Clinics in Orthopedic Surgery最新文献

Backgroud: The International Hip Outcome Tool 12 (iHOT12), which is now widely adopted in clinical settings, has been established as reliable, valid, and responsive, positioning as a critical evaluation tool globally to gauge the efficacy of hip arthroscopy. This study aimed to translate the iHOT12 questionnaire into Korean and assess its feasibility, internal consistency, and validity concerning the psychometric properties of the Korean version of iHOT12 (iHOT12-K).

Methods: The iHOT12 questionnaire was translated into Korean and adapted culturally, following international guidelines, involving forward translation, back-translation, and reconciliation by bilingual experts to ensure cross-cultural equivalence. A cohort of 67 patients diagnosed with femoroacetabular impingement and scheduled for hip arthroscopy between November 2015 and February 2021 participated in assessing the psychometric properties of the iHOT12-K, alongside standardized questionnaires (Korean iterations of the Short Form-36 [SF-36], Hip Disability and Osteoarthritis Outcome Score [HOOS], Korean version of Hip Outcome Score [HOS-K], and modified Harris Hip Score [mHHS]). Psychometric evaluations focusing on feasibility, internal consistency (Cronbach's alpha), and convergent validity (Spearman's rank correlation) demonstrated the reliability and relevance of iHOT12-K.

Results: In the psychometric evaluation of the adapted version, 67 participants (38 men and 29 women; median age, 41 years) were enrolled, with 59 completing the iHOT12-K. The questionnaire showed excellent internal consistency (Cronbach's alpha, 0.896) without floor or ceiling effects, indicating good feasibility. Strong convergent validity was noted between the iHOT12-K and various hip-specific questionnaires (HOOS, HOS-K, and mHHS), except for the maximal visual analog scale score, demonstrating the reliability and applicability of the iHOT12-K for clinical assessments in Korea.

Conclusions: The iHOT12-K has successfully undergone transcultural adaptation, demonstrating significant feasibility, internal consistency, and validity. It has been validated for use among Korean-speaking patients undergoing hip arthroscopy, proving to be a valuable tool for clinical assessments.

Background: To compare knee laxity between the conventional round tunnel and oval tunnel techniques in primary anterior cruciate ligament (ACL) reconstruction in a porcine knee model.

Methods: Twenty porcine knees were used for evaluating laxity in terms of anterior translation and anterolateral rotation. The study determined porcine knee kinematics on the Instron instruments under simulated Lachman (89 N anterior tibial load) at 15°, 30°, and 60° of flexion and a simulated pivot shift test (89 N anterior tibial load, 10 Nm valgus, and 4 Nm internal tibial torque) at 30° of flexion. Kinematics were recorded for intact (n = 10), ACL-deficient (n = 10), and conventional round (n = 10) or oval tunnel (n = 10) techniques. All measurements were repeated twice, and the average was used for comparison.

Results: Under the Lachman test, the conventional round tunnel and oval tunnel both showed significantly larger anterior tibial translation (ATT) at 30° and 60° compared to the intact knee (p < 0.05), but smaller ATT compared to the ACL-deficient knees (p < 0.05). However, there were no differences in ATT between the conventional round tunnel and oval tunnel techniques (p > 0.05). Under simulated pivot shift at 30° flexion, there was a significant difference between the conventional round tunnel and oval tunnel techniques (round vs. oval: 4.27 ± 0.87 mm vs. 3.52 ± 0.49 mm, p = 0.028).

Conclusions: Both conventional round tunnel and oval tunnel techniques reduced ATT compared to ACL-deficient knees but failed to restore normal knee stability. However, the oval tunnel technique showed better rotational stability at 30° than the round tunnel technique. These findings suggest that the oval tunnel technique would be a reasonable option in anatomical single-bundle ACL reconstruction.

Background: This study compares the difference in the clinical and radiologic outcomes when minimally invasive plate osteosynthesis (MIPO) technique is performed with or without using a positional screw in the treatment of humeral shaft fractures.

Methods: From January 2010 to January 2021, a retrospective study was conducted on a total of 63 patients who underwent the MIPO technique for the treatment of humeral shaft fractures. We divided these patients into 2 groups: in group I, patients underwent MIPO without a positional screw; in group II, patients underwent MIPO with a positional screw. We compared functional outcomes including the American Shoulder and Elbow Surgeons score, University of California at Los Angeles score, Simple Shoulder Test, range of motion before and after surgery, operation time, blood loss, and complications. And we compared radiologic outcomes including pre- and postoperative anteroposterior (AP) and lateral displacement of the fracture and union time on plain radiographs.

Results: The average patient age was 64.6 ± 15.1 years (range, 25-88 years). Group I consisted of 30 patients (10 men and 20 women), and group II consisted of 33 patients (11 men and 22 women). Between the 2 groups, there was no statistically significant difference in sex, body mass index, functional scores, AP and lateral displacement of the fracture on postoperative x-ray, operation time, and blood loss. In group II, a faster bony union was obtained than that in group I (4.6 vs. 6.4 months). Complications included 2 cases of transient radial nerve palsy in both groups and metallic failures (2 in group I and 1 in group II).

Conclusions: When performing MIPO for humeral shaft fractures, adding a positional screw could be more stabilizing than bridge plating without a positional screw, leading to faster bony union. A positional screw might help control interfragmentary movement without inhibiting essential interfragmentary movement for fracture healing.

Background: To evaluate the clinical impact of intraoperative tranexamic acid administration in minimizing intraoperative blood loss and transfusion requirements during minimally invasive scoliosis surgery (MISS).

Methods: Consecutive data were collected from 97 patients with adolescent idiopathic scoliosis who underwent MISS between 2021 and 2023. Tranexamic acid was first introduced in June 2022. Surgical outcomes, complications, and blood parameters were compared between group A (no tranexamic acid) and group B (tranexamic acid).

Results: Forty-three patients underwent surgery without intraoperative tranexamic acid (group A), and 54 underwent surgery with tranexamic acid (group B). Variables including age, height, weight, body mass index, hospital stay duration, Cobb angle, correction rate, curve type, fusion extent, and pre- and postoperative hemoglobin levels were not significantly different between the 2 groups (all p > 0.50). On average, 2.03 red blood cell (RBC) transfusions were administered. Group A required 2.6 units, whereas group B required 1.7 units, representing a significant reduction (p = 0.005). Postoperatively, an average of 0.5 RBC units were administered. Group A required 0.9 units, and group B required 0.3 units, with a significant difference (p = 0.001). No significant difference was found in the hemoglobin level between the day before surgery and postoperative days 1 and 4 (all p > 0.05). Significant differences were observed between the 2 groups in the estimated blood loss change (1,358 vs. 1,118 mL, p = 0.035) and Hemovac volume (1,063.26 vs. 910.65 mL, p = 0.002). Eleven patients in group A required thoracentesis or chest tube insertion after MISS, whereas those in Group B did not require invasive procedures.

Conclusions: In MISS, tranexamic acid reduced blood transfusion needs, Hemovac volume, incidence and severity of hemothorax, and pleural effusion were associated with thoracoplasty.

Background: The medial meniscus posterior root tear is a common cause of knee osteoarthritis, often misdiagnosed. Surgical repair aims to restore knee biomechanics, with evolving techniques focusing on direct fixation. The objective of this study was to evaluate the clinical and radiographic outcomes of arthroscopic soft suture anchor repair, without utilizing the posterior portal technique, for medial meniscus posterior root tears over a 2-year follow-up period.

Methods: This is a retrospective study involving 32 patients, including 13 men and 19 women, with a mean age of 57 years and follow-up of 2 years. All tears were classified as LaPrade type 2 medial meniscus posterior root tears. The paired t-test was used to compare the International Knee Documentation Committee Subjective Knee Form (IKDC) and Lysholm score, as well as meniscus extrusion between preoperative and postoperative states. The Wilcoxon signed-rank test was utilized to compare the Kellgren-Lawrence (KL) grades. Healing rates were assessed on magnetic resonance imaging (MRI).

Results: MRI revealed complete healing in 17 out of 32 knees (53.1%), partial healing in 12 knees (37.5%), and signs of retear in 3 knees (9.4%). At final follow-up, the mean IKDC and Lysholm scores were 57.4 ± 10.3 and 84.8 ± 11.3, respectively, showing significant improvement from preoperative values (c 0.001). There was also a significant reduction in medial meniscus extrusion postoperatively, decreasing from 4.1 ± 0.8 mm preoperatively to 3.6 ± 0.9 mm postoperatively (p = 0.002). Additionally, KL grades did not progress significantly during the 2-year follow-up period, as evidenced by median KL grades of 2 both preoperatively and postoperatively (p = 0.072).

Conclusions: Arthroscopic repair of medial meniscus posterior root tears using a soft suture anchor without a posterior portal yielded a high healing rate in MRI and favorable patient-reported outcomes in short-term follow-up duration.

Backgroud: Different from adults, adolescents with genu varum or valgum can be treated with hemi-epiphysiodesis. We conducted a study to report our recent experience of treating idiopathic genu varum and valgum with clinical relevance to planning of hemi-epiphysiodesis. The aim of this study was to compare the varus and valgus groups focusing on the contribution of the distal femur and proximal tibia to the deformities.

Methods: Among patients who visited the outpatient clinic during the recent 4 years, adolescents with genu varum (the varus group) or valgum (the valgus group) greater than 5° were included. The mechanical lateral distal femoral angle (mLDFA) and medial proximal tibial angle (MPTA) were measured. The contribution to deformity (%) in each of the distal femur and the proximal tibia was calculated.

Results: One hundred twenty patients and their 120 legs (randomly selected in bilateral cases) were included. In the varus group (n = 51), the mean hip-knee-ankle alignment was varus 7.1° (range, 5.1°-12.1°). The contribution to deformity was 74.1% ± 27.6% at the proximal tibia (MPTA, 81.9° ± 2.0°) and 14.9% ± 25.1% at the distal femur (mLDFA, 88.1° ± 1.7°). In the valgus group (n = 69), the mean alignment was valgus 6.6° (range, 5.1°-11.9°). The contribution was 69.8% ± 30.8% at the distal femur (mLDFA, 82.4° ± 2.1°) and 33.1% ± 27.8% at the proximal tibia (MPTA = 89.2° ± 1.9°). In subgroup analyses, the MPTA was significantly lower in the varus ≥ 8.4° group than the varus < 8.4° group. The mLDFA was significantly lower and the frequency of MPTA > 91.5° was significantly higher in the valgus ≥ 7.7° group than the valgus < 7.7° group.

Conclusions: Genu varum was mainly associated with deformity of the proximal tibia, whereas genu valgum was related to deformities of the distal femur and proximal tibia. Considering the predominant deformity of the proximal tibia, performing hemi-epiphysiodesis only at the proximal tibia is ideal in most adolescents with genu varum.

Backgroud: Staged operations are commonly employed in the management of high-energy tibial plateau fractures (TPF) complicated by acute compartment syndrome (ACS); however, complications, such as nonunion, deep wound infection, and traumatic arthritis, often occur due to severe bone and soft-tissue damage. We aimed to report the radiological and clinical outcomes of staged surgical interventions performed following complete closure of the fasciotomy wound for the treatment of TPF complicated by ACS. Additionally, we analyzed factors associated with complications arising from these procedures.

Methods: Thirty patients with TPF and ACS were included (23 men and 7 women; average age, 59.7 years). The mean follow-up period was 33.2 months (range, 12-85 months). An external fixator was initially applied with emergency fasciotomy, and open reduction and plate fixation were performed after complete closure of the fasciotomy wound and soft-tissue stabilization (mean, 31 days; range, 9-55 days). Radiological evaluation of bone union and alignment was conducted, functional evaluation of the knee and ankle joints was performed using the Knee Society and American Orthopedic Foot and Ankle Society (AOFAS) scores, and complications and related factors were analyzed.

Results: Primary bone union was achieved in 29 of the 30 cases (96.7%) at an average of 20.8 weeks (range, 12-35 weeks). Malalignment was not observed in any case. At the final follow-up examination, the mean Knee Society and AOFAS scores were 92.5 (range, 65-100) and 95.5 (range, 74-100), respectively. Complications included 1 case of nonunion (3.3%), 2 cases of deep wound infection (6.7%), and 5 cases of traumatic arthritis (16.7%). A statistically significant correlation was noted between complications and patients who underwent dual approaches for the fixation of bicondylar TPFs.

Conclusions: A staged operation coupled with sufficient soft-tissue healing can achieve excellent bone union and functional outcomes in patients with TPF and ACS. However, complications may occur more often in patients undergoing dual approaches for bicondylar TPFs, necessitating vigilant monitoring and management.

Backgroud: Although symptomatic local recurrence (SLR) of spinal metastasis is relatively common after aggressive surgery, there have been few studies on SLR according to the extent of tumor removal. This study aimed to evaluate the incidence of SLR after surgery in spinal metastasis and analyze the risk factors of SLR.

Methods: This study included patients with spinal metastasis to all 3 vertebral columns. SLR was defined as the occurrence of new symptoms, confirmed by radiologic regrowth of tumor. The extent of tumor removal was classified into 3 types (corpectomy, separation surgery, and only posterior column removal). The Kaplan-Meier method was used to analyze the SLR rate after surgery. The presumed risk factors of SLR were evaluated using log-rank test and Cox regression analysis.

Results: This study included 102 patients with a mean follow-up period of 17.7 months (range, 3-84 months). After surgical treatment, SLR was confirmed in 35 patients (34.3%). Kaplan-Meier analysis predicted that the incidence of SLR was 4.4% at 6 months, 21.5% at 12 months, 34.0% at 18 months, and 42.7% at 24 months. In the univariate analysis, the primary malignancy site, number of vertebral metastases, and surgery for progressed tumor after previous radiation therapy were significant (p = 0.042, p = 0.048, and p = 0.008, respectively). No significant differences were observed in the extent of tumor removal (p = 0.536). In the multivariate analysis, the significant risk factors of SLR included only previous radiation therapy (p = 0.012). The risk of SLR was 2.8 times higher in patients who received surgery for progressed tumor after previous radiation therapy than in those without it.

Conclusions: The SLR of spinal metastasis was predicted in 21.5% of patients at 1 year after surgical treatment. The extent of tumor removal did not seem to affect SLR. Surgery for progressed tumor after previous radiation therapy was confirmed as the only substantial risk factor. Therefore, the tumor's response to preoperative radiation therapy is the most important factor in determining SLR.

Background: A torn plantar plate (PP) is important pathologic anatomy related to a dislocated or subluxated metatarsophalangeal joint (MTPJ). Traditionally, a torn PP was treated with Weil osteotomy through a dorsal approach. However, because of the limited visualization of the dorsal approach, PP repair through a plantar approach has been proposed as a new technique. This study aimed to radiologically evaluate the outcome of PP repair through the plantar approach using an improved MTPJ overlap distance (MOD) on an anteroposterior view and the degree of subluxation on an oblique view. We also aimed to investigate the potential factors affecting the recurrence of MTPJ instability.

Methods: In this study, we included 31 patients who had a subluxated or dislocated MTPJ of the second or third toe and underwent surgical PP repair. PP repair was performed via a plantar approach after shortening metatarsal (MT) osteotomy with a dorsal approach for longer MT bone. We assessed the severity of MTPJ subluxation by measuring the MOD and subluxation subtype on radiographs. Radiologic recurrence was defined as an increase in MOD or change from subluxation type A to subluxation type B. The relationship of recurrence with clinical and radiologic factors was evaluated by comparing the recurred group against the non-recurred group.

Results: Shortening MT osteotomy was performed in 26 of 31 cases (84%). Repeated measures analysis of variance comparing preoperation, pin removal, and the latest follow-up MOD values revealed the effectiveness of PP repair through the plantar approach (p < 0.001). The MOD did not significantly change after pin removal and the latest follow-up (p = 0.130), indicating that reduction was well maintained. None of the clinical and radiologic factors were significantly related to recurrence. However, 3 of 12 rheumatoid arthritis (RA) feet (25%) recurred and 3 of 5 recurred cases (60%) were RA feet. This result suggests that RA indicated a tendency for recurrence.

Conclusions: PP repair through the plantar approach has the advantage of excellent visualization of a torn PP and direct repair. We, therefore, recommend using the plantar approach for PP repair of the MTPJ.

Background: The choice of an appropriate type of orthosis depends on the patient's specific condition and needs. Different types of orthoses can affect plantar pressure distribution during certain gait patterns. Toe and heel gaits are common patterns of gait assigned for optimal recovery in patients with foot or ankle injuries. This study aimed to evaluate differences in plantar pressure between postoperative shoes and walker boots during toe and heel gaits in healthy individuals.

Methods: A total of 30 healthy individuals with a mean age of 21.7 ± 1.2 years were included in this study. Two types of gaits, toe and heel, were performed while wearing each orthosis on the right side of the foot. A standardized running shoe was worn on the left side of the foot. Plantar pressure variables including contact area, peak pressure, and maximum force were collected using the Pedar-X in-shoe pressure measuring system.

Results: During toe gait, while both orthoses demonstrated similar offloading in the hindfoot areas, walker boots were superior in reducing the peak pressure (first toe, p = 0.003; second to fifth toes, p < 0.001) and contact area (first toe, p = 0.003; second to fifth toes, p = 0.003) in the forefoot areas. During heel gait, both orthoses demonstrated similar offloading in the toe areas; however, the walker boots were superior in reducing the peak pressure in the lateral hindfoot (p < 0.001).

Conclusions: The results of our study can serve as a guideline for orthopedic physicians in prescribing an appropriate type of orthosis during specific types of gait for patients following foot and ankle injury and postoperative recovery.