Rotator cuff tears are commonly seen in athletes and older adults. Rotator cuff arthropathy (RCA), the end stage of untreated or neglected massive rotator cuff tears, leads to debilitating restriction of shoulder movements. The condition typically occurs in the seventh decade of life. While the entity can be suspected clinically, imaging clinches the diagnosis and guides the appropriate management. However, it may be missed by the radiologist on a radiograph, and sometimes on magnetic resonance imaging as well, where the findings of cuff tears take apparent priority in the impression over those of arthropathy. The inexperienced radiologist may also fail to mention findings important for surgical decision-making, such as muscle atrophy, fatty infiltration of muscles, and the location of the retracted end of the cuff tendons. This review article aims to provide teaching points on the correct diagnosis, and the importance of relevant and comprehensive reporting of such cases for timely management.
{"title":"“Rotator cuff arthropathy: Insights into this under-recognized entity”","authors":"Soham Banerjee, Stanzin Spalkit, Ankur Goyal, Shivanand Gamanagatti","doi":"10.1016/j.jcot.2025.103307","DOIUrl":"10.1016/j.jcot.2025.103307","url":null,"abstract":"<div><div>Rotator cuff tears are commonly seen in athletes and older adults. Rotator cuff arthropathy (RCA), the end stage of untreated or neglected massive rotator cuff tears, leads to debilitating restriction of shoulder movements. The condition typically occurs in the seventh decade of life. While the entity can be suspected clinically, imaging clinches the diagnosis and guides the appropriate management. However, it may be missed by the radiologist on a radiograph, and sometimes on magnetic resonance imaging as well, where the findings of cuff tears take apparent priority in the impression over those of arthropathy. The inexperienced radiologist may also fail to mention findings important for surgical decision-making, such as muscle atrophy, fatty infiltration of muscles, and the location of the retracted end of the cuff tendons. This review article aims to provide teaching points on the correct diagnosis, and the importance of relevant and comprehensive reporting of such cases for timely management.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103307"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839737","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}
Degenerative cervical myelopathy (DCM) is the most common cause of non-traumatic spinal cord dysfunction in adults, resulting from conditions such as cervical spondylosis, ossification of the posterior longitudinal ligament (OPLL), and disc degeneration. Radiological evaluation is essential to diagnosis, surgical planning, and prognosis. This review outlines the current role of imaging modalities, ranging from plain radiographs and computed tomography (CT) to magnetic resonance imaging (MRI), in the assessment of DCM. Plain radiographs and CT scans provide valuable information on cervical alignment, instability, and ossification patterns, while MRI remains the gold standard for evaluating spinal cord compression and changes in signal intensity. Advanced techniques, including diffusion tensor imaging (DTI), magnetic resonance spectroscopy (MRS), and functional MRI (fMRI), offer additional insights into spinal cord integrity and metabolic alterations, though their clinical application remains limited. A systematic and multimodal imaging approach enhances diagnostic precision, helps in surgical decision-making, and supports individualized treatment strategies in patients with cervical myelopathy.
{"title":"Radiological assessment in cervical spine myelopathy","authors":"Shanmuganathan Rajasekaran , Gnanaprakash Gurusamy , Pushpa Bhari Thippeswamy , Karthik Ramachandran , Stefano Conti","doi":"10.1016/j.jcot.2025.103301","DOIUrl":"10.1016/j.jcot.2025.103301","url":null,"abstract":"<div><div>Degenerative cervical myelopathy (DCM) is the most common cause of non-traumatic spinal cord dysfunction in adults, resulting from conditions such as cervical spondylosis, ossification of the posterior longitudinal ligament (OPLL), and disc degeneration. Radiological evaluation is essential to diagnosis, surgical planning, and prognosis. This review outlines the current role of imaging modalities, ranging from plain radiographs and computed tomography (CT) to magnetic resonance imaging (MRI), in the assessment of DCM. Plain radiographs and CT scans provide valuable information on cervical alignment, instability, and ossification patterns, while MRI remains the gold standard for evaluating spinal cord compression and changes in signal intensity. Advanced techniques, including diffusion tensor imaging (DTI), magnetic resonance spectroscopy (MRS), and functional MRI (fMRI), offer additional insights into spinal cord integrity and metabolic alterations, though their clinical application remains limited. A systematic and multimodal imaging approach enhances diagnostic precision, helps in surgical decision-making, and supports individualized treatment strategies in patients with cervical myelopathy.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103301"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839814","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 : 2025-12-09DOI: 10.1016/j.jcot.2025.103306
Anil Regmi , Bishwa Bandhu Niraula
Background
The optimal surgical strategy, whether to proceed with posterior-only or combined anterior-posterior correction for severe, rigid scoliosis, remains a topic of debate. This systematic review and meta-analysis compared radiological correction and perioperative outcomes between these two techniques.
Methods
A systematic review and meta-analysis (PROSPERO: CRD420251142691) of PubMed, Embase, and Scopus identified studies of patients with severe rigid scoliosis treated by posterior-only or AP approaches. Data on demographics, deformity features, operative parameters, hospital stay, correction rates, and complications were extracted. Quality was assessed using the Newcastle–Ottawa Scale. A meta-analysis of operative and radiographic outcomes was performed using a random-effects model with inverse variance, pooling raw means or standardized mean differences (SMD), and assessing heterogeneity with I2 and Chi2.
Results
Posterior-only and combined anterior–posterior (AP) approaches both achieved significant correction of coronal (SMD 4.58, 95 % CI 3.86–5.30) and sagittal (SMD 1.38, 95 % CI 0.13–2.63) Cobb angles. Posterior-only approaches were associated with shorter operative time (356.7 min) and lower intraoperative blood loss (2306 mL) compared with combined AP approaches. Hospital stay varied across studies (mean 18.7 days). Post-operative coronal and sagittal balance showed no significant differences from pre-operative alignment. Heterogeneity across studies was substantial, reflecting variations in technique and patient selection.
Conclusion
Posterior-only correction achieves comparable deformity correction and spinal balance to combined anterior–posterior approaches, with shorter operative time and lower blood loss. Careful patient selection remains essential, and further prospective studies are needed to validate these findings.
背景：对于严重的僵硬性脊柱侧凸，最佳的手术策略是单纯后路矫正还是前后路联合矫正，仍然是一个有争议的话题。本系统综述和荟萃分析比较了这两种技术的放射矫正和围手术期结果。方法对PubMed、Embase和Scopus进行系统回顾和荟萃分析（PROSPERO: CRD420251142691），确定了采用单纯后路或AP入路治疗严重刚性脊柱侧凸患者的研究。提取了人口统计学、畸形特征、手术参数、住院时间、矫正率和并发症的数据。使用纽卡斯尔-渥太华量表评估质量。采用随机效应模型对手术和影像学结果进行荟萃分析，该模型具有逆方差，汇集原始平均值或标准化平均差异（SMD），并评估I2和Chi2的异质性。结果单纯后侧入路和前后联合入路均能显著矫正冠状（SMD 4.58, 95% CI 3.86 ~ 5.30）和矢状（SMD 1.38, 95% CI 0.13 ~ 2.63） Cobb角。与联合AP入路相比，单纯后路手术时间更短（356.7 min），术中出血量更低（2306 mL）。住院时间因研究而异（平均18.7天）。术后冠状面和矢状面平衡与术前比较无显著差异。研究的异质性是实质性的，反映了技术和患者选择的差异。结论单纯后路矫形与前后路联合矫形的畸形矫形和脊柱平衡效果相当，手术时间短，出血量少。谨慎的患者选择仍然是必要的，需要进一步的前瞻性研究来验证这些发现。
{"title":"Posterior-only versus combined anterior–posterior approaches in severe rigid scoliosis: A systematic review and meta-analysis","authors":"Anil Regmi , Bishwa Bandhu Niraula","doi":"10.1016/j.jcot.2025.103306","DOIUrl":"10.1016/j.jcot.2025.103306","url":null,"abstract":"<div><h3>Background</h3><div>The optimal surgical strategy, whether to proceed with posterior-only or combined anterior-posterior correction for severe, rigid scoliosis, remains a topic of debate. This systematic review and meta-analysis compared radiological correction and perioperative outcomes between these two techniques.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis (PROSPERO: CRD420251142691) of PubMed, Embase, and Scopus identified studies of patients with severe rigid scoliosis treated by posterior-only or AP approaches. Data on demographics, deformity features, operative parameters, hospital stay, correction rates, and complications were extracted. Quality was assessed using the Newcastle–Ottawa Scale. A meta-analysis of operative and radiographic outcomes was performed using a random-effects model with inverse variance, pooling raw means or standardized mean differences (SMD), and assessing heterogeneity with I<sup>2</sup> and Chi<sup>2</sup>.</div></div><div><h3>Results</h3><div>Posterior-only and combined anterior–posterior (AP) approaches both achieved significant correction of coronal (SMD 4.58, 95 % CI 3.86–5.30) and sagittal (SMD 1.38, 95 % CI 0.13–2.63) Cobb angles. Posterior-only approaches were associated with shorter operative time (356.7 min) and lower intraoperative blood loss (2306 mL) compared with combined AP approaches. Hospital stay varied across studies (mean 18.7 days). Post-operative coronal and sagittal balance showed no significant differences from pre-operative alignment. Heterogeneity across studies was substantial, reflecting variations in technique and patient selection.</div></div><div><h3>Conclusion</h3><div>Posterior-only correction achieves comparable deformity correction and spinal balance to combined anterior–posterior approaches, with shorter operative time and lower blood loss. Careful patient selection remains essential, and further prospective studies are needed to validate these findings.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103306"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839640","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 : 2025-12-08DOI: 10.1016/j.jcot.2025.103302
Anton A. Semenistyy , Leonid N. Solomin , Artem V. Komarov , Roman Y. Mitsikov , Borislav G. Tasev , Andrey N. Mironov
Background
A universal classification providing a clinically relevant and anatomically comprehensive framework for long bone nonunions has been recently introduced. This study aimed to evaluate its inter- and intra-observer reliability and compare its performance with the widely used Weber–Cech classification.
Methods
This multicenter, three-stage validation study included 191 cases meeting the FDA definition of nonunion. Four expert raters participated. In Stage 1, cases were classified using existing systems: AO/OTA for anatomical location and Weber–Cech for biological type. In Stage 2, 133 eligible cases were independently classified using the Universal Long Bone Nonunion Classification (ULBNC) in two rounds, two weeks apart. Stage 3 involved refinement of classification criteria based on feedback and statistical analysis, followed by re-assessment of 90 cases. Inter-observer reliability was assessed using free-marginal Fleiss' kappa; intra-observer reliability using Cohen's kappa with linear weighting.
Results
Substantial to almost perfect inter-observer agreement was observed for type classification (κ = 0.85), with the highest reliability in diaphyseal nonunions (κ = 0.90). Incorporating pathological mobility significantly improved agreement compared to Weber–Cech (κ = 0.38, p < 0.05). Periarticular nonunions showed substantial agreement (κ = 0.72). Group-level agreement improved from moderate (κ = 0.42–0.57) to substantial (κ = 0.79–0.82) after refining criteria. Subgroup agreement was excellent (κ = 0.89–1.00). Intra-observer reliability ranged from substantial to almost perfect across all levels.
Conclusion
ULBNC is a reliable and reproducible classification system for long bone nonunions. Incorporation of clinical features—such as pathological mobility, alignment, and correction strategy—enhances its clinical utility and supports standardization in treatment and research.
{"title":"Multicenter reliability study of the universal long bone nonunion classification","authors":"Anton A. Semenistyy , Leonid N. Solomin , Artem V. Komarov , Roman Y. Mitsikov , Borislav G. Tasev , Andrey N. Mironov","doi":"10.1016/j.jcot.2025.103302","DOIUrl":"10.1016/j.jcot.2025.103302","url":null,"abstract":"<div><h3>Background</h3><div>A universal classification providing a clinically relevant and anatomically comprehensive framework for long bone nonunions has been recently introduced. This study aimed to evaluate its inter- and intra-observer reliability and compare its performance with the widely used Weber–Cech classification.</div></div><div><h3>Methods</h3><div>This multicenter, three-stage validation study included 191 cases meeting the FDA definition of nonunion. Four expert raters participated. In Stage 1, cases were classified using existing systems: AO/OTA for anatomical location and Weber–Cech for biological type. In Stage 2, 133 eligible cases were independently classified using the Universal Long Bone Nonunion Classification (ULBNC) in two rounds, two weeks apart. Stage 3 involved refinement of classification criteria based on feedback and statistical analysis, followed by re-assessment of 90 cases. Inter-observer reliability was assessed using free-marginal Fleiss' kappa; intra-observer reliability using Cohen's kappa with linear weighting.</div></div><div><h3>Results</h3><div>Substantial to almost perfect inter-observer agreement was observed for type classification (κ = 0.85), with the highest reliability in diaphyseal nonunions (κ = 0.90). Incorporating pathological mobility significantly improved agreement compared to Weber–Cech (κ = 0.38, p < 0.05). Periarticular nonunions showed substantial agreement (κ = 0.72). Group-level agreement improved from moderate (κ = 0.42–0.57) to substantial (κ = 0.79–0.82) after refining criteria. Subgroup agreement was excellent (κ = 0.89–1.00). Intra-observer reliability ranged from substantial to almost perfect across all levels.</div></div><div><h3>Conclusion</h3><div>ULBNC is a reliable and reproducible classification system for long bone nonunions. Incorporation of clinical features—such as pathological mobility, alignment, and correction strategy—enhances its clinical utility and supports standardization in treatment and research.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103302"},"PeriodicalIF":0.0,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839810","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 : 2025-12-07DOI: 10.1016/j.jcot.2025.103303
Khaled A. Elmenawi , Benjamin E. Jevnikar , Arjun Dinesh , Yuxuan Jin , Nicolas S. Piuzzi
Background
As the United States healthcare system transitions toward value-based care, patient-reported outcomes (PROMs) have become central to defining surgical quality and guiding reimbursement. Under the Centers for Medicare & Medicaid Services (CMS) Patient-Reported Outcomes Performance Measure (PRO-PM) initiative, hospitals are required to collect and report PROMs following total hip arthroplasty (THA). However, it remains unclear whether patients treated at high- and low-volume hospitals achieve comparable rates of clinically meaningful improvement.
Methods
We retrospectively analyzed 4962 Medicare beneficiaries who underwent primary THA within a large integrated health system between 2016 and 2023. Hospitals were stratified by procedural volume (≥500 vs < 500 THAs annually). Patient-reported outcomes were assessed using the Hip Disability and Osteoarthritis Outcome Score for Pain, Physical Function (PS), and Joint Replacement (JR). Clinically meaningful thresholds included the minimal clinically important difference (MCID), patient acceptable symptom state (PASS) threshold, substantial clinical benefit (SCB), and satisfaction. Multivariable logistic regression evaluated associations between hospital volume and failure to achieve each PROM threshold, adjusting for demographic and clinical covariates.
Results
Hospital procedural volume was not associated with differences in PROM achievement. The odds of failing to reach MCID, PASS, or SCB thresholds, or to report satisfaction, were comparable between high- and low-volume hospitals across all HOOS domains (all P > 0.05).
Conclusions
Patients achieved similar rates of meaningful improvement following THA regardless of hospital volume. As CMS increasingly ties reimbursement to PROM-based benchmarks, these findings support the equitable implementation of PRO-PM initiatives across diverse care settings and reinforce that standardized, evidence-based care, rather than procedural volume, drives high-value arthroplasty outcomes.
{"title":"Hospital volume is not associated with clinically meaningful PROM achievement following primary total hip arthroplasty","authors":"Khaled A. Elmenawi , Benjamin E. Jevnikar , Arjun Dinesh , Yuxuan Jin , Nicolas S. Piuzzi","doi":"10.1016/j.jcot.2025.103303","DOIUrl":"10.1016/j.jcot.2025.103303","url":null,"abstract":"<div><h3>Background</h3><div>As the United States healthcare system transitions toward value-based care, patient-reported outcomes (PROMs) have become central to defining surgical quality and guiding reimbursement. Under the Centers for Medicare & Medicaid Services (CMS) Patient-Reported Outcomes Performance Measure (PRO-PM) initiative, hospitals are required to collect and report PROMs following total hip arthroplasty (THA). However, it remains unclear whether patients treated at high- and low-volume hospitals achieve comparable rates of clinically meaningful improvement.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 4962 Medicare beneficiaries who underwent primary THA within a large integrated health system between 2016 and 2023. Hospitals were stratified by procedural volume (≥500 vs < 500 THAs annually). Patient-reported outcomes were assessed using the Hip Disability and Osteoarthritis Outcome Score for Pain, Physical Function (PS), and Joint Replacement (JR). Clinically meaningful thresholds included the minimal clinically important difference (MCID), patient acceptable symptom state (PASS) threshold, substantial clinical benefit (SCB), and satisfaction. Multivariable logistic regression evaluated associations between hospital volume and failure to achieve each PROM threshold, adjusting for demographic and clinical covariates.</div></div><div><h3>Results</h3><div>Hospital procedural volume was not associated with differences in PROM achievement. The odds of failing to reach MCID, PASS, or SCB thresholds, or to report satisfaction, were comparable between high- and low-volume hospitals across all HOOS domains (all <em>P</em> > 0.05).</div></div><div><h3>Conclusions</h3><div>Patients achieved similar rates of meaningful improvement following THA regardless of hospital volume. As CMS increasingly ties reimbursement to PROM-based benchmarks, these findings support the equitable implementation of PRO-PM initiatives across diverse care settings and reinforce that standardized, evidence-based care, rather than procedural volume, drives high-value arthroplasty outcomes.</div></div><div><h3>Level of evidence</h3><div>II (prospective)</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103303"},"PeriodicalIF":0.0,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839742","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}
Managing severe and rigid spinal deformities with limited flexibility and high Cobb angles (≥90°) remains a significant challenge in spine surgery. Halo Gravity Traction (HGT) has been adopted preoperatively to optimize surgical tolerance, facilitate spinal correction, and improve surgical outcomes.
Objective
This study aimed to determine the outcomes of severe scoliosis managed by preoperative HGT followed by definitive spinal fusion.
Methods
A retrospective analysis of 27 patients was conducted at a single center between 2010 and 2023. The inclusion criteria were patients with severe scoliosis or kyphoscoliosis who underwent HGT before definitive spinal fusion, with a minimum 2-year follow-up. The variables collected included age, HGT duration, sex, deformity etiology, preoperative, post-HGT, and postoperative coronal and sagittal Cobb angles, curve flexibility, and complications. Continuous variables were assessed in Microsoft excel and p value was calculated for categorical variables using Paired T Test (p value < 0.05 was taken as significant)
Results
The mean age of the patients was 13.17 years (range, 4–26 years), with an average HGT duration of 40.5 days (SD ± 29.43). The mean preoperative, post-HGT, and postoperative Cobb angles in the 27 patients were 95.18°, 70.46°, and 46.76°, respectively, reflecting a significant postoperative correction rate of 50.87 %. Intraoperative monitoring changes were observed in 18.51 % of the patients. Four (12.5 %) patients had postoperative neuro-deficits, of which three completely recovered. One patient had a neurology of ASIA B in the immediate postoperative period, which improved to AISA D at 2 years of follow-up. The postoperative complications included pin-site infections (14.81 %), wound healing issues (11.11 %), implant prominence (7.40 %), implant failure (14.81 %), and proximal/distal junctional kyphosis (11.11 %).
Conclusion
HGT followed by definitive spinal fusion is an effective method for managing severe rigid spinal deformities because HGT can partially correct the deformity and aid in gradual stretching and spinal stress relaxation.
{"title":"Preoperative halo gravity traction (HGT) in severe rigid scoliosis – A single centre study","authors":"Saumyajit Basu , Ayon Ghosh , Kushal Gohil , Vikas Hanasoge","doi":"10.1016/j.jcot.2025.103294","DOIUrl":"10.1016/j.jcot.2025.103294","url":null,"abstract":"<div><h3>Background</h3><div>Managing severe and rigid spinal deformities with limited flexibility and high Cobb angles (≥90°) remains a significant challenge in spine surgery. Halo Gravity Traction (HGT) has been adopted preoperatively to optimize surgical tolerance, facilitate spinal correction, and improve surgical outcomes.</div></div><div><h3>Objective</h3><div>This study aimed to determine the outcomes of severe scoliosis managed by preoperative HGT followed by definitive spinal fusion.</div></div><div><h3>Methods</h3><div>A retrospective analysis of 27 patients was conducted at a single center between 2010 and 2023. The inclusion criteria were patients with severe scoliosis or kyphoscoliosis who underwent HGT before definitive spinal fusion, with a minimum 2-year follow-up. The variables collected included age, HGT duration, sex, deformity etiology, preoperative, post-HGT, and postoperative coronal and sagittal Cobb angles, curve flexibility, and complications. Continuous variables were assessed in Microsoft excel and p value was calculated for categorical variables using Paired T Test (p value < 0.05 was taken as significant)</div></div><div><h3>Results</h3><div>The mean age of the patients was 13.17 years (range, 4–26 years), with an average HGT duration of 40.5 days (SD ± 29.43). The mean preoperative, post-HGT, and postoperative Cobb angles in the 27 patients were 95.18°, 70.46°, and 46.76°, respectively, reflecting a significant postoperative correction rate of 50.87 %. Intraoperative monitoring changes were observed in 18.51 % of the patients. Four (12.5 %) patients had postoperative neuro-deficits, of which three completely recovered. One patient had a neurology of ASIA B in the immediate postoperative period, which improved to AISA D at 2 years of follow-up. The postoperative complications included pin-site infections (14.81 %), wound healing issues (11.11 %), implant prominence (7.40 %), implant failure (14.81 %), and proximal/distal junctional kyphosis (11.11 %).</div></div><div><h3>Conclusion</h3><div>HGT followed by definitive spinal fusion is an effective method for managing severe rigid spinal deformities because HGT can partially correct the deformity and aid in gradual stretching and spinal stress relaxation.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103294"},"PeriodicalIF":0.0,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797113","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}
High tibial osteotomy (HTO) is a key joint-preserving procedure for medial compartment osteoarthritis and varus deformity, but conventional planning is operator-dependent. Machine learning (ML) offers potential to automate radiographic assessment and predict surgical outcomes. This systematic review evaluated the accuracy, efficiency, and generalizability of ML models applied to HTO planning and prediction.
Methods
Following PRISMA 2020 guidelines (PROSPERO CRD420251122187), PubMed, EMBASE, and Web of Science were searched to August 2025. Studies using ML for HTO planning, alignment measurement, or outcome prediction were included. Two reviewers independently extracted data and assessed risk of bias using the PROBAST tool across four domains: participants, predictors, outcomes, and analysis.
Results
From 43 retrieved records, 11 studies met inclusion criteria. Most were retrospective, single-center analyses with heterogeneous datasets. Convolutional neural networks and deep learning systems achieved sub-2° mean absolute error for alignment parameters such as hip–knee–ankle, medial proximal tibial and lateral distal femoral angles. Ensemble ML models predicted lateral hinge-fracture risk and postoperative alignment with area-under-curve values exceeding 0.80. Intraclass correlation coefficients for AI-derived measures were consistently >0.90. Automated analysis was markedly faster than manual measurement—0.2 s versus 1–2 min per radiograph. Only a single study performed multicenter external validation; others remained internally tested.
Conclusion
ML demonstrates excellent precision and efficiency in radiographic analysis and complication prediction for HTO. Nonetheless, evidence is constrained by single-center data, small cohorts, and lack of functional validation. Future multicentric, prospective, and explainable AI studies are required to confirm clinical applicability and patient-reported benefit.
背景：胫骨高位截骨术（HTO）是治疗内侧骨室骨关节炎和内翻畸形的关键保关节手术，但传统的手术计划取决于手术者。机器学习（ML）提供了自动化放射评估和预测手术结果的潜力。本系统综述评估了应用于HTO规划和预测的ML模型的准确性、效率和通用性。方法按照PRISMA 2020指南（PROSPERO CRD420251122187），检索PubMed、EMBASE和Web of Science至2025年8月。使用ML进行HTO计划、对齐测量或结果预测的研究也包括在内。两名审稿人独立提取数据，并使用PROBAST工具评估四个领域的偏倚风险：参与者、预测因素、结果和分析。结果在检索到的43份文献中，有11项研究符合纳入标准。大多数是具有异构数据集的回顾性单中心分析。卷积神经网络和深度学习系统对髋关节-膝关节-踝关节、胫骨内侧近端角和股骨外侧远端角等对准参数实现了低于2°的平均绝对误差。集合ML模型预测外侧铰链骨折风险和术后对齐，曲线下面积值超过0.80。人工智能衍生测量的类内相关系数一致为>；0.90。自动分析明显比人工测量快——每张x光片0.2秒比1-2分钟。只有一项研究进行了多中心外部验证；其他公司仍在进行内部测试。结论ml对HTO的影像学分析和并发症预测具有较高的准确性和效率。然而，证据受到单中心数据、小队列和缺乏功能验证的限制。需要未来的多中心、前瞻性和可解释的人工智能研究来确认临床适用性和患者报告的益处。
{"title":"The role of machine learning in high tibial osteotomy: A systematic review of predictive modeling, planning, and outcome analysis","authors":"Ankush Mohabey , Vivaan Jain , Sitanshu Barik , Vikash Raj , Mukund Madhav Ojha , Vishal Kumar","doi":"10.1016/j.jcot.2025.103290","DOIUrl":"10.1016/j.jcot.2025.103290","url":null,"abstract":"<div><h3>Background</h3><div>High tibial osteotomy (HTO) is a key joint-preserving procedure for medial compartment osteoarthritis and varus deformity, but conventional planning is operator-dependent. Machine learning (ML) offers potential to automate radiographic assessment and predict surgical outcomes. This systematic review evaluated the accuracy, efficiency, and generalizability of ML models applied to HTO planning and prediction.</div></div><div><h3>Methods</h3><div>Following PRISMA 2020 guidelines (PROSPERO CRD420251122187), PubMed, EMBASE, and Web of Science were searched to August 2025. Studies using ML for HTO planning, alignment measurement, or outcome prediction were included. Two reviewers independently extracted data and assessed risk of bias using the PROBAST tool across four domains: participants, predictors, outcomes, and analysis.</div></div><div><h3>Results</h3><div>From 43 retrieved records, 11 studies met inclusion criteria. Most were retrospective, single-center analyses with heterogeneous datasets. Convolutional neural networks and deep learning systems achieved sub-2° mean absolute error for alignment parameters such as hip–knee–ankle, medial proximal tibial and lateral distal femoral angles. Ensemble ML models predicted lateral hinge-fracture risk and postoperative alignment with area-under-curve values exceeding 0.80. Intraclass correlation coefficients for AI-derived measures were consistently >0.90. Automated analysis was markedly faster than manual measurement—0.2 s versus 1–2 min per radiograph. Only a single study performed multicenter external validation; others remained internally tested.</div></div><div><h3>Conclusion</h3><div>ML demonstrates excellent precision and efficiency in radiographic analysis and complication prediction for HTO. Nonetheless, evidence is constrained by single-center data, small cohorts, and lack of functional validation. Future multicentric, prospective, and explainable AI studies are required to confirm clinical applicability and patient-reported benefit.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103290"},"PeriodicalIF":0.0,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747385","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}
Severe rigid scoliosis is a stiff and complex three-dimensional deformity. The children presenting with severe scoliosis need to be timely treated to prevent further deterioration of the curves and physiological function. The goals of treatment include to stop the progression of the curve, restore the spinal alignment, prevent neurological deterioration or improve the neurology if it is already deteriorated, improvement of pulmonary function and improve cosmetic outcomes. The various surgical options are one stage correction with osteotomies, posterior only approach, staged anterior release and posterior approach, pre-operative optimization by halo traction followed by posterior fusion and temporary internal distraction.
Method
The study protocol was published in PROSPERO with the ID CRD420251046131.Studies with participants diagnosed with severe rigid scoliosis who were operated and reporting the baseline values and correction of the scoliosis at follow-up were included. Studies mentioning the type of procedure and complications associated with the procedure were also included. Studies dealing with exclusive kyphosis, infective deformities, porcine models, adult degenerative lumbar scoliosis and those that did not give details about the scoliosis correction were excluded.
Results
A total of Seventy-Five studies were included with 2314 patients. Both neurological and non-neurological complications were significantly more likely in osteotomy compared to halo traction followed by definitive surgery. The difference was very significant in neurological complications (RR∼3.76, 95 % CI = 2.52–5.60).
Conclusion
Among the various strategies employed to treat severe rigid scoliosis, Spinal Osteotomy techniques had the highest rates of neurological and non-neurological complications. All the techniques described like halo traction, osteotomy and staged procedures gave a good curve correction in severe rigid scoliosis.
背景：重度刚性脊柱侧凸是一种僵硬复杂的三维畸形。出现严重脊柱侧凸的患儿需要及时治疗，防止脊柱曲度和生理功能进一步恶化。治疗的目标包括停止弯曲的进展，恢复脊柱的排列，防止神经系统恶化或改善神经系统，如果它已经恶化，改善肺功能和改善美容效果。各种手术选择包括一期截骨矫正，单纯后路入路，分阶段前路释放和后路入路，术前通过晕轮牵引进行优化，然后进行后路融合和暂时内撑开。研究方案发表在《普洛斯彼罗》杂志上，编号CRD420251046131。被诊断为严重僵硬性脊柱侧凸的参与者接受了手术，并在随访中报告了脊柱侧凸的基线值和矫正情况。涉及手术类型和手术并发症的研究也包括在内。排除了排他性脊柱后凸、感染性畸形、猪模型、成人退行性腰椎侧凸以及未提供脊柱侧凸矫正细节的研究。结果共纳入75项研究，2314例患者。截骨术中神经系统和非神经系统并发症的发生率明显高于halo牵引后的最终手术。神经系统并发症的差异非常显著（RR ~ 3.76, 95% CI = 2.52 ~ 5.60）。结论在治疗重度刚性脊柱侧凸的方法中，脊柱截骨术的神经和非神经并发症发生率最高。所有描述的技术，如光晕牵引，截骨术和分阶段手术都能很好地矫正严重的刚性脊柱侧凸。
{"title":"Different treatment modalities and their impact on outcomes in severe rigid scoliosis: a systematic review and pooled data meta-analysis","authors":"Syed Ifthekar , Deepankar Satapathy , Kaustubh Ahuja , Samarth Mittal , Siddharth Sekhar Sethy , Pankaj Kandwal","doi":"10.1016/j.jcot.2025.103295","DOIUrl":"10.1016/j.jcot.2025.103295","url":null,"abstract":"<div><h3>Background</h3><div>Severe rigid scoliosis is a stiff and complex three-dimensional deformity. The children presenting with severe scoliosis need to be timely treated to prevent further deterioration of the curves and physiological function. The goals of treatment include to stop the progression of the curve, restore the spinal alignment, prevent neurological deterioration or improve the neurology if it is already deteriorated, improvement of pulmonary function and improve cosmetic outcomes. The various surgical options are one stage correction with osteotomies, posterior only approach, staged anterior release and posterior approach, pre-operative optimization by halo traction followed by posterior fusion and temporary internal distraction.</div></div><div><h3>Method</h3><div>The study protocol was published in PROSPERO with the ID CRD420251046131.Studies with participants diagnosed with severe rigid scoliosis who were operated and reporting the baseline values and correction of the scoliosis at follow-up were included. Studies mentioning the type of procedure and complications associated with the procedure were also included. Studies dealing with exclusive kyphosis, infective deformities, porcine models, adult degenerative lumbar scoliosis and those that did not give details about the scoliosis correction were excluded.</div></div><div><h3>Results</h3><div>A total of Seventy-Five studies were included with 2314 patients. Both neurological and non-neurological complications were significantly more likely in osteotomy compared to halo traction followed by definitive surgery. The difference was very significant in neurological complications (RR∼3.76, 95 % CI = 2.52–5.60).</div></div><div><h3>Conclusion</h3><div>Among the various strategies employed to treat severe rigid scoliosis, Spinal Osteotomy techniques had the highest rates of neurological and non-neurological complications. All the techniques described like halo traction, osteotomy and staged procedures gave a good curve correction in severe rigid scoliosis.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103295"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797115","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: 10.1016/j.jcot.2025.103293
Stephane Owusu-Sarpong , Tejas Subramanian , Han Jo Kim
Severe rigid scoliosis presents some unique challenges with respect to surgical techniques and complications. Anterior and posterior techniques, as well as combined approaches, can be employed for the surgical management of this condition. The purpose of this article is to describe severe rigid scoliosis as an entity and to delve into the surgical tools that may be utilized for the treatment of this complex condition. Specific techniques are presented in detail, including preoperative halo-gravity/halo-pelvic traction, as well as correction maneuvers such as anterior release, thoracoplasty, concave rib osteotomy, and posterior vertebral column resection. Preoperative halo traction improves curve flexibility and pulmonary status, anterior release and concave rib osteotomy enhance mobilization, thoracoplasty addresses rib prominence, and posterior vertebral column resection provides powerful single-stage correction. Collectively, these techniques expand surgical options and mitigate neurologic and cardiopulmonary risks in severe rigid scoliosis.
{"title":"Surgical techniques for the management of severe rigid scoliosis","authors":"Stephane Owusu-Sarpong , Tejas Subramanian , Han Jo Kim","doi":"10.1016/j.jcot.2025.103293","DOIUrl":"10.1016/j.jcot.2025.103293","url":null,"abstract":"<div><div>Severe rigid scoliosis presents some unique challenges with respect to surgical techniques and complications. Anterior and posterior techniques, as well as combined approaches, can be employed for the surgical management of this condition. The purpose of this article is to describe severe rigid scoliosis as an entity and to delve into the surgical tools that may be utilized for the treatment of this complex condition. Specific techniques are presented in detail, including preoperative halo-gravity/halo-pelvic traction, as well as correction maneuvers such as anterior release, thoracoplasty, concave rib osteotomy, and posterior vertebral column resection. Preoperative halo traction improves curve flexibility and pulmonary status, anterior release and concave rib osteotomy enhance mobilization, thoracoplasty addresses rib prominence, and posterior vertebral column resection provides powerful single-stage correction. Collectively, these techniques expand surgical options and mitigate neurologic and cardiopulmonary risks in severe rigid scoliosis.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103293"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839735","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}
Posterior tibial slope (PTS) is believed to influence range of motion (ROM) and functional outcomes after total knee arthroplasty (TKA), particularly in cruciate-retaining and posterior-stabilized designs. However, limited data exist on its impact in mobile-bearing systems. This study evaluated whether variations in PTS affect ROM and patient-reported outcome measures (PROMs) following mobile-bearing TKA using the Buechel-Pappas design.
Methods
This was a retrospective, single center cohort study on 359 patients who underwent cemented mobile-bearing TKA between 2018 and 2022, with a minimum follow-up of 2 years. Patients were stratified into three PTS categories: <4°, 4–7°, and >7° and analyzed. Functional outcomes were assessed using the Oxford Knee Score (OKS), Forgotten Joint Score (FJS), maximal knee ROM, and complications.
Results
Patient had a mean follow-up of 2.8 years (SD = 0.9) with a mean age was 61.3 (SD = 7.7) years. Baseline demographic characteristics were comparable between the 3 cohorts. Mean postoperative ROM improved significantly from 75.2° to 95.3°, and mean OKS from 16.2 to 34.5 (p < 0.001). However, no significant differences in ROM, OKS, or FJS were observed between PTS groups (p > 0.05). Analysis of change in PTS between pre-operative to post-operative showed no significant difference. ROC analyses and logistic regression demonstrated poor predictive ability of PTS for functional outcomes.
Conclusion
Variations in posterior tibial slope within typical clinical ranges (<4°, 4–7°, >7°), as well as the degree of change in slope achieved from preoperative to postoperative alignment, did not significantly affect postoperative range of motion or patient-reported outcomes following mobile-bearing total knee arthroplasty.
{"title":"Impact of posterior tibial slope on functional outcomes after mobile-bearing total knee arthroplasty","authors":"Tarun Jayakumar, Kushal Hippalgaonkar, Albin Savio, Chiranjeevi Thayi, AV.Gurava Reddy","doi":"10.1016/j.jcot.2025.103296","DOIUrl":"10.1016/j.jcot.2025.103296","url":null,"abstract":"<div><h3>Background</h3><div>Posterior tibial slope (PTS) is believed to influence range of motion (ROM) and functional outcomes after total knee arthroplasty (TKA), particularly in cruciate-retaining and posterior-stabilized designs. However, limited data exist on its impact in mobile-bearing systems. This study evaluated whether variations in PTS affect ROM and patient-reported outcome measures (PROMs) following mobile-bearing TKA using the Buechel-Pappas design.</div></div><div><h3>Methods</h3><div>This was a retrospective, single center cohort study on 359 patients who underwent cemented mobile-bearing TKA between 2018 and 2022, with a minimum follow-up of 2 years. Patients were stratified into three PTS categories: <4°, 4–7°, and >7° and analyzed. Functional outcomes were assessed using the Oxford Knee Score (OKS), Forgotten Joint Score (FJS), maximal knee ROM, and complications.</div></div><div><h3>Results</h3><div>Patient had a mean follow-up of 2.8 years (SD = 0.9) with a mean age was 61.3 (SD = 7.7) years. Baseline demographic characteristics were comparable between the 3 cohorts. Mean postoperative ROM improved significantly from 75.2° to 95.3°, and mean OKS from 16.2 to 34.5 (p < 0.001). However, no significant differences in ROM, OKS, or FJS were observed between PTS groups (p > 0.05). Analysis of change in PTS between pre-operative to post-operative showed no significant difference. ROC analyses and logistic regression demonstrated poor predictive ability of PTS for functional outcomes.</div></div><div><h3>Conclusion</h3><div>Variations in posterior tibial slope within typical clinical ranges (<4°, 4–7°, >7°), as well as the degree of change in slope achieved from preoperative to postoperative alignment, did not significantly affect postoperative range of motion or patient-reported outcomes following mobile-bearing total knee arthroplasty.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103296"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797000","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}
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