Advances in Orthopedics最新文献

Objective: Radiological biometrics of the metatarsal have been reported in few studies but mostly with no relevance to clinical settings. The smaller female metatarsal diameter could be an impediment for intramedullary implants. This study investigates female radiological metatarsal morphometry for diameter suitability of intramedullary implants used for midfoot Charcot fusion.

Methods: Standing foot roentgenograms of 143 female patients were collected for radiological measurements. Cortical thickness at the metatarsal neck level was calculated by subtracting inner width from outer width values. After hypothetical reaming, inner width, outer width, and cortical thickness mean values were considered for suitability estimation. Implant suitability was deemed acceptable when (a) inner width values more than the cut-off value of 6 mm and/or (b) cortical thickness more than the cut-off value of 2 mm (1 mm on each cortex side).

Results: The results were (a) inner width: M5 had a higher mean value when compared to M2, M3, and M4 (p < 0.00001) with no difference between central metatarsals and (b) outer width: M2 showed a significantly higher outer width than M3 and M4 (p < 0.00001) with no difference with M5. Based on the cut-off values, the simulated reaming width values to accept implant diameter were found unsuitable for M2, M3, and M4 and the estimated cortical thickness values were found unsuitable for M3, M4, and M5.

Conclusion: Our study indicates for the first time a mismatch between the inner width of the lateral metatarsals at the neck level with the commercially available Charcot-specific IM implants for female patients.

Purpose: Augmented reality (AR) blends computer-generated information with the real environment to support surgical visualization, guidance, and training. In sports surgery, where arthroscopic views constrain depth perception and hand-eye coordination, AR may enhance intraoperative accuracy and efficiency and enable engaging rehabilitation. Novelty: To our knowledge, this is the first systematic review focused specifically on AR across the sports surgery continuum (operative and rehabilitative), synthesizing visualization modalities, use cases, and measured outcomes to identify translational gaps. Methods: We searched MEDLINE (PubMed), Embase, Scopus, and Web of Science (January 2024), registered the protocol on PROSPERO (CRD42024543974), and reported according to PRISMA 2020. Eligibility included preclinical and clinical studies using AR/MR in sports-orthopedic contexts. Risk of bias was assessed using RoB 2 (RCTs), ROBINS-I (nonrandomized studies), and NIH tools for other designs. Qualitative synthesis was structured by AR type, surgical indication/use case, and outcome domain. Results and Findings: Twenty-one articles met the criteria. Sixteen assessed intraoperative applications and four rehabilitation, with knee arthroscopy being the most common. Comparative human studies reported more accurate femoral tunnel placement in ACL reconstruction and shorter operative time in selected workflows, while several studies showed feasibility in simulators/cadavers. Video see-through (VST) and optical see-through (OST) (e.g., HoloLens) were most frequently used. Conclusions: AR shows early promise for guidance, training/telementoring, and postoperative rehabilitation in sports surgery, but current evidence is heterogeneous and often feasibility-focused. Larger, controlled clinical trials with standardized outcome definitions and reporting are needed to confirm benefits, evaluate learning curves and ergonomics, and support integration into operating room workflows.

Introduction: Multiple biomechanical models have been suggested to quantify lower limb joint contact stress distributions, with varying results. Among others, the choice of cartilage morphology and gait loading patterns can significantly affect simulation results. Moreover, there is currently no consensus on simulating the input and output data needed to obtain reliable results and enable a comprehensive analysis. Objectives: The aim of this study was to compare the reliability and clinical relevance of joint contact metrics by calculating pre- and postoperative hip joint contact stress distributions of a dysplastic cohort under various simulation scenarios. Methods: A cohort of 22 dysplastic patients has been treated using periacetabular osteotomy (6-month follow-up). Five radiographic measurements of the acetabular cup were taken from imagery pre- and postoperatively. Eight osteoarthritis-predictive joint stress metrics were computed using discrete element analysis in 6 unique simulation scenarios (2 cartilage models; 3 hip gait loading profiles) pre- and postoperatively. Results: A multivariate analysis of variance confirmed the significant effects of treatment, cartilage model, and loading profile on the computed stress metrics (p < 0.01). Also, average- and threshold-based metrics, such as average contact area, average stress, and Maxian overdose, were shown as more reliable indicators of successful surgical treatment than the maximum-based metrics. Finally, correlations between radiographic measurements and stress metrics revealed greater influence of the acetabular index and anterior center-edge angle than the lateral center-edge angle. Conclusions: Average and threshold-based metrics, as well as the acetabular index and anterior center-edge angle, should be of greater interest in future studies regarding hip dysplasia. Clinical Significance: Level 2 (Prospective Study: Therapeutic).

Finite element analysis (FEA) stands as a cornerstone in preclinical investigations for implant therapy, particularly in orthopaedics and biomechanics. Accurate modelling of bone properties is crucial for meaningful FEA outcomes, considering the complex nature of bone tissue. This study proposes a novel approach by integrating CT-based imaging data and machine learning to predict patient-specific Young's modulus values. A back propagation neural network (BPNN), incorporating texture properties extracted from CT images, demonstrates robustness in predicting Young's modulus. Validation against three-point bending experiments on rabbit femur bones shows promising results, with stress values within 13% of those from FEA. The proposed methodology holds the potential for enhancing preclinical evaluations of implant therapy and fostering the development of patient-specific implants for improved clinical outcomes.

Introduction: Carpal tunnel syndrome (CTS), a painful prevalent orthopedic hand condition causing pain and paresthesia, is typically diagnosed clinically. Initial management involves analgesia trials, steroid injections, and night splints, with surgery as an option for failed conservative treatment. While prior research has explored the relationship between patients' educational status and various orthopedic conditions, no studies have investigated its association with clinical presentation and symptom severity in CTS. Therefore, our study aims to investigate this important link. Methods: Our study utilized a retrospective study design, which included 681 patients undergoing carpal tunnel release surgery at a prominent teaching hospital. The aim was to investigate the association between four distinct educational levels and the clinical presentation and severity of the disease. Disease severity was evaluated using the Boston Carpal Tunnel Questionnaire (BCTQ). Results: The study included individuals with a mean age of 52.0 years and diverse educational backgrounds: 20.0% high school, 34.9% diploma, 28.5% bachelor's degree, and 6.6% higher education qualifications. Subjective grip strength decline was more pronounced in high school and diploma categories (83.1% and 82.4%, respectively) compared to bachelor's and higher education categories (71.0% and 68.8%, respectively; p=0.005). Additionally, high school patients had higher Gabapentin usage for analgesia (32.4%) compared to other groups (p=0.014). Conclusion: In patients with CTS, there is a correlation between lower education and symptoms of subjective weakened grip strength, increased analgesic use, and higher Gabapentin utilization. Conversely, higher education is associated with greater utilization of night splints. Moreover, postoperative improvements were observed across all educational groups with no significant differences. Level of Evidence: Level III, Retrospective Study.

Introduction: Spinopelvic dissociation is a devastating injury that remains difficult to manage due to its complexity and low incidence. Lumbopelvic fixation is a treatment option traditionally performed with an open approach. However, open fixation is associated with substantial blood loss and infection risk in critical polytrauma patients. Technological advancements have enabled this procedure to be performed percutaneously. Thus, we evaluate outcomes between patients receiving open lumbopelvic fixation and those receiving percutaneous lumbopelvic fixation. Methods: A retrospective review was conducted of patients undergoing either open or percutaneous lumbopelvic fixation for spinopelvic dissociation from 2012 to 2024. The AOSpine classification system was used to classify all fractures. Patient demographic, clinical, and operative outcomes were analyzed. Results: 48 patients with spinopelvic dissociation were included in the final analysis, with 21 receiving open lumbopelvic fixation and 27 receiving percutaneous lumbopelvic fixation. Preoperative characteristics and demographics were similar between the two groups. The percutaneous group demonstrated significantly reduced blood loss (82 vs. 679 mL; p < 0.01), shorter operative time (168 vs. 284 min; p < 0.01), fewer surgical site infections (0 vs. 4; p=0.03), and reduced OR cost ($35,097 vs. $23,743; p=0.01) but had a higher rate of anterior pelvic ring injuries (63% vs. 19%; p=0.003). There was no significant difference in length of stay (p=0.63) or length of follow-up (p=0.64). Conclusion: Our findings suggest that percutaneous lumbopelvic fixation offers an attractive less invasive and shorter procedure to treat spinopelvic dissociation without added morbidity.

Background: Recently, intra-articular injection of mesenchymal stem cells (MSCs) had been proposed as a conservative treatment for hip osteoarthritis (HOA). Adipose tissue was demonstrated as a viable source of MSCs because of the high concentration of cells and the easy access to the donor site. The purpose of this study was to evaluate the time-related results of a single intra-articular injection of autologous adipose-derived stem cells (aASCs) in a series of patients with HOA. Methods: A retrospective study was conducted on 30 patients with HOA, who underwent an intra-articular injection of aASCs between September 2018 and January 2021. Inclusion criteria for the procedure were as follows: onset of symptoms of the affected hip in the prior six or more months ago, failure of the conservative treatment (NSAIDs and/or physiotherapy) and age > 18 years. Exclusion criteria were trauma in the affected hip occurred in the previous 3 months, recent arthroscopic treatment, infectious joint disease, chondromatosis of the hip or any other secondary HOA, malignancy, hyaluronic acid or other injections in the previous 6 months and incomplete follow-up. Because a low BMI makes extremely difficult to harvest enough adipose tissue, patients with a BMI < 18 were also excluded. The Oxford Hip Score, the 12-item Short Form Survey and Visual Analogue Scale were used to evaluate the results of the proposed treatment at regular intervals. Results: In 27/30 patients, a constant improvement in pain relief, hip function and quality of life was observed during the entire follow-up period of 12 months. Two patients underwent a subsequent total hip arthroplasty. Conclusion: The single injection of aAMSCs seems to be a valuable treatment for HOA. A constant amelioration of pain and function could be observed in most patients at 12 months of follow-up.

Bone fractures involving critical-sized defects pose a significant challenge in orthopedic surgery, often requiring innovative strategies to promote bone regeneration. This study aimed to evaluate the effectiveness of polypropylene surgical mesh in repairing critical-sized radius bone defects in a rat model. Treatments included autologous grafts and a combination of mesh and graft, compared with an untreated control group. After 6 weeks, X-ray and CT scan analyses revealed significant bone healing and callus formation in the treated groups, with the graft + mesh group showing the most pronounced improvement. Histomorphometric analyses demonstrated that the mesh scaffold significantly enhanced new bone formation, osteoblast and osteocyte counts, and bone microarchitecture compared with grafts alone. These findings suggest that mesh scaffolds offer superior osteogenic potential and could provide a promising adjunct for treating critical-sized bone defects. Future studies should explore optimized mesh designs and the interplay between osteogenesis and angiogenesis to improve clinical outcomes.

Intramedullary nail fixation is the "gold standard" for surgical intervention of femoral fractures. While many aspects of nail design and patient anatomy have received specific focus, anatomic variations in proximal femoral geometry and greater trochanteric height variation have been poorly studied. Understanding the potential relationship of the greater trochanter to patient demographics may provide an opportunity to improve implant placement. Retrospective review of x-ray and computed tomography images of the proximal femur was performed. Inclusion criteria consisted of skeletally mature patients over 18 years old with imaging of the proximal femur. Inclusion criteria identified 296 patients. Mean age of included patients was 34 ± 20 years. Average greater trochanter height was 40 ± 8.1 mm. Mean caput-collum-diaphyseal angle was 141 ± 8.6 degrees. After identifying significant factors using univariate analyses a multivariable linear regression demonstrated that patient height and caput-collum-diaphyseal angle were statistically significant predictors for greater trochanter height. For every 1 cm increase in patient height there was a predicted 0.11 mm increase in greater trochanter height (p=0.01). Conversely, every 1 degree increase in caput-collum-diaphyseal angle results in an associated 0.17 mm decrease in greater trochanter height (p < 0.001). This study provides information that may allow for the potential optimization of implant design or implant position to minimize proximal nail protrusion, enhance nail fit and ensure cephalomedullary lag screw position in the head based on the proximal nail dimensions of the implant used.

Background: Graft choice, together with operative technique, remains the most controversial topic surrounding ACL reconstruction. The ideal graft choice should recreate normal anatomy and biomechanics, allow for rapid return to play and have minimal harvest-site morbidity. The purposes of this study were to compare donor-site morbidity in all-soft-tissue quadriceps autograft vs. hamstring autografts based on Hacken et al.'s ACL Donor-Site Morbidity Questionnaire (32,587,874) and to assess the role played by external factors such as sex, mood, activity level and smoking status. Materials and Methods: We performed a retrospective analysis of our patients' records to identify individuals who were 30 years old or younger at the time of surgery and underwent ACL reconstruction using the anteromedial portal technique, without any additional treatments for ligament or meniscal injuries. At 12 months postintervention, donor-site morbidity was evaluated using the ACL donor-site morbidity questionnaire by Hacken et al. (2020). Analyses were performed using Jamovi freeware Version 2.3.19.0 (the Jamovi project, 2021). Independent samples t-test with Cohen's d as the effects' size statistics were used to compare donor-site morbidity and functional outcomes. Results: Significant differences between quadriceps tendon (QT) and STG groups were found for ACL donor-site morbidity questionnaire total score, numbness, size of numbness and muscle atrophy, all in favour of the QT cohort. Weak associations were found between female sex and low mood, both negatively impacting the reported donor site morbidity. No statistically significant differences were found for functional outcomes. Conclusion: ACL reconstruction with all-soft-tissue QT autograft showed overall superior donor-site morbidity outcomes when compared with HT autograft. Statistically significant results were also found in favour of QT when comparing numbness and size of numbness at the donor site and self-perceived muscle atrophy. Female sex and low mood have been found to impact donor-site morbidity negatively although larger samples are necessary to confirm this association. Graft choice in ACL reconstruction should always remain an individualized choice, but QT should be considered an equal, if not superior, alternative to other autologous autografts when comparing donor-site morbidity. Trial Registration: CINECA: 6458.