Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"Functional outcome of anterior cruciate ligament reconstruction with hamstring tendon autograft in Indian population: A systematic review and meta-analysis","authors":"R. Annamalai ,&nbsp;C. Venkatramanaiah ,&nbsp;A. Sujhithra ,&nbsp;N. Vignesh ,&nbsp;D. Danis Vijay","doi":"10.1016/j.jcot.2024.102805","DOIUrl":"10.1016/j.jcot.2024.102805","url":null,"abstract":"<div><h3>Background</h3><div>Anterior cruciate ligament (ACL) injury is a significant orthopedic issue globally with varying success rates among different populations. Better understanding of functional outcome can help design suitable protocols for ACL reconstruction and recovery. This review aims to evaluate the epidemiological trends and functional outcomes of ACLR procedures in India.</div></div><div><h3>Methods</h3><div>The review was conducted following PRISMA guidelines, by searching in Google Scholar, Pubmed, Web of Science and Science Direct databases in February 2024. The study encompassed patient demographics, and postoperative outcomes in Indian populations upon ACLR using hamstring tendon autografts. Meta-analysis was conducted with RevMan 5.4 using random-effects models. Funnel plots were used to explore publication bias. Subgroup analyses of follow-up terms and age were also performed.</div></div><div><h3>Results</h3><div>A total of 26 studies were pooled for overall qualitative and quantitative analysis. Sports injuries (52 %) were found to be more common, followed by road traffic accidents (31 %). Injuries were mostly on the right knees (56 %). Functional outcome analysis using Lysholm Knee Scoring Scale (MD 34.74, 95 % CI 31.58 to 37.89), International Knee Documentation Committee (MD 36.74, 95 % CI 32.36 to 41.13), Tegner Activity Scale (MD 0.90, 95 % CI -0.01 to 1.80) revealed statistically significant overall outcome effect. Statistically non-significant differences were found between follow-up to 6 months and follow-up above 6 months as well as with age. However, meta-analysis showed high level of heterogeneity.</div></div><div><h3>Conclusion</h3><div>ACLR in Indian population is largely successful in restoring functional activity. However, the outcome of this review is limited by the heterogeneity factor. Further, the Indian studies have not focused on factors affecting the outcome. Therefore, future studies in this direction are needed for understanding the clinical success.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"59 ","pages":"Article 102805"},"PeriodicalIF":0.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142705464","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}

{"title":"Avascular necrosis of femoral head – Demographic profile, natural history of asymptomatic hips and native hip survivorship in an indian subcontinent cohort","authors":"Jeremy Bliss Dorai ,&nbsp;Bhim Bahadur ,&nbsp;Arun Shankar ,&nbsp;Anil Thomas Oommen ,&nbsp;Manasseh Nithyananth","doi":"10.1016/j.jcot.2024.102801","DOIUrl":"10.1016/j.jcot.2024.102801","url":null,"abstract":"<div><h3>Background</h3><div>Avascular Necrosis of the femoral head is still considered an unsolved orthopedic problem despite significant research and advances in treatment.</div></div><div><h3>Purposes</h3><div><ul><li><span>1.</span><span><div>Describe the demographic pattern</div></span></li><li><span>2.</span><span><div>Assess postoperative survival of the native hip</div></span></li><li><span>3.</span><span><div>Observe the natural history in asymptomatic hips</div></span></li></ul></div></div><div><h3>Patients and methods</h3><div>A South Indian quaternary care hospital based retrospective study. Patients diagnosed with non-traumatic avascular necrosis of the femoral head who underwent hip-preserving procedures between 2004 and 2017 were studied. The clinical and radiological outcomes were assessed. Statistical analysis for hip survival was done using Kaplan–Meier survival analysis.</div></div><div><h3>Results</h3><div>The study was conducted on 306 hips of 190 patients. The most common etiology was steroid intake. The average follow-up period was 8 years. 216(76 %) hips survived clinically and 125(44 %) hips survived radiologically. The mean duration of clinical survival was 8 years and radiological survival was 7.5 years. The overall regression was highest in the fibula grafting. In asymptomatic hips clinical failure was observed in 36(53 %) hips and radiological failure in 52(77 %) hips with a mean follow-up of 5.9 years.</div></div><div><h3>Conclusion</h3><div>The earlier stage of presentation and a hip-preserving surgery exhibited a 70 % chance of survival of the native hip. Core decompression decreased the rate of progression in the early stages. Disease regression rates were significant in fibula grafting for stages 2a and 2b. Non-operative treatment is not advisable given rapid disease progression.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"59 ","pages":"Article 102801"},"PeriodicalIF":0.0,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142705323","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}

{"title":"Do two distal locking screws in two planes offer the best option in the nailing of diaphyseal tibial fractures?","authors":"Sebastian Pereira ,&nbsp;Germán Garabano ,&nbsp;Leonel Perez Alamino ,&nbsp;Fernando Bidolegui ,&nbsp;Cesar Angel Pesciallo","doi":"10.1016/j.jcot.2024.102802","DOIUrl":"10.1016/j.jcot.2024.102802","url":null,"abstract":"<div><h3>Background</h3><div>Although the intramedullary nail represents the treatment for most tibia diaphyseal fractures, there is no agreement on the configuration of the distal locking screws. Therefore, this study aimed to investigate the impact of the configuration of distal locking bolts on the healing of a tibial shaft fracture.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 170 closed fractures of the tibia diaphyseal operated consecutively between 2018 and 2021. Patients with postoperative unacceptable reduction (&gt;5° in any plane or gap &gt;4 mm), nail-canal ratio &lt;0.78, and less than 12 months of follow-up were excluded. Using a univariate and multivariate analysis, we analyzed comorbidities (smoking, Body mass index &gt;30, diabetes), fracture type (OTA/AO), the number (one, two, three distal locking screws), and configuration (uniplanar, biplanar, triplanar) of distal locking screws between patients with and without a bone union.</div></div><div><h3>Results</h3><div>One hundred and forty-two fractures were available for analysis. The bone union and non-union rates were 89.4 % (n = 127) and 10.6 % (n = 15), respectively. The multivariate analysis showed that type A fractures (OR 6.67, p = 0.010) and using two distal locking screws with a biplanar configuration (OR 3.63, p = 0.036) were independent variables related to bone union. In contrast, smoking habit (OR 0.12, p = 0.041), fractures type B (OR 0.22, p = 0.013), and uniplanar fixation (OR 0.51, p = 0.003) were related to non-union.</div></div><div><h3>Conclusion</h3><div>The findings of this study suggest that using two distal locking screws (anteroposterior + mediolateral) in the nailing of closed tibial diaphyseal fracture represents the optimal configuration, offering a higher likelihood of healing compared to other locking options.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"59 ","pages":"Article 102802"},"PeriodicalIF":0.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142652318","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}

{"title":"Patient experiences with a smartphone application dedicated to postoperative recovery after elective arthroplasty","authors":"Abdul-Rahman Gomaa ,&nbsp;Momna Sajjad Raja ,&nbsp;Sara Monteiro ,&nbsp;Sriram Srinivasan ,&nbsp;Srinivasan Shyamsundar ,&nbsp;Hamidreza Khairandish ,&nbsp;Faizal Rayan","doi":"10.1016/j.jcot.2024.102557","DOIUrl":"10.1016/j.jcot.2024.102557","url":null,"abstract":"<div><h3>Introduction</h3><div>In the rapidly evolving landscape of digital health technologies, the widespread use of smartphones has paved the way for innovative applications designed to enhance healthcare experiences. This introduction underscores the global prevalence of smartphone users and their potential in healthcare, particularly exemplified by therapeutic apps such as the ‘Post Op’ smartphone application. Focused on postoperative support, this app prioritises user-friendly design, data recording, and adherence to national standards. The study aims to evaluate the app's success in achieving these objectives, highlighting its continuous improvement based on real user feedback and its potential impact on improving patient experiences and recovery processes.</div></div><div><h3>Methods and materials</h3><div>A cohort of elective joint arthroplasty procedure patients at Kettering General Hospital (KGH), spanning a timeframe of one to 12 months post-surgery were surveyed over the telephone regarding their experience of the ‘Post Op’ smartphone utilising a custom, well-structured standardised questionnaire.</div></div><div><h3>Results</h3><div>The study surveyed 42 consecutive patients who had undergone elective joint arthroplasty procedures at Kettering General Hospital, including 22 total hip replacement (THR) and 20 total knee replacement (TKR) patients. The respondents, with a median age of 66 years, provided overwhelmingly positive feedback about the ‘Post Op’ smartphone application. On a scale of 1–6, the mean ease-of-use score was 5.31, with only two THR patients providing lower scores due to difficulties with photography. However, the app's overall functionality, particularly in uploading photos, received a mean score of 4.78. Despite some technical issues, 97.6 % of respondents would recommend the app, emphasising its positive impact on confidence in the recovery and reducing unnecessary healthcare visits. Narrative responses highlighted the app's simplicity, support, and prompt communication with healthcare teams. Overall, the feedback indicates a high level of satisfaction with the ‘Post Op’ application among elective arthroplasty patients, showcasing its potential benefits for postoperative care.</div></div><div><h3>Conclusion</h3><div>The study provides valuable insights into the impact of the ‘Post Op’ smartphone application on postoperative care, acknowledging both its successes and areas for enhancement. Further research and iterative improvements are crucial for optimising patient experiences and ensuring the app aligns effectively with healthcare needs.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"59 ","pages":"Article 102557"},"PeriodicalIF":0.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142652249","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}

{"title":"Analgesic use may not decrease in the first postoperative year in patients underwent total knee arthroplasty due to advanced osteoarthritis","authors":"Ahmet Aslan ,&nbsp;Erkan Maytalman ,&nbsp;Anil Gulcu","doi":"10.1016/j.jcot.2024.102800","DOIUrl":"10.1016/j.jcot.2024.102800","url":null,"abstract":"<div><h3>Background</h3><div>Total knee arthroplasty (TKA) is expected to relieve pain and reduce the use of analgesics in patients with advanced knee osteoarthritis. However, in some cases, there is no relief in the pain of the patients and the use of analgesics continues. The aim of this study was to compare analgesic consumption one year before and after TKA in the same patient group and to evaluate whether there is a decrease in analgesic consumption after TKA.</div></div><div><h3>Method</h3><div>The cumulative amounts of analgesia used by the patients in the one-year periods before and after the operation were checked from the automated patient records system and the national systems showing drug prescriptions. The dosages of all the analgesics used in the one-year periods before and after the operation were calculated and converted to oral morphine equivalents (OME). The demographic data of the patients, cumulative OME and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were used in the assessment.</div></div><div><h3>Results</h3><div>It was observed that there was a statistically significant improvement in Womac scores after the treatment compared to the pre-treatment. Although the mean amount of analgesics decreased compared to pre-treatment, it was not statistically significant. Also, age and preoperative analgesic use were found to be the two most important factors in relation to total postoperative analgesic consumption.</div></div><div><h3>Conclusion</h3><div>The results of this study indicate that there may not be a substantial reduction in the use of analgesic by patients within the first year after TKA. Furthermore, the age and preoperative analgesic use were identified as the two primary factors influencing postoperative analgesic consumption.</div></div><div><h3>Level of evidence</h3><div>Retrospective Cohort Study.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"59 ","pages":"Article 102800"},"PeriodicalIF":0.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142652364","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}

{"title":"Accuracy of femoral tunnel placement using three different techniques in performing arthroscopic all-inside anterior Cruciate Ligament reconstruction; A randomized study","authors":"Pankaj Rai ,&nbsp;Vikas Kulshrestha ,&nbsp;Munish Sood ,&nbsp;Santhosh Kumar ,&nbsp;Mustajib Ali ,&nbsp;Soma Kulshrestha","doi":"10.1016/j.jcot.2024.102799","DOIUrl":"10.1016/j.jcot.2024.102799","url":null,"abstract":"<div><h3>Background</h3><div>One of the key steps in arthroscopic Anterior Cruciate Ligament Reconstruction (ACLR) is getting the femoral tunnel at the right position to attach the graft. While the correct position has been described as a low and posterior position behind the bifurcate ridge on the medial surface of lateral femoral condyle, to reproducibly achieve it more than one technique is being used by surgeons. There are no randomized studies in literature which have evaluated the efficacy of these in a surgeon's hand. This study attempts to do that.</div></div><div><h3>Methods</h3><div>This randomized study was performed at a military sports injury centre by a single surgical team led by two sports fellowship-trained surgeons. One hundred fifty patients undergoing ACLR surgery were randomized to Anteromedial Portal technique e (AMP)group, Far Anteromedial portal technique (FAMP) group and Outside in drilling (OI) group. We used postoperative three-dimensional Computed Tomogram (3D CT) to study tunnel position (Magnussen method), length and orientation (Basdekis method).</div></div><div><h3>Results</h3><div>80 % of femoral entry points were in satisfactory position using all three techniques. The ideal position was achieved more often using FAMP &amp; OI technique which was better than AMP, however it was not below level of significance set at P &lt; 0.025 (18, 13 &amp; 5 respectively using FAMP, OI and AMP techniques, p-value 0.08 OI vs AMP &amp; 0.07 AMP vs FAMP). The average femoral tunnel length was longest in OI group 34.72 ± 2.41 mm. The mean FAMP tunnel lengths were significantly smaller than the mean tunnel length of AMP and OI groups. (p-value &lt;0.01 FAMP vs OI and p-value &lt;0.01 FAMP vs AMP)</div></div><div><h3>Conclusion</h3><div>Our study showed that all three techniques achieved acceptable femoral tunnel placement in 80 % cases. However, FAMP and OI technique further improved accuracy of achieving ideal tunnel location and OI technique predictably achieved longer tunnel length preventing risk of lateral blow out while using suspensory fixation.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"59 ","pages":"Article 102799"},"PeriodicalIF":0.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142652316","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}

{"title":"Safety and efficacy of autologous adipose-derived stem cells for knee osteoarthritis in the elderly population: A systematic review","authors":"Biagio Zampogna ,&nbsp;Francesco Rosario Parisi ,&nbsp;Augusto Ferrini ,&nbsp;Andrea Zampoli ,&nbsp;Giuseppe Francesco Papalia ,&nbsp;Saseendar Shanmugasundaram ,&nbsp;Rocco Papalia","doi":"10.1016/j.jcot.2024.102804","DOIUrl":"10.1016/j.jcot.2024.102804","url":null,"abstract":"<div><h3>Introduction</h3><div>Osteoarthritis (OA) is a progressive joint disease, and over 240 million people suffer from symptomatic OA, primarily in the knee, and mainly affects the elderly population over 65. A combination of different risk factors leads to biological changes in the microenvironments of the joints, causing cartilage overload and chondrocyte aging. Adipose-derived MSCs (ADSCs) are demonstrated to improve joint environments with an effective therapy for Knee OA. This review focused on patients over 65 years old to evaluate the effectiveness of ADSC therapies in treating KOA in elderly patients and demonstrate that complications are not higher in this cohort of patients.</div></div><div><h3>Materials and methods</h3><div>We conducted a bibliography search through the PubMed, Scopus, and Cochrane databases for English-language and human clinical trials published until Feb 7, 2024. We extracted the following study characteristics: Authors, year of publication, type of study, number of patients, number of knees, sex, Kellgren-Lawrence classification, culture ADSC, Number of cells injected, mean follow-up, adverse events, significant complications, and clinical outcomes data were extracted recorded and analyzed.</div></div><div><h3>Results</h3><div>According to inclusion criteria, seven clinical trials on autologous adipose-derived stem cells were considered. Four studies analyzed stem cells as a stromal vascular fraction (SVF), two as ADSC cultured, and 1 study investigated the MAT procedure. All studies reported improved clinical outcomes using autologous adipose-derived stem cells, on 339 knees. Post-treatment increased KOOS, WOMAC, IKS, VAS, and Lysholm knee scores were highlighted. All studies showed an improvement in all outcomes scores, and regarding complications, only 44 knees underwent adverse events, but no significant complications were found in all the studies reported.</div></div><div><h3>Conclusions</h3><div>The current systematic review demonstrated that using autologous adipose-derived stem cells improved clinical outcomes and is effective and safe in elderly patients. Additionally, this study will encourage orthopedic surgeons not to consider surgery as the only solution in elderly patients who are refractory to treatment and do not show end-stage knee osteoarthritis.</div></div><div><h3>Level of evidence</h3><div>Level IV, systematic review of level IV studies<strong>.</strong></div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"59 ","pages":"Article 102804"},"PeriodicalIF":0.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142652317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New evidence on patella resurfacing in modern total knee arthroplasty for all inflammatory arthritis in a mixed Asian population","authors":"Sherlyn Yen Yu Tham ,&nbsp;Wu Chean Lee ,&nbsp;Zavier Yongxuan Lim ,&nbsp;Remesh Kunnasegaran","doi":"10.1016/j.jcot.2024.102798","DOIUrl":"10.1016/j.jcot.2024.102798","url":null,"abstract":"<div><h3>Background</h3><div>Traditional teaching advocates for routine patella resurfacing (PR) during total knee arthroplasty (TKA) in patients with inflammatory arthritis. However, evidence on this topic remains limited in the Asian population. This study aims to evaluate the postoperative outcomes and complication of patella resurfacing (PR) during primary total knee arthroplasty (TKA) in Asian patients with inflammatory arthritis.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted using registry data from our institution. Patients with inflammatory arthritis who underwent primary TKA from August 2017 to December 2021 were included in the study. Patients were divided into two groups - patella resurfaced (PR, n = 25) and non-resurfaced patella (PNR, n = 31) groups. Demographics, operative data, patient reported outcome measures, and complications were compared.</div></div><div><h3>Results</h3><div>Preoperative range of motion (ROM) (PR:95.3 ± 23.6° vs PNR:105 ± 19.5°, p = 0.106), Knee Society Scoring System Knee score (KS-KS) (PR:44.6 ± 17.4 vs PNR:49.3 ± 17.7, p = 0.331) and Knee Society Function Score (KS-FS) (PR:40.9 ± 27.3 vs PNR:47.7 ± 27.0, p = 0.325) and Oxford Knee Score (OKS) (PR:25.0 ± 7.8 vs PNR:23.3 ± 10.3, p = 0.525) were similar in both groups. Outcomes between PR and PNR groups at the one-year mark in terms of ROM (PR:112.7 ± 18.1 vs PNR:114.6 ± 16.5, p = 0.455), OKS (PR:41.5 ± 3.9 vs PNR:41 ± 4.7, p = 0.954), KS-KS (PR:84.5 ± 13.2 vs PNR:89.2 ± 9.3, p = 0.095) and KS-FS (PR:73.6 ± 18.3 vs PNR:78.7 ± 19.3, p = 0.173) were also similar. Intraoperative complication (PR:0/25 vs PNR: 3/31 (9.6 %), p = 0.245) and re-operation rates (PR: 1/25 (4 %) vs PNR: 1/31 (3.2 %), p = 0.877) were also similar in both groups.</div></div><div><h3>Conclusion</h3><div>This study conducted on a mixed Asian population with inflammatory arthritis demonstrated that the one-year postoperative ROM and functional outcomes, complication, and re-operation rates between PR and PNR groups were similar. Hence, routine patella resurfacing on all Asian patients with inflammatory arthritis undergoing TKA may not be necessary.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"58 ","pages":"Article 102798"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593323","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}

{"title":"Rehabilitation from delayed bilateral complete quadriceps tendon repairs with knee extension assist braces: A case report","authors":"Benjamin Hewins,&nbsp;Sara Sparavalo,&nbsp;Ivan Wong","doi":"10.1016/j.jcot.2024.102789","DOIUrl":"10.1016/j.jcot.2024.102789","url":null,"abstract":"<div><div>Simultaneous bilateral quadriceps tears are rare with fewer than 150 cases reported in the literature and typically occur in male patients greater than 40 years of age. If left untreated or with delayed clinical intervention, these injuries often lead to chronic disability including pain and reduced ambulation. Typical treatments include surgical repair with considerable post-operative rehabilitation and a guarded prognosis. However, given the scarcity of these cases, a consensus on a standard course of treatment remains unclear and ultimately at the discretion of the clinician.</div><div>A 67-year-old male presented 6-months after complete, retracted tears of bilateral quadriceps tendons after a fall onto both knees in flexion. Treatment included: immediate bilateral quadriceps tendon repairs, immobilization, physiotherapy, and the daily use of novel tri-compartment offloader knee braces providing knee-extension assist. To our knowledge, this is the first report of a full return to independent ambulation following a delayed diagnosis and surgical intervention of complete bilateral quadriceps tendon tears.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"58 ","pages":"Article 102789"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142571370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing surgical treatment of De Quervain's tendinopathy: A retrospective cross-sectional observational study","authors":"Arjuna Thakker ,&nbsp;Nicholas Johnson ,&nbsp;Joseph Dias","doi":"10.1016/j.jcot.2024.102790","DOIUrl":"10.1016/j.jcot.2024.102790","url":null,"abstract":"<div><h3>Background</h3><div>The literature surrounding how different patient, sociodemographic, and anatomical factors influence surgical treatment of De Quervain's tendinopathy (DQT) is limited.</div></div><div><h3>Purpose</h3><div>We hypothesised that different patient, anatomical, or sociodemographic factors influence the management of DQT with regard to non-operative vs. surgical management.</div></div><div><h3>Methods</h3><div>This retrospective cross-sectional study reviewed 155 cases of patients with DQT seen over a 10 year period. Patient-specific factors included age, gender, hand affected, dominant hand, steroid injection given and mean number of injections. Sociodemographic factors included ethnicity, employment, and deprivation, were measured using deprivation quintiles through The Index of Multiple Deprivation. Anatomical factors included the presence of subcompartmentalization, number of APL and EPB tendon slips, tendon thickening, exudative tenosynovitis, hypervascularization, and the presence of a sheath ganglion Patients were categorized into either non-operative or surgical cohort. Bivariate analysis was used to compare factors between the cohorts, and significant factors (p &lt; 0.05) were included in the logistic regression model, used to predict factors influencing surgical management.</div></div><div><h3>Results</h3><div>Bivariate analysis detected a significant difference in the mean number of steroids given between the non-operative and surgical cohort (p = 0.001) patient factors. For sociodemographic factors, a significant difference was found between deprivation quintiles (p = 0.02). From the anatomical factors, the surgical cohort had more patients with multiple APL tendon slips (p = 0.02) and the presence of a tendon ganglion sheath ganglion (p = 0.02). For patient and sociodemographic factors, logistic regression identified that the number of steroids (per patient) and being in deprivation quintile 4 were associated with surgical treatment. For anatomical factors, multiple APL tendon slips and the presence of a tendon sheath ganglion were associated with the surgical treatment.</div></div><div><h3>Conclusion</h3><div>This study suggests that several factors are associated with the need for surgical treatment of DQT, including the number of steroid injections received, social deprivation, and anatomical factors, such as the presence of multiple tendon slips and a tendon sheath ganglion. Our findings add to the growing body of literature exploring factors that may influence treatment pathways for patients with DQT.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"58 ","pages":"Article 102790"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593243","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}