AimsPatients with hip pathology frequently report concurrent knee pain before total hip arthroplasty (THA). This prospective study aimed to evaluate the frequency and severity of knee pain before and after THA, and analyze the factors influencing knee pain.MethodsData were collected from 149 primary THAs for hip osteoarthritis (OA) in 147 patients. Knee and hip pain were assessed using a visual analogue scale (VAS) preoperatively, and three, six, and 12 months postoperatively. We analyzed: 1) changes in knee pain severity before and after THA; 2) prevalence of knee pain before and after THA; and 3) factors affecting the severity of knee pain before and after THA.ResultsThe knee VAS scores significantly decreased from 2.2 before THA to 1.1 at three months, 0.8 at six months, and 0.7 at 12 months after surgery. The prevalence of knee pain also significantly decreased from 52.3% (n = 78) before THA to 37.6% (n = 56) at three months, 29.5% (n = 44) at six months, and 27.5% (n = 41) at 12 months after surgery. The preoperative hip VAS score positively influenced, and the preoperative pelvic tilt negatively influenced, the preoperative knee VAS score. In contrast, Kellgren-Lawrence grade in the knee and postoperative varus whole-leg alignment, in addition to the preoperative knee VAS score, positively influenced the knee VAS score 12 months after surgery.ConclusionApproximately half of the patients experienced knee pain before THA, influenced by the severity of their preoperative hip pain. Notably, both the severity and prevalence of knee pain showed significant improvement following THA. Patients with radiological knee OA, postoperative varus alignment, and severe preoperative knee pain were more likely to experience persistent knee pain at 12 months after THA.
{"title":"Knee pain improvement following total hip arthroplasty : a prospective study on frequency, severity, and influencing factors.","authors":"Yugo Morita,Yuriko Uchida,Toshiyuki Kawai,Kohei Nishitani,Shinichiro Nakamura,Yutaka Kuroda,Shinichi Kuriyama,Shuichi Matsuda","doi":"10.1302/0301-620x.108b2.bjj-2025-0640.r1","DOIUrl":"https://doi.org/10.1302/0301-620x.108b2.bjj-2025-0640.r1","url":null,"abstract":"AimsPatients with hip pathology frequently report concurrent knee pain before total hip arthroplasty (THA). This prospective study aimed to evaluate the frequency and severity of knee pain before and after THA, and analyze the factors influencing knee pain.MethodsData were collected from 149 primary THAs for hip osteoarthritis (OA) in 147 patients. Knee and hip pain were assessed using a visual analogue scale (VAS) preoperatively, and three, six, and 12 months postoperatively. We analyzed: 1) changes in knee pain severity before and after THA; 2) prevalence of knee pain before and after THA; and 3) factors affecting the severity of knee pain before and after THA.ResultsThe knee VAS scores significantly decreased from 2.2 before THA to 1.1 at three months, 0.8 at six months, and 0.7 at 12 months after surgery. The prevalence of knee pain also significantly decreased from 52.3% (n = 78) before THA to 37.6% (n = 56) at three months, 29.5% (n = 44) at six months, and 27.5% (n = 41) at 12 months after surgery. The preoperative hip VAS score positively influenced, and the preoperative pelvic tilt negatively influenced, the preoperative knee VAS score. In contrast, Kellgren-Lawrence grade in the knee and postoperative varus whole-leg alignment, in addition to the preoperative knee VAS score, positively influenced the knee VAS score 12 months after surgery.ConclusionApproximately half of the patients experienced knee pain before THA, influenced by the severity of their preoperative hip pain. Notably, both the severity and prevalence of knee pain showed significant improvement following THA. Patients with radiological knee OA, postoperative varus alignment, and severe preoperative knee pain were more likely to experience persistent knee pain at 12 months after THA.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"67 1","pages":"160-168"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146095489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1302/0301-620x.108b2.bjj-2025-0132.r1
In Hyeok Rhyou,Ji-Ho Lee,Christopher W Jenkins,Jung Hyun Lee,Min Ho Lee
AimsEarly identification and appropriate surgery are essential in the management of patients with posteromedial rotatory instability of the elbow to prevent the development of early post-traumatic osteoarthritis. The aim of this study was analyze the radiological findings in order to suggest appropriate treatment strategies.MethodsA total of 58 patients with posteromedial rotatory instability of the elbow, with available 3D CT and MRI scans, were included. We investigated the size of the anteromedial coronoid facet fracture and the patterns of injury to the lateral collateral ligament complex and ulnar collateral ligament, relating them to the O'Driscoll subtypes 2-1, 2-2, and 2-3 of injury.ResultsSubtypes 2-1, 2-2, and 2-3 comprised eight, 41, and nine patients, respectively. The mean size of the coronoid fracture significantly increased from subtype 2-1 (3.2 mm (SD 1.5)) to 2-3 (10.0 mm (SD 2.2mm)) (p < 0.001). The rate of rupture of the lateral ligament and the requirement for repair decreased significantly from 100% in subtype 2-1 to 33% in subtype 2-3 (p = 0.038, p = 0.005). The rate of rupture of the posterior bundle of the ulnar ligament increased significantly from 25% in subtype 2-1 to 100% in subtype 2-3 (p = 0.006).ConclusionThere are distinct patterns of radiological injury in the subtypes of posteromedial instability. Subtype 2-1 is primarily associated with substantial lateral ligamentous injury, whereas subtype 2-3 features larger coronoid fractures and an increased rate of associated injury to the posterior bundle of the ulnar ligament; subtype 2-2 is intermediate. These findings inform a proposed algorithm for the surgical treatment: lateral ligamentous repair is key for 2-1, and fixation of the coronoid fracture fixation is key for 2-3, with intraoperative assessment guiding further steps. This observational study establishes a theoretical framework for the management of these patients, which will require validation in the future.
目的肘关节后内侧旋转不稳定患者的早期识别和适当的手术治疗对于预防早期创伤后骨关节炎的发展至关重要。本研究的目的是分析放射学表现，以提出适当的治疗策略。方法对58例肘关节后内侧旋转不稳患者进行三维CT和MRI扫描。我们研究了前内侧冠突小面骨折的大小以及外侧副韧带复合体和尺侧副韧带的损伤模式，并将它们与O'Driscoll损伤亚型2-1、2-2和2-3联系起来。结果2-1、2-2和2-3亚型分别为8例、41例和9例。冠状面骨折的平均大小从亚型2-1 （3.2 mm (SD 1.5)）显著增加到亚型2-3 (10.0 mm (SD 2.2mm)) （p < 0.001）。侧韧带断裂率和修复需求从亚型2-1的100%下降到亚型2-3的33% （p = 0.038, p = 0.005）。尺韧带后束断裂率由2-1亚型的25%上升至2-3亚型的100% （p = 0.006）。结论后内侧不稳各亚型有明显的放射损伤模式。亚型2-1主要与外侧韧带损伤相关，而亚型2-3表现为较大的冠状面骨折和尺韧带后束相关损伤的发生率增加；亚型2-2是中间类型。这些发现提示了一种拟议的手术治疗算法：外侧韧带修复是2-1的关键，冠状突骨折固定是2-3的关键，术中评估指导进一步的步骤。这项观察性研究为这些患者的管理建立了一个理论框架，这将需要在未来进行验证。
{"title":"Radiological findings in posteromedial rotatory instability of the elbow and their application to treatment.","authors":"In Hyeok Rhyou,Ji-Ho Lee,Christopher W Jenkins,Jung Hyun Lee,Min Ho Lee","doi":"10.1302/0301-620x.108b2.bjj-2025-0132.r1","DOIUrl":"https://doi.org/10.1302/0301-620x.108b2.bjj-2025-0132.r1","url":null,"abstract":"AimsEarly identification and appropriate surgery are essential in the management of patients with posteromedial rotatory instability of the elbow to prevent the development of early post-traumatic osteoarthritis. The aim of this study was analyze the radiological findings in order to suggest appropriate treatment strategies.MethodsA total of 58 patients with posteromedial rotatory instability of the elbow, with available 3D CT and MRI scans, were included. We investigated the size of the anteromedial coronoid facet fracture and the patterns of injury to the lateral collateral ligament complex and ulnar collateral ligament, relating them to the O'Driscoll subtypes 2-1, 2-2, and 2-3 of injury.ResultsSubtypes 2-1, 2-2, and 2-3 comprised eight, 41, and nine patients, respectively. The mean size of the coronoid fracture significantly increased from subtype 2-1 (3.2 mm (SD 1.5)) to 2-3 (10.0 mm (SD 2.2mm)) (p < 0.001). The rate of rupture of the lateral ligament and the requirement for repair decreased significantly from 100% in subtype 2-1 to 33% in subtype 2-3 (p = 0.038, p = 0.005). The rate of rupture of the posterior bundle of the ulnar ligament increased significantly from 25% in subtype 2-1 to 100% in subtype 2-3 (p = 0.006).ConclusionThere are distinct patterns of radiological injury in the subtypes of posteromedial instability. Subtype 2-1 is primarily associated with substantial lateral ligamentous injury, whereas subtype 2-3 features larger coronoid fractures and an increased rate of associated injury to the posterior bundle of the ulnar ligament; subtype 2-2 is intermediate. These findings inform a proposed algorithm for the surgical treatment: lateral ligamentous repair is key for 2-1, and fixation of the coronoid fracture fixation is key for 2-3, with intraoperative assessment guiding further steps. This observational study establishes a theoretical framework for the management of these patients, which will require validation in the future.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"389 1","pages":"195-201"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146095487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1302/0301-620x.108b2.bjj-2024-1529.r2
Ashlee Dobbe,Emily K Schaeffer,Njalalle Baraza,Firoz Miyanji,Christine Alvarez,Anthony P Cooper,Chris W Reilly,Kishore Mulpuri
AimsWe sought to evaluate whether loss of reduction in lateral Kirschner (K)-wiring is noninferior to crossed K-wiring in closed reduction and percutaneous pinning of Type III supracondylar humerus fractures.MethodsA prospective, randomized, non-inferiority trial was conducted. Emergency department patients aged three to seven years with Type III supracondylar humerus fractures were invited to participate with informed consent. Block randomization allocated patients into one of two pin configuration groups (lateral or crossed). Surgical technique and postoperative management were standardized between groups. All patients were treated with above-elbow casts, but no strict standardized protocol was applied. The primary outcome was loss of reduction, measured from Baumann's angle on radiographs taken postoperatively and at K-wire removal. Secondary outcomes included humerocapitellar angle and iatrogenic ulnar nerve injury. Data were analyzed using an independent-samples t-test.ResultsA total of 55 patients were enrolled. Of these, 22 were allocated to lateral pinning (40%) and 29 to crossed pinning (53%). Six (five crossed, one lateral) received a third wire in the operating theatre. Four were excluded: one did not return for radiography at pin removal, one was not randomized, and two did not provide assent. There was no significant difference between groups in change in Baumann's angle during pin removal (mean difference -0.7° (95% CI -2.7 to 1.3)). Two crossed-group patients developed postoperative iatrogenic ulnar nerve injuries.ConclusionClosed reduction and percutaneous pinning using lateral K-wiring was not inferior to crossed K-wiring in managing this cohort of Type III supracondylar humerus fractures in children aged three to seven years, suggesting this approach as an option to reduce iatrogenic ulnar nerve injury risk. However, lack of a patient-reported outcome measure and economic evaluation, coupled with randomization after reduction, a narrow age range, and low recruitment rate limit the generalizability of these findings and may have introduced bias.
目的：我们试图评估在III型肱骨髁上骨折闭合复位和经皮钉钉治疗中，侧克氏针复位损失是否优于交叉克氏针复位损失。方法采用前瞻性、随机、非劣效性试验。在知情同意的情况下，邀请3至7岁的急诊科III型肱骨髁上骨折患者参与研究。随机分组将患者分为两组（横向或交叉）。两组间手术技术及术后处理标准化。所有患者均采用肘上石膏治疗，但未采用严格的标准化方案。主要结果是复位损失，从术后和拆除k线时拍摄的x线片上的鲍曼角测量。次要结局包括肱骨头角和医源性尺神经损伤。数据分析采用独立样本t检验。结果共纳入55例患者。其中22例侧钉（40%），29例交叉钉（53%）。6例（5例交叉，1例侧边）在手术室接受了第三根电线。4例被排除在外：1例在取针时没有返回x线摄影，1例不是随机的，2例没有提供同意。拔针时各组间鲍曼角变化无显著差异（平均差-0.7°（95% CI -2.7 ~ 1.3））。2例交叉组患者术后发生医源性尺神经损伤。结论在治疗3 - 7岁儿童III型肱骨髁上骨折时，外侧k线闭合复位经皮钉钉术并不比交叉k线术差，提示该入路可降低医源性尺神经损伤风险。然而，缺乏患者报告的结果测量和经济评估，加上减少后的随机化，狭窄的年龄范围和低招募率限制了这些发现的普遍性，并可能引入偏倚。
{"title":"Management of displaced supracondylar fractures of the humerus using lateral versus crossed Kirschner wires: a prospective randomized controlled clinical trial.","authors":"Ashlee Dobbe,Emily K Schaeffer,Njalalle Baraza,Firoz Miyanji,Christine Alvarez,Anthony P Cooper,Chris W Reilly,Kishore Mulpuri","doi":"10.1302/0301-620x.108b2.bjj-2024-1529.r2","DOIUrl":"https://doi.org/10.1302/0301-620x.108b2.bjj-2024-1529.r2","url":null,"abstract":"AimsWe sought to evaluate whether loss of reduction in lateral Kirschner (K)-wiring is noninferior to crossed K-wiring in closed reduction and percutaneous pinning of Type III supracondylar humerus fractures.MethodsA prospective, randomized, non-inferiority trial was conducted. Emergency department patients aged three to seven years with Type III supracondylar humerus fractures were invited to participate with informed consent. Block randomization allocated patients into one of two pin configuration groups (lateral or crossed). Surgical technique and postoperative management were standardized between groups. All patients were treated with above-elbow casts, but no strict standardized protocol was applied. The primary outcome was loss of reduction, measured from Baumann's angle on radiographs taken postoperatively and at K-wire removal. Secondary outcomes included humerocapitellar angle and iatrogenic ulnar nerve injury. Data were analyzed using an independent-samples t-test.ResultsA total of 55 patients were enrolled. Of these, 22 were allocated to lateral pinning (40%) and 29 to crossed pinning (53%). Six (five crossed, one lateral) received a third wire in the operating theatre. Four were excluded: one did not return for radiography at pin removal, one was not randomized, and two did not provide assent. There was no significant difference between groups in change in Baumann's angle during pin removal (mean difference -0.7° (95% CI -2.7 to 1.3)). Two crossed-group patients developed postoperative iatrogenic ulnar nerve injuries.ConclusionClosed reduction and percutaneous pinning using lateral K-wiring was not inferior to crossed K-wiring in managing this cohort of Type III supracondylar humerus fractures in children aged three to seven years, suggesting this approach as an option to reduce iatrogenic ulnar nerve injury risk. However, lack of a patient-reported outcome measure and economic evaluation, coupled with randomization after reduction, a narrow age range, and low recruitment rate limit the generalizability of these findings and may have introduced bias.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"93 1","pages":"209-215"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146095496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1302/0301-620x.108b2.bjj-2025-0942.r1
Rory J Dyke,Warran Wignadasan,Fares S Haddad
{"title":"Arthroplasty for hip fracture : the art and evidence of hip arthroplasty.","authors":"Rory J Dyke,Warran Wignadasan,Fares S Haddad","doi":"10.1302/0301-620x.108b2.bjj-2025-0942.r1","DOIUrl":"https://doi.org/10.1302/0301-620x.108b2.bjj-2025-0942.r1","url":null,"abstract":"","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"184 1","pages":"143-146"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146095492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1302/0301-620x.108b2.bjj-2024-1473.r3
Michael Seungcheol Kang,Arnav Kak,Lauren Osborne,John A Herring,Harry Kwang Woo Kim
AimsThe outcome of treatment for Perthes' disease has historically been assessed using the Stulberg classification, which is categorical and subjective, as reported in a large prospective multicentre study by the original Perthes' Study Group in 2004. The aim of this study was to reanalyze these outcomes and prognostic determinants using a quantitative outcome measure, the sphericity deviation score.MethodsWe reanalyzed the demographic and radiological data, which included 319 patients followed up for a mean of 8.7 years (2.2 to 15.3), until skeletal maturity. The sphericity deviation scores of all 319 hips were measured by two independent observers. The forms of treatment included no treatment or range of motion (ROM) exercises, bracing, proximal femoral varus osteotomy, and Salter innominate osteotomy. We compared differences in the outcomes of treatment after stratification by significant patient characteristics determined by a multivariate linear regression. The patients were also analyzed using a regression tree model.ResultsMultivariate analysis identified age at the time of onset of the condition, sex, and the form of treatment as significant prognostic factors, with bone age at onset as the most significant factor, followed by chronological age and the form of treatment. In patients with a bone age of ≤ six years at the time of onset, the form of treatment did not affect the outcome. In patients with a bone age of > six years, femoral osteotomy or Salter osteotomy produced significantly better sphericity scores than no treatment or ROM exercises. The regression tree analysis corroborated these findings and found that those who had a femoral osteotomy had significantly better outcomes than those who did not, in patients with a chronological age of > 7.6 years.ConclusionAnalysis based on scores of the sphericity of the femoral head showed that age at the onset of Perthes' disease, sex, and the form of treatment were significant prognostic factors of outcome. Multivariate analysis with dichotomization of the bone age (≤ 6 yrs or > 6 yrs) revealed significantly better sphericity scores after proximal femoral osteotomy or Salter osteotomy than after no treatment or ROM exercises in patients with a bone age of > six years at the time of onset. The regression tree analysis without prior dichotomization showed that the patients who were treated with a femoral osteotomy had significantly better outcomes than those who did not, in patients with a chronological age of > 7.6 years.
{"title":"The outcomes of treatment and prognostic determinants of patients with Perthes' disease : reanalyses of large prospective multicentre study data using the sphericity deviation score.","authors":"Michael Seungcheol Kang,Arnav Kak,Lauren Osborne,John A Herring,Harry Kwang Woo Kim","doi":"10.1302/0301-620x.108b2.bjj-2024-1473.r3","DOIUrl":"https://doi.org/10.1302/0301-620x.108b2.bjj-2024-1473.r3","url":null,"abstract":"AimsThe outcome of treatment for Perthes' disease has historically been assessed using the Stulberg classification, which is categorical and subjective, as reported in a large prospective multicentre study by the original Perthes' Study Group in 2004. The aim of this study was to reanalyze these outcomes and prognostic determinants using a quantitative outcome measure, the sphericity deviation score.MethodsWe reanalyzed the demographic and radiological data, which included 319 patients followed up for a mean of 8.7 years (2.2 to 15.3), until skeletal maturity. The sphericity deviation scores of all 319 hips were measured by two independent observers. The forms of treatment included no treatment or range of motion (ROM) exercises, bracing, proximal femoral varus osteotomy, and Salter innominate osteotomy. We compared differences in the outcomes of treatment after stratification by significant patient characteristics determined by a multivariate linear regression. The patients were also analyzed using a regression tree model.ResultsMultivariate analysis identified age at the time of onset of the condition, sex, and the form of treatment as significant prognostic factors, with bone age at onset as the most significant factor, followed by chronological age and the form of treatment. In patients with a bone age of ≤ six years at the time of onset, the form of treatment did not affect the outcome. In patients with a bone age of > six years, femoral osteotomy or Salter osteotomy produced significantly better sphericity scores than no treatment or ROM exercises. The regression tree analysis corroborated these findings and found that those who had a femoral osteotomy had significantly better outcomes than those who did not, in patients with a chronological age of > 7.6 years.ConclusionAnalysis based on scores of the sphericity of the femoral head showed that age at the onset of Perthes' disease, sex, and the form of treatment were significant prognostic factors of outcome. Multivariate analysis with dichotomization of the bone age (≤ 6 yrs or > 6 yrs) revealed significantly better sphericity scores after proximal femoral osteotomy or Salter osteotomy than after no treatment or ROM exercises in patients with a bone age of > six years at the time of onset. The regression tree analysis without prior dichotomization showed that the patients who were treated with a femoral osteotomy had significantly better outcomes than those who did not, in patients with a chronological age of > 7.6 years.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"84 1","pages":"251-258"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146095485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1302/0301-620x.108b2.bjj-2025-0439.r1
Nick D Clement, ,James T Patton,Nicholas E Ohly,Pit Putzeys,Clement Favroul,Sébastien Lustig,Cecile Batailler,David Ferguson,Sam Oussedik,John Bayram,Donald Kieffer
AimsThe aim of this study was to assess the implant survival and patient-reported outcome measures of robotic arm-assisted patellofemoral arthroplasty (raPFA) and to define patient-acceptable symptom state (PASS) thresholds.MethodsA multicentre retrospective cohort study of 112 raPFA was undertaken. The mean age of the patients was 63.3 years (21 to 89), and 88 (78.6%) were female. Oxford Knee Score (OKS), Kujala score, EuroQol five-dimension questionnaire (EQ-5D), EuroQol-visual analogue scale (EQ-VAS), Net Promoter Score (NPS), and patient satisfaction were assessed. Mean follow-up was 3.3 years (1.0 to 7.7).ResultsThere were four reoperations (three revisions) during the follow-up period. The four-year survival was 94.4% (95% CI 89.9 to 98.9) for all-cause reoperation, 96.7% (95% CI 94.5 to 100) for all-cause revision, and 97.7% (95% CI 93.8 to 100) for aseptic revision. A total of 79 (76.0%), 62 (59.6%), 67 (64.4%), and 49 (54.4%) knees achieved the PASS thresholds in the OKS, Kujala, EQ-5D, and EQ-VAS scores, respectively. The satisfaction rate was 77.9% (n = 81) and the NPS was 59.7. Increasing American Society of Anesthesiologists (ASA) grade (odds ratio 0.02, 95% CI 0.00 to 0.22, p = 0.001) was independently associated with dissatisfaction. The OKS (area under the curve (AUC) 89.1, 95% CI 82.5 to 95.8) and Kujala score (AUC 86.1, 95% CI 77.7 to 94.5) were excellent, and the EQ-5D (AUC 75.4, 95% CI 61.7 to 89.1) and EQ-VAS (AUC 76.7, 95% CI 64.0 to 89.5) were acceptable discriminators of satisfaction, with PASS thresholds of 36, 72, 0.710, and 74, respectively. Using these new thresholds, the number achieving a PASS decreased in the OKS (n = 75; 72.1%), increased in the Kujala score (n = 73; 70.2%) and EQ-VAS (n = 58; 64.4%), and remained identical for the EQ-5D.ConclusionraPFA was associated with clinically meaningful postoperative outcome measures and a high NPS. However, approximately one in five were not satisfied, which was independently associated with increasing comorbidity, and approximately one in 20 underwent reoperation in the first four years postoperatively. The defined PASS thresholds specifically for PFA could be used to help interpret outcomes in future studies.
本研究的目的是评估机械臂辅助髌骨股骨置换术（raPFA）的植入物存活率和患者报告的结果测量，并定义患者可接受的症状状态（PASS）阈值。方法对112例raPFA患者进行多中心回顾性队列研究。患者平均年龄63.3岁（21 ~ 89岁），女性88例（78.6%）。评估牛津膝关节评分（OKS）、Kujala评分、EuroQol五维问卷（EQ-5D）、EuroQol视觉模拟量表（EQ-VAS）、净促进者评分（NPS）和患者满意度。平均随访时间为3.3年（1.0 ~ 7.7年）。结果随访期间再手术4次（复查3次）。全因再手术的4年生存率为94.4% (95% CI 89.9 ~ 98.9)，全因翻修的4年生存率为96.7% (95% CI 94.5 ~ 100)，无菌翻修的4年生存率为97.7% （95% CI 93.8 ~ 100）。在OKS、Kujala、EQ-5D和EQ-VAS评分中，分别有79个（76.0%）、62个（59.6%）、67个（64.4%）和49个（54.4%）膝关节达到PASS阈值。满意度为77.9% (n = 81)， NPS为59.7。美国麻醉医师协会（ASA）评分增加（优势比0.02,95% CI 0.00 ~ 0.22, p = 0.001）与不满意程度独立相关。OKS（曲线下面积（AUC） 89.1, 95% CI 82.5 ~ 95.8）和Kujala评分（AUC 86.1, 95% CI 77.7 ~ 94.5）表现优异，EQ-5D （AUC 75.4, 95% CI 61.7 ~ 89.1）和EQ-VAS （AUC 76.7, 95% CI 64.0 ~ 89.5）是可接受的满意度判别指标，其合格阈值分别为36、72、0.710和74。使用这些新的阈值，获得及格的人数在OKS中下降（n = 75, 72.1%），在Kujala评分中增加（n = 73, 70.2%），在EQ-VAS中增加（n = 58, 64.4%），在EQ-5D中保持不变。结论rapfa与有临床意义的术后预后指标和高NPS相关。然而，大约五分之一的患者不满意，这与合并症的增加独立相关，大约二十分之一的患者在术后前四年内再次手术。专门为PFA定义的PASS阈值可用于帮助解释未来研究的结果。
{"title":"Survival and patient-reported outcomes of robotic arm-assisted patellofemoral arthroplasty and patient-acceptable symptom state thresholds : a multicentre retrospective cohort study with minimum one-year follow-up.","authors":"Nick D Clement, ,James T Patton,Nicholas E Ohly,Pit Putzeys,Clement Favroul,Sébastien Lustig,Cecile Batailler,David Ferguson,Sam Oussedik,John Bayram,Donald Kieffer","doi":"10.1302/0301-620x.108b2.bjj-2025-0439.r1","DOIUrl":"https://doi.org/10.1302/0301-620x.108b2.bjj-2025-0439.r1","url":null,"abstract":"AimsThe aim of this study was to assess the implant survival and patient-reported outcome measures of robotic arm-assisted patellofemoral arthroplasty (raPFA) and to define patient-acceptable symptom state (PASS) thresholds.MethodsA multicentre retrospective cohort study of 112 raPFA was undertaken. The mean age of the patients was 63.3 years (21 to 89), and 88 (78.6%) were female. Oxford Knee Score (OKS), Kujala score, EuroQol five-dimension questionnaire (EQ-5D), EuroQol-visual analogue scale (EQ-VAS), Net Promoter Score (NPS), and patient satisfaction were assessed. Mean follow-up was 3.3 years (1.0 to 7.7).ResultsThere were four reoperations (three revisions) during the follow-up period. The four-year survival was 94.4% (95% CI 89.9 to 98.9) for all-cause reoperation, 96.7% (95% CI 94.5 to 100) for all-cause revision, and 97.7% (95% CI 93.8 to 100) for aseptic revision. A total of 79 (76.0%), 62 (59.6%), 67 (64.4%), and 49 (54.4%) knees achieved the PASS thresholds in the OKS, Kujala, EQ-5D, and EQ-VAS scores, respectively. The satisfaction rate was 77.9% (n = 81) and the NPS was 59.7. Increasing American Society of Anesthesiologists (ASA) grade (odds ratio 0.02, 95% CI 0.00 to 0.22, p = 0.001) was independently associated with dissatisfaction. The OKS (area under the curve (AUC) 89.1, 95% CI 82.5 to 95.8) and Kujala score (AUC 86.1, 95% CI 77.7 to 94.5) were excellent, and the EQ-5D (AUC 75.4, 95% CI 61.7 to 89.1) and EQ-VAS (AUC 76.7, 95% CI 64.0 to 89.5) were acceptable discriminators of satisfaction, with PASS thresholds of 36, 72, 0.710, and 74, respectively. Using these new thresholds, the number achieving a PASS decreased in the OKS (n = 75; 72.1%), increased in the Kujala score (n = 73; 70.2%) and EQ-VAS (n = 58; 64.4%), and remained identical for the EQ-5D.ConclusionraPFA was associated with clinically meaningful postoperative outcome measures and a high NPS. However, approximately one in five were not satisfied, which was independently associated with increasing comorbidity, and approximately one in 20 underwent reoperation in the first four years postoperatively. The defined PASS thresholds specifically for PFA could be used to help interpret outcomes in future studies.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"42 1","pages":"169-176"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146095510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1302/0301-620x.107b12.bjj-2025-0375.r2
Katrina R Bell,Liam Z Yapp,Timothy O White,Samuel G Molyneux,Nicholas D Clement,Andrew D Duckworth
AimsThe aim of this study was to predict the number and incidence of fractures of the distal radius in Scotland during the next two decades, according to sex and age group, categorized into under 65 years (< 65 years) and 65 years and older (≥ 65 years). A secondary aim was to estimate the potential increased operative burden associated with this.MethodsThe number of fractures of the distal radius in Scotland was identified from the Global Burden of Diseases, Injuries and Risk Factors Study of 2021. This was used, in conjunction with historical population data and estimations of population, to create a multivariable generalized linear model allowing the incorporation of sex, age group, size of population, and time. A negative binomial regression model was used to predict the incidence of fractures of the distal radius in 2030 and 2040, and to calculate the projected number of fractures. A rate of surgical intervention of 20.4% for those patients aged ≥ 65 years was assumed from historical data.ResultsThere was a predicted 84.71% increase in fractures of the distal radius in the ≥ 65 years age group, with an overall increase of 5,078 fractures per year, increasing from 5,995 in 2020 (95% CI 5,796 to 6,201) to 11,073 in 2040 (95% CI 10,074 to 12,173). The predicted increase between 2020 and 2040 was similar for both sexes (82.60% in females, 93.18% in males), although the absolute increase in the number of fractures was higher in females. Overall, these increases are estimated to be associated with 1,035 additional operations per year by 2040 for those patients aged ≥ 65 years.ConclusionThe number of fractures of the distal radius is predicted to nearly double in the next two decades due to a predicted increase in the number of fractures in older patients (aged ≥ 65 years). This will have substantial implications for future health and social care resource planning. Further work that aims to better define the indications for surgery and the role of non-operative management in this patient group is an urgent research priority.
目的本研究的目的是预测未来20年苏格兰桡骨远端骨折的数量和发生率，根据性别和年龄组，分为65岁以下（< 65岁）和65岁及以上（≥65岁）。第二个目的是估计与此相关的可能增加的手术负担。方法从2021年全球疾病、损伤和危险因素负担研究中确定苏格兰桡骨远端骨折的数量。该方法与历史人口数据和人口估计相结合，创建了一个多变量广义线性模型，允许将性别、年龄组、人口规模和时间纳入其中。采用负二项回归模型预测2030年和2040年桡骨远端骨折发生率，并计算预测骨折数。根据历史数据，年龄≥65岁的患者手术干预率为20.4%。结果≥65岁年龄组桡骨远端骨折预计增加84.71%，总体每年增加5,078例骨折，从2020年的5,995例（95% CI 5,796 ~ 6,201）增加到2040年的11073例（95% CI 10,074 ~ 12,173）。在2020年至2040年期间，两性的预测增幅相似（女性为82.60%，男性为93.18%），尽管女性骨折数量的绝对增幅更高。总体而言，到2040年，这些增加估计与年龄≥65岁的患者每年1035例额外手术相关。结论由于老年患者（≥65岁）骨折数量的增加，桡骨远端骨折数量预计在未来20年内将增加近一倍。这将对今后的保健和社会保健资源规划产生重大影响。进一步的工作旨在更好地确定手术指征和非手术治疗在该患者群体中的作用是一个迫切的研究重点。
{"title":"The number of fractures of the distal radius in older adult patients will almost double by 2040 : prediction modelling using national data from Scotland.","authors":"Katrina R Bell,Liam Z Yapp,Timothy O White,Samuel G Molyneux,Nicholas D Clement,Andrew D Duckworth","doi":"10.1302/0301-620x.107b12.bjj-2025-0375.r2","DOIUrl":"https://doi.org/10.1302/0301-620x.107b12.bjj-2025-0375.r2","url":null,"abstract":"AimsThe aim of this study was to predict the number and incidence of fractures of the distal radius in Scotland during the next two decades, according to sex and age group, categorized into under 65 years (< 65 years) and 65 years and older (≥ 65 years). A secondary aim was to estimate the potential increased operative burden associated with this.MethodsThe number of fractures of the distal radius in Scotland was identified from the Global Burden of Diseases, Injuries and Risk Factors Study of 2021. This was used, in conjunction with historical population data and estimations of population, to create a multivariable generalized linear model allowing the incorporation of sex, age group, size of population, and time. A negative binomial regression model was used to predict the incidence of fractures of the distal radius in 2030 and 2040, and to calculate the projected number of fractures. A rate of surgical intervention of 20.4% for those patients aged ≥ 65 years was assumed from historical data.ResultsThere was a predicted 84.71% increase in fractures of the distal radius in the ≥ 65 years age group, with an overall increase of 5,078 fractures per year, increasing from 5,995 in 2020 (95% CI 5,796 to 6,201) to 11,073 in 2040 (95% CI 10,074 to 12,173). The predicted increase between 2020 and 2040 was similar for both sexes (82.60% in females, 93.18% in males), although the absolute increase in the number of fractures was higher in females. Overall, these increases are estimated to be associated with 1,035 additional operations per year by 2040 for those patients aged ≥ 65 years.ConclusionThe number of fractures of the distal radius is predicted to nearly double in the next two decades due to a predicted increase in the number of fractures in older patients (aged ≥ 65 years). This will have substantial implications for future health and social care resource planning. Further work that aims to better define the indications for surgery and the role of non-operative management in this patient group is an urgent research priority.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"1 1","pages":"1333-1342"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
AimsThe aim of this study was to identify the number of ambulant children with cerebral palsy (CP) who are eligible for single-event multilevel surgery (SEMLS) in the UK, to explore regional variations in care and estimate the outcomes over a two-year period.MethodsThis was a prospective, comprehensive cohort study, to evaluate current surgical practice in ambulant patients with bilateral CP. The case mix, intervention variables, and clinical outcomes, including patient-based outcomes, were recorded in a consented sub-group. Data from children who did not undergo surgery within the time of the study were used for comparison.ResultsA total of 203 children were enrolled, over a period of 52 months. There were 138 males and 65 females, with a mean age of 12.6 years (5.4 to 18.1). A total of 188 children met the inclusion criteria. At the time of enrolment, the surgical and non-surgical groups had similar clinical characteristics. Of the 139 children who underwent SEMLS, the mean was 5.3 procedures (2 to 12) per patient. There was considerable variation in the procedures undertaken at the different sites. Outcome measures were available in a subgroup of children. Complications were recorded in 25 children (18%). At two years following SEMLS, the Gait Profile Score improved beyond the minimal clinically important difference, as did the parental perception of motor function (Gait Outcomes Assessment List questionnaire). There was some indication of improvement in motor function (Functional Mobility Scale). While the non-surgical group was small, there was a general decline in gait over the same period in this group.ConclusionNational data illustrating the practice of SEMLS across the UK, which is useful for clinicians to inform discussions with patients, were collected in this study. While the natural history of these children is of gradual functional decline, there was a clear signal of the effectiveness of SEMLS. Consensus to standardize clinical practice is needed, as are further studies to assess the outcomes accurately.
{"title":"A UK national prospective cohort study investigating current practices in single-event multilevel surgery for children with bilateral cerebral palsy and its impact on gait and function: the CPinBOSS study.","authors":"Tim Theologis,Jacqueline Birks,Julie Stebbins,Nicky Thompson,Loretta Davies,Cushla Cooper,Marie Caroline Nogaro,James Wright,David J Beard,Daniel C Perry, ,Stephen Cooke,Alex Aarvold,Clare Carpenter,Mark Gaston,Owain Evans,Yael Gelfer,Jenny Anstead,Guy Atherton,Piers Mitchell,Jose Blanco,Robert Freeman,David Wright,Dan Perry,Rebecca Tate,James Metcalfe,James Aird,Nirmal Tulwa,Helen Chase,David Emery,Belen Carsi,David Bryson,Kathryn Price,Deborah Eastwood,Simon Barker,Michail Kokkinakis,Emmanouil Morakis,Heather Read,Janet McCaul,Sally Hobson,Fabian Norman-Taylor","doi":"10.1302/0301-620x.107b12.bjj-2025-0014.r2","DOIUrl":"https://doi.org/10.1302/0301-620x.107b12.bjj-2025-0014.r2","url":null,"abstract":"AimsThe aim of this study was to identify the number of ambulant children with cerebral palsy (CP) who are eligible for single-event multilevel surgery (SEMLS) in the UK, to explore regional variations in care and estimate the outcomes over a two-year period.MethodsThis was a prospective, comprehensive cohort study, to evaluate current surgical practice in ambulant patients with bilateral CP. The case mix, intervention variables, and clinical outcomes, including patient-based outcomes, were recorded in a consented sub-group. Data from children who did not undergo surgery within the time of the study were used for comparison.ResultsA total of 203 children were enrolled, over a period of 52 months. There were 138 males and 65 females, with a mean age of 12.6 years (5.4 to 18.1). A total of 188 children met the inclusion criteria. At the time of enrolment, the surgical and non-surgical groups had similar clinical characteristics. Of the 139 children who underwent SEMLS, the mean was 5.3 procedures (2 to 12) per patient. There was considerable variation in the procedures undertaken at the different sites. Outcome measures were available in a subgroup of children. Complications were recorded in 25 children (18%). At two years following SEMLS, the Gait Profile Score improved beyond the minimal clinically important difference, as did the parental perception of motor function (Gait Outcomes Assessment List questionnaire). There was some indication of improvement in motor function (Functional Mobility Scale). While the non-surgical group was small, there was a general decline in gait over the same period in this group.ConclusionNational data illustrating the practice of SEMLS across the UK, which is useful for clinicians to inform discussions with patients, were collected in this study. While the natural history of these children is of gradual functional decline, there was a clear signal of the effectiveness of SEMLS. Consensus to standardize clinical practice is needed, as are further studies to assess the outcomes accurately.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"55 1","pages":"1370-1378"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1302/0301-620x.107b12.bjj-2025-0572.r1
Mirte Langeveld,Caroline A Hundepool,Tom J P Mangnus,Marieke A Paping,Tjebbe Hagenaars,Frank J P M Huygen,J Michiel Zuidam
AimsAmputation as a form of treatment for patients with complex regional pain syndrome (CRPS) remains controversial. The aim of this study was to assess the long-term outcomes of amputation in patients with CRPS according to the criteria set by the core outcome measurement set for complex regional PAin syndrome Clinical sTudies (COMPACT) group.MethodsThis was a single-centre retrospective case series involving patients who underwent amputation for CRPS type I or II between January 2012 and December 2022. The primary outcome measure was the numerical rating scale (NRS) pain score in the residual limb at rest. Secondary outcomes included pain during activity, the patient's global impression of the change in pain, health-related quality of life, self-efficacy, pain catastrophizing, and phantom limb pain.ResultsThe study included 11 patients: seven with CRPS type I and four with type II. Three patients underwent amputation involving the upper limb, seven patients had an amputation of the lower limb, and one had amputations of both an upper and lower limb. At a median follow-up of 8.1 years (IQR 2.2 to 11.9), the median NRS pain score at rest in the residual limb was 4.0 (IQR 2.0 to 7.0). Seven patients reported an improvement in pain; six had a considerable improvement. The median EuroQol five-dimension five-level questionnaire score for health-related quality of life was 0.246 (IQR 0.102 to 0.640). Nine patients had phantom limb pain with a median NRS pain score of 5.0 (IQR 1.0 to 8.0).ConclusionAmputation as a last resort can reduce the level of pain in a proportion of patients with CRPS. The high incidence of of phantom limb pain poses a challenge to the overall effective management of pain in these patients. Although the level of pain improved postoperatively in most patients, the overall health-related quality of life remained low.
{"title":"Long-term outcomes of amputation in the treatment of complex regional pain syndrome : a case series.","authors":"Mirte Langeveld,Caroline A Hundepool,Tom J P Mangnus,Marieke A Paping,Tjebbe Hagenaars,Frank J P M Huygen,J Michiel Zuidam","doi":"10.1302/0301-620x.107b12.bjj-2025-0572.r1","DOIUrl":"https://doi.org/10.1302/0301-620x.107b12.bjj-2025-0572.r1","url":null,"abstract":"AimsAmputation as a form of treatment for patients with complex regional pain syndrome (CRPS) remains controversial. The aim of this study was to assess the long-term outcomes of amputation in patients with CRPS according to the criteria set by the core outcome measurement set for complex regional PAin syndrome Clinical sTudies (COMPACT) group.MethodsThis was a single-centre retrospective case series involving patients who underwent amputation for CRPS type I or II between January 2012 and December 2022. The primary outcome measure was the numerical rating scale (NRS) pain score in the residual limb at rest. Secondary outcomes included pain during activity, the patient's global impression of the change in pain, health-related quality of life, self-efficacy, pain catastrophizing, and phantom limb pain.ResultsThe study included 11 patients: seven with CRPS type I and four with type II. Three patients underwent amputation involving the upper limb, seven patients had an amputation of the lower limb, and one had amputations of both an upper and lower limb. At a median follow-up of 8.1 years (IQR 2.2 to 11.9), the median NRS pain score at rest in the residual limb was 4.0 (IQR 2.0 to 7.0). Seven patients reported an improvement in pain; six had a considerable improvement. The median EuroQol five-dimension five-level questionnaire score for health-related quality of life was 0.246 (IQR 0.102 to 0.640). Nine patients had phantom limb pain with a median NRS pain score of 5.0 (IQR 1.0 to 8.0).ConclusionAmputation as a last resort can reduce the level of pain in a proportion of patients with CRPS. The high incidence of of phantom limb pain poses a challenge to the overall effective management of pain in these patients. Although the level of pain improved postoperatively in most patients, the overall health-related quality of life remained low.","PeriodicalId":516847,"journal":{"name":"The Bone & Joint Journal","volume":"156 1","pages":"1379-1384"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1302/0301-620x.107b12.bjj-2025-0742.r2
Natalia Martinez-Catalan,Santiago Gabardo-Calvo,Maria Valencia,Gonzalo Luengo-Alonso,Cristina Delgado,Antonio M Foruria,Javier Fernandez-Jara,Emilio Calvo
AimsThe conservative treatment of degenerative full-thickness supraspinatus tears yields satisfactory results in most patients. However, identifying those likely to require surgery remains difficult. The aim of this study was to evaluate the effectiveness of conservative treatment and identify the characteristics of the patient or the size of the tear which are associated with treatment failure.MethodsThis prospective study included patients with degenerative full-thickness supraspinatus tears treated with a standardized physiotherapy protocol. Exclusion criteria were patients aged > 75 years, those with traumatic or massive tears, cuff arthropathy, those without MRI scans, or with < two years of follow-up. The patients were reviewed at three, six and 12 months and annually thereafter. Outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV), and pain using a visual analogue scale (VAS). Failure of treatment was defined as the need for surgery. The tears were classified from MRI scans according to the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine criteria. The mean follow-up was 30.5 months (SD 6.2). The study included 348 patients with a mean age of 63.4 years (SD 7.6); 230 (66.1%) were female, the dominant side was affected in 234 (67%), and 170 (49%) were manual workers. A total of 171 tears (49%) were grade C1, 131 (38%) were C2, and 46 (13%) were C3. Partial infraspinatus tears occurred in 162 (46.6%) and 243 (69.8%) had subscapularis involvement (Lafosse I to II).ResultsAt the final follow-up, 268 patients (77%) had a satisfactory outcome without surgery. Mean improvements were: ASES +31.3 (SD 20); SSV +35.6 (SD 24); and VAS -4.3 (SD 2.7) (all p < 0.001). There were no significant differences in final outcomes between those who had surgery and those who did not. The surgical group were significantly younger (58.7 years (SD 8) vs 64.8 years (SD 6.8); p < 0.001), significantly more likely to be manual workers (62.5% (50/80) vs 44.8% (120/268); p = 0.008), had significantly higher BMI, lower initial ASES and SSV scores, previous contralateral shoulder surgery, and significantly larger sagittal tears (14.7 mm (SD 5) vs 13.5 mm (SD 5); p = 0.021).ConclusionConservative treatment was effective in 77% of patients with a degenerative supraspinatus tear. Younger patients, manual workers, those with more painful shoulders, and those with a history of previous surgery in the contralateral shoulder were at a significantly increased risk of requiring surgery.
目的对退行性冈上肌全层撕裂的保守治疗效果满意。然而，确定那些可能需要手术的人仍然很困难。本研究的目的是评估保守治疗的有效性，并确定患者的特征或与治疗失败相关的撕裂大小。方法本前瞻性研究纳入采用标准化物理治疗方案治疗的退行性冈上肌全层撕裂患者。排除标准为年龄在bb0 ~ 75岁之间、有创伤性或大量撕裂、袖带关节病、未进行MRI扫描或随访时间< 2年的患者。患者分别在3个月、6个月和12个月进行复查，此后每年一次。结果采用美国肩肘外科医生（ASES）评分、主观肩值（SSV）和疼痛视觉模拟量表（VAS）进行评估。治疗失败被定义为需要手术。根据国际关节镜、膝关节外科和矫形运动医学协会的标准，通过核磁共振扫描对撕裂进行分类。平均随访30.5个月（SD 6.2）。该研究纳入348例患者，平均年龄63.4岁（SD 7.6）；女性230例（66.1%），优势侧234例（67%），体力劳动者170例（49%）。C1级171例（49%），C2级131例（38%），C3级46例（13%）。162例（46.6%）发生部分冈下肌撕裂，243例（69.8%）累及肩胛下肌（Lafosse I至II）。结果最后随访时，268例（77%）患者无手术治疗。平均改善：as +31.3 (SD 20)；SSV +35.6 (sd 24)；VAS -4.3 (SD 2.7)（均p < 0.001）。在接受手术的患者和未接受手术的患者之间，最终结果没有显著差异。手术组患者明显年轻化(58.7岁（SD 8） vs 64.8岁（SD 6.8）；P < 0.001)，体力劳动者的可能性明显更高(62.5% (50/80)vs 44.8% (120/268)；p = 0.008)， BMI明显较高，初始ase和SSV评分较低，既往对侧肩关节手术，矢状面撕裂明显较大(14.7 mm (SD 5) vs 13.5 mm (SD 5)；P = 0.021)。结论保守治疗对退行性冈上肌撕裂有77%的疗效。年轻患者、体力劳动者、肩部疼痛更严重的患者以及对侧肩部既往手术史的患者需要手术的风险显著增加。
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