nonoperative management of structural failure.

Results: Twenty-nine patients were evaluated with mean follow-up of 7.4 years (range 4.0-10.5 years). 21% underwent revision surgery (n = 6) and 79% were treated nonoperatively (n = 23). Mean postoperative ASES, Numerical Rating Scale (NRS), and Single Assessment Numeric Evaluation (SANE) scores at final follow-up were 82 +/- 20 (range 33-100), 1.6 +/- 2.2 (range 0-7), and 82 +/- 20 (range 22-100) respectively. 41% of the total cohort (n = 12) had a suboptimal clinical result. On bivariate analysis, structural failure following acute reinjury was associated with suboptimal clinical outcomes (50% vs 6%, p = 0.011) and a higher likelihood of reoperation (67% vs 13%, p = 0.018).

Conclusion: Structural failures of AC reconstruction following an acute injury are more likely to experience suboptimal clinical outcomes and undergo reoperation compared to spontaneous loss of reduction. Larger analyses are warranted to determine if there are additional factors which may affect outcomes and guide management in these clinical scenarios.

Objectives: Forward head posture (FHP) is one of the most common postural disorders affecting the head and neck region, typically assessed by measuring the craniovertebral angle (CVA). Selecting an appropriate tool for quantifying this angle is crucial. The primary aim of the present study was to evaluate the reliability of ImageJ software in assessing the CVA in participants with and without neck pain.

Methods: The study included twenty participants with neck pain and twenty without. Reflective markers were placed on the tragus of the ear and the spinous process of C7. Three lateral images were captured from the dominant side while the participants were seated, with measurements taken at two-hour and one-week intervals. The craniovertebral angle (CVA) was then analyzed using ImageJ software.

Results: The Intraclass Correlation Coefficient (ICC) values for both within-day and between-day reliability in both groups ranged from 0.89 to 0.94. The Standard Error of Measurement (SEM) ranged from 0.92° to 1.02°, while the Minimal Detectable Change (MDC) values ranged from 2.56° to 2.84°. Furthermore, the absolute Technical Error of Measurement (TEM) ranged from 0.91° to 1.06°, and the relative TEM (rTEM) ranged from 2.13% to 2.42%.

Conclusion: ImageJ software appears to be a suitable tool for assessing the craniovertebral angle (CVA) in individuals with or without neck pain, demonstrating good to excellent reliability.

Objectives: Bone sarcomas are rare, aggressive tumors with poor outcomes and limited systemic options in advanced stages. This systematic review and meta-analysis evaluated its efficacy and safety in bone sarcomas using randomized controlled trials (RCTs).

Methods: We searched PubMed, Scopus, and Web of Science for RCTs published from September 27, 2012, to October 14, 2024. After removing duplicates, 350 records were screened, and five RCTs met the inclusion criteria. Primary outcomes were progression-free survival (PFS), overall survival (OS), and adverse events (AEs). Study quality was assessed using the Cochrane Risk of Bias 2 (RoB2) tool. Meta-analyses were performed with a random-effects model, and heterogeneity was evaluated using I² statistics. All analyses were conducted using R version 4.3.1.

Results: A total of 350 records were screened after duplicate removal, of which 339 were excluded based on title and abstract. Eleven full-text articles were assessed for eligibility, and six were excluded for not meeting RCT criteria, resulting in five RCTs being included. Most had metastatic disease at baseline. Regorafenib significantly improved PFS (MD = 9.69 weeks; 95% CI: 4.54-14.84; I² = 0%), with no statistically significant overall survival (OS) benefit (MD = 0.85 weeks; 95% CI: -36.33 to 38.02; I² = 0%). These findings were consistent across studies and histological subtypes. All pooled analyses demonstrated zero or near-zero heterogeneity (I² = 0%), indicating highly consistent treatment effects among trials. No significant between-group heterogeneity was observed in subgroup analyses, confirming that regorafenib's benefit on progression-free survival was stable across different bone sarcoma types. Common regorafenib-related AEs included hand-foot skin reaction, hypertension, fatigue, and diarrhea. Grade 3-5 events were mostly hypertension and pain, generally manageable with dose modifications. Safety results were also consistent across studies, showing zero or near-zero heterogeneity (I² = 0%) and no significant subgroup differences, indicating a homogeneous safety profile across sarcoma subtypes.

Conclusion: Regorafenib significantly improves progression-free survival in bone sarcomas across multiple subtypes, with a manageable toxicity profile. These results support its use as a novel therapy and highlight the need for future trials focused on optimizing dosing and patient selection. .

Objectives: This study aimed to analyze the prevalence of osteopenia and osteoporosis in MEN1-related primary hyperparathyroidism (PHPT), examine the impact of parathyroidectomy (PTX) on bone metabolic outcomes, and compare bone density metrics between sporadic and MEN1-related PHPT.

Methods: A systematic review and meta-analysis were conducted in accordance with the guidelines for Meta-Analyses and Systematic Reviews of Observational Studies (MOOSE). We searched PubMed, Web of Science, and Scopus up to June 2024, subsequently screening the articles to identify relevant research. Studies focusing on bone mineral density (BMD), T and Z-scores in patients with MEN1-related conditions were included. Meta-analyses were conducted using random-effects models.

Results: From the initial 2,563 articles, 15 studies were included in the meta-analysis. The pooled prevalence of osteoporosis and osteopenia in patients with MEN1-related PHPT was 45.2% (95% CI: 39.1-51.4%; I2: 16.7%) and 53.3% (95% CI: 44.4-62.0%; I2: 36.15%), respectively. PTX showed no significant impact on BMD in MEN1-related PHPT patients at the lumbar spine (mean difference: -0.054; P-value = 0.092; I2: 0.86%) or femoral neck (mean difference: -0.025; P-value = 0.219; I2: 0.47%). Comparisons of bone density metrics showed that MEN1-related PHPT patients had significantly lower Z-scores at the lumbar spine (mean difference: -0.676; P-value < 0.001; I2: 41.86%), total hip (mean difference: -0.629; P < 0.001; I2: 23.4%), and femoral neck (mean difference: -0.516; P < 0.001; I2 = 38.82%) compared to patients with sporadic PHPT.

Conclusion: Patients with MEN1-related PHPT exhibited a high prevalence of osteopenia and osteoporosis, along with lower BMD metrics compared to those with sporadic PHPT. PTX was not associated with significant changes in BMD among MEN1-related PHPT patients.

Objectives: Current literature on surgical techniques has evaluated minimally invasive surgery (MIS) cheilectomy and its efficacy in comparison to the open technique. However, no study to date has evaluated MIS-Moberg in relation to open and MIS cheilectomy. This study assessed radiological outcomes and early healing and complications of patients who underwent open, MIS, and MIS-Moberg cheilectomies.

Methods: We conducted a retrospective cohort review of 134 patients who underwent first metatarsophalangeal (MTP) cheilectomy at an academic medical center between 2015 and 2024. Success of cheilectomy was determined radiographically. Postoperative complications were identified through medical record review.

Results: 73 open and 61 MIS cheilectomies were performed on 134 patients with a primary diagnosis of hallux rigidus. The pre-operative versus post-operative differences in dorsal cortical length (3.7±1.4) and sagittal articular P1 angle (7.3±4.8) were found to be statistically significant (P<0.05) for the MIS-Moberg group. Ten patients in the open cheilectomy were found to have dorsiflexion and plantarflexion stiffness compared to zero patients in the MIS and MIS-Moberg groups (P<0.01).

Conclusion: We showed a significantly greater rate of plantar- and dorsiflexion stiffness in open surgeries compared to MIS and MIS-Moberg. No other differences in healing rates or radiologic outcomes were observed. Based on preliminary results, the MIS-Moberg can successfully alter the radiographic alignment of the great toe and does not increase complications as compared to open or MIS cheilectomy alone.