Archives of Bone and Joint Surgery-ABJS最新文献

Objectives: This research aimed to compare the changes in knee MRI findings after the injection of platelet-rich plasma with those after the injection of a placebo (normal saline) in patients with knee osteoarthritis.

Methods: This randomized clinical trial study was conducted on 63 patients with grade 2 and 3 knee osteoarthritis. Patients were randomly assigned to one of three injection groups: double-centrifuged PRP, single-centrifuged PRP, or placebo (normal saline). Patients were evaluated with MRI, VAS (visual analog scale), WOMAC (Western Ontario and McMaster Universities Arthritis Index), knee ROM (range of motion), and functional tests before and six months after the intervention. The investigated MRI characteristics included cartilage thickness of the medial tibia and patella, WORMS score of osteophyte and subchondral cyst, as well as severity of subchondral sclerosis.

Results: In the comparison between the three groups six months after the intervention, the VAS, ROM, functional tests, WOMAC scores, sclerosis severity, and the thickness of the medial tibial and patellar cartilage in the two groups, single centrifuged and double centrifuged, were significantly better than the placebo group. However, the mean overall WORMS score for osteophyte (p = 0.480) and subarticular cyst (p = 0.559) was not significant between the groups, and the PRP groups did not show a significant difference in reducing osteophyte and subarticular cysts compared to the placebo group.

Conclusion: Compared to the control group, PRP was effective in improving pain, range of motion (ROM), functional performance, WOMAC scores, articular cartilage thickness, and the severity of sclerosis. No significant difference was observed between the two groups of PRP in improving these variables.

Osteomyelitis is a calamitous illness produced by microbial infection in deep osseous tissue. Its elevated recurrence percentage is a major defiance in management. Besides, microbial-mediated dysregulation of the osseous tissue immune microhabitat hinders the process of osseous regeneration, resulting in defective repair of the osseous defect. In spite of advancements in surgical approaches and medication employments for the management of infections of the osseous tissue within the most recent years, dares endure in clinical treatment. The creation and employment of tissue engineering materials have rendered new approaches for the management of infections of the osseous tissue. In the discipline of tissue engineering, we should center on utilizing materials science and engineering technology to create biomimetic 3D printed degradable frameworks with structure, layout, and mechanical attributes; accomplishing controlled liberation of antimicrobial medications via nanocarriers or scaffold surface coating technologies; and utilizing coaxial printing or gradient printing techniques to accomplish graded controlled liberation of antimicrobial medications and osteogenic active drugs.

Objectives: Fractures located at the inferior pole of the patella pose challenges in terms of fracture fixation, primarily due to inadequate bone quality at the lower pole and typically limited options for secure fixation. This study introduces a novel approach that involves employing the Krackow suture technique on the patellar tendon, followed by a longitudinal transosseous and upside-down fixation at the superior aspect of the patella using a suture anchor to address this challenge.

Methods: A retrospective cohort case series was conducted at a single center, involving ten patients with fractures at the lower pole of the patella. Follow-up assessments were performed for a minimum of six months to observe postoperative gap formation and evaluate bony union. Knee motion, pain, function, and any intra- and postoperative complications were documented throughout the follow-up periods.

Results: All patients exhibited complete bone union without gap formation six months postoperatively, accompanied by a regained full range of motion without any functional limitations. No instances of postoperative anterior knee pain, refracture of the inferior patellar pole, or other complications were reported during the follow-up period.

Conclusion: The innovative technique involving longitudinal transosseous and upside-down suture anchor repair for the management of inferior patellar pole fractures is a straightforward and easily executable surgical procedure. This method offers stable fixation and yields favorable functional outcomes.

Objectives: Residual instability following anterior cruciate ligament reconstruction (ACLR) is a common concern among young, active patients. Currently, two primary methods are used to address this matter: anterolateral ligament reconstruction (ALLR) using a graft and lateral extra-articular tenodesis (LET). This study aims to compare the Lemaire method for LET with ALLR in minimizing rotational instability after ACLR.

Methods: This retrospective cohort study included patients with ACL ruptures who underwent simultaneous arthroscopic ACLR and either Lemaire lateral tenodesis or ALL reconstruction between April 2013 and March 2021. Patients were re-examined approximately 24 months post-operatively. We evaluated rotational instability using the pivot shift test, and anterior stability with the KT-1000 test. Outcomes were measured using the Lysholm and International Knee Documentation Committee (IKDC) questionnaires.

Results: This study evaluated 53 patients who underwent ACLR using either the Lemaire method for LET (n=24) or ALLR technique (n=29). No substantial differences were observed in terms of age, sex, body mass index (BMI), number of physiotherapy sessions, time from injury to surgery, or the diameter of the ACL graft. Rotational stability was significantly better in the Lemaire group (16.7% vs. 82.8%, P < 0.001). Although functional outcomes were higher in the Lemaire group, these differences were not statistically significant. Multivariate logistic regression analysis revealed that the surgical technique was the only significant predictor of rotational instability, with patients undergoing ALLR being 18.8 times more likely to experience a positive pivot shift (OR: 18.78, 95% CI: 4.34-81.18, P < 0.001).

Conclusion: This retrospective cohort study suggests that Lemaire LET may be more effective than ALLR in minimizing rotational instability following arthroscopic ACLR. However, there was no superiority in functional scores between the groups.

From the intricate movements that allow us to create art, express emotions, and communicate with others to the tactile sensations that connect us to the world, hands play a vital role in shaping our experiences and interactions. Hand is the bridge between the man's imagination and the physical world, the conduit through which inspiration flows and ideas take shape. However, our hands' remarkable skill and precision didn't simply come into existence; it required significant changes in other body parts and biomechanics to accommodate and support them.

Objectives: This study aims to provide a comprehensive understanding of the unique morphological dimensions and neurovascular pattern of the triangular fibrocartilage complex (TFCC) of the wrist joint, using innovative techniques such as digital Vernier calliper, auramine chloride (Palmgren's method) and immunohistochemistry.

Methods: Samples were collected from 20 formalin-embalmed human cadavers. The morphometric parameters were measured. After gross examination, tissues were placed in 10% neutral buffered formalin for fixation. Paraffin-embedded blocks were prepared, and tissue sections were taken at 5-7 microns thickness. The slides were subjected to Palmgren's and immunohistochemistry staining following a standardised protocol.

Results: The morphometric parameters of the articular disc (AD) and neurovascular pattern of the seven components of TFCC were assessed. There was no significant difference in the morphometric parameters between either sides of the limb. The AD had minimal nerve fibre innervation. Periphery of the complex, which consisted of different ligaments, showed higher nerve density comparatively. The distribution of nerve fibres predominated in the proximal portion compared to distal areas of TFCC. The vascular pattern observed in various components showed fewer blood vessels in the AD than in the periphery. Higher vascularity was observed in the proximal portion of the TFCC complex.

Conclusion: The insights gained from this study, particularly the understanding of the innervation and distribution of nerve fibres of TFCC, can significantly enhance the effectiveness of selective denervation procedures during wrist arthroscopy. Moreover, the knowledge about the vascularity of TFCC is a crucial factor that can influence the end outcomes of wrist surgeries.

Objectives: The primary goal of total knee arthroplasty (TKA) is to restore the neutral mechanical axis of the lower limb using mechanical alignment. However, no studies to date have investigated the risk factors of coronal malalignment (CM) following conventional TKA. In this study, we aimed to determine the incidence of post-TKA CM and identify its potential risk factors.

Methods: We retrospectively reviewed all conventional primary TKAs utilizing cemented posterior-stabilized prostheses in our institute from January 2019 to 2022. The following variables were extracted from the Joint Reconstruction Research Center (JRRC) Knee Registry Database: demographics, varus classification, flexion contracture, femoral and tibial bowing, pre- and postoperative Hip-knee-ankle angle (HKAA), mechanical lateral distal femoral angle (LDFA), mechanical medial proximal tibial angle (MPTA), joint-line congruency angle (JLCA), and caput-collum-diaphyseal (CCD) angle. Multiple logistic regression was used to develop a predictive model for post-TKA CM.

Results: Among the 402 TKAs analyzed after exclusions, 172 (42.79%) fell outside the acceptable postoperative HKAA range (180° ± 3°). Of the 17 factors studied, the following were associated with an increased risk of postoperative CM: flexion contracture > 10° (OR = 2.95, P < 0.001), femoral bowing > 4.9° (OR= 1.89, P= 0.006), tibial bowing > 2.2° (OR= 2.00, P= 0.002), preoperative MPTA≤ 85° (OR= 1.68, P= 0.037) or HKAA ≥ 20° varus (OR= 5.07, P= 0.017), preoperative JLCA 4°-10° (OR= 2.49, P= 0.023), and CCD ≤ 131° (OR= 1.62, P= 0.044). The results remained almost consistent even after excluding the extreme HKAA outliers (> ±6° varus and valgus).

Conclusion: In mechanically aligned TKAs, the risk of post-TKA CM can be estimated preoperatively based on specific risk factors (e.g., a 40.5% risk for patients with ≥ 3 risk factors). Identifying higher risks can warn the surgeon to address these factors and perform the TKA with greater precision.

Objectives: Critical evaluation of implant costs may help mitigate the cost of orthopedic care. In an effort to decrease the financial burden of operative fixation for fractures of the distal radius, a standardized shelf price was established by a large orthopedic practice for all distal radius implants. We hypothesized that by negotiating a fixed reduced cost, total number of screws, number of locking screws, and number of wasted screws would be unchanged and overall implant utilization would not change.

Methods: This was a retrospective analysis of the effect implant price standardization had on the operative care of distal radius fractures at a single outpatient urban surgical center. The total number of screws, as well as the number discarded during each procedure was reviewed. We analyzed the financials three months before and three months following price standardization. We surveyed the ten fellowship trained hand surgeons affected by the change regarding differences in operating procedure and perceived changes in the attendance and utility of the manufacturer's representative.

Results: We reviewed 30 distal radius open reduction internal fixations three months before and 28 cases three months following shelf price implementation. On average, there was a 32% reduction in total implant costs after price standardization. No statistically significant difference in any clinical variables were noted. Negligible change was noted in the surgeon experience in representative availability and surgery-related attributes on the survey. 20% of surgeons switched implants due to the cost restrictions.

Conclusion: Despite a set price for distal radius implants, there was no significant difference in the number of screws utilized or discarded after price standardization. Additionally, despite a 32% reduction in cost, the level of representative attendance and utility were similar before and after the change. Surgeons are willing to be flexible in implant choices based on a cost restriction model.

Objectives: We evaluated the adequacy of gross anatomical knowledge of the upper and lower limbs among 20 orthopedic residents and two groups of undergraduate medical students in the Department of Orthopedics.

Methods: Twenty orthopedic residents completed a review course on the gross anatomy of the upper and lower limbs, delivered by the Department of Anatomy. Two quizzes were administered to the orthopedic residents and to two groups of undergraduate medical students. The first quiz, consisting of 42 questions, assessed the knowledge of upper limb gross anatomy among the residents and 22 undergraduate students (Group I). The second quiz, administered one month later, consisted of 25 questions and assessed the knowledge of lower limb gross anatomy among the residents and 42 undergraduate students (Group II).

Results: The mean scores on the 42 upper limb questions were 27 ± 7 (60%, range 13-38) for the orthopedic residents, 17 ± 4 (37%, range 9-33) for the interns, and 18 ± 7 (40%, range 12-24) for the undergraduate students. The mean scores on the 25 lower limb questions were 20 ± 4 (80%, range 10-24) for the residents, 11 ± 5 (44%, range 3-18) for the interns, and 12 ± 4 (48%, range 3-19) for the students.

Conclusion: The present study demonstrated that the gross anatomical knowledge of our orthopedic residents was suboptimal. This deficiency may stem from insufficient exposure to anatomy during undergraduate medical education. Therefore, orthopedic residents should regularly review and update their anatomical knowledge through collaboration and interdisciplinary courses conducted in conjunction with the Department of Anatomy.