Archives of Orthopaedic and Trauma Surgery最新文献

英文中文

Retropatellar resurfacing in primary total knee arthroplasty does not improve clinical outcomes but increases revision rates. 初次全膝关节置换术中髌骨后表面置换不能改善临床结果，但会增加翻修率。

IF 2.1 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery

Pub Date : 2026-02-02 DOI: 10.1007/s00402-026-06200-y

Tom Schiener, Alexandra Leica, Felix Amsler, Rolf Hügli, Andrej Maria Nowakowski, Michael T Hirschmann, Dominic T Mathis

引用次数: 0

Leg length and offset in short-stem total hip arthroplasty: is a single offset-implant sufficient to restore the hip rotation centre within a range of 5 mm? 短柄全髋关节置换术中的腿长和偏移量：单个偏移植入物是否足以在5mm范围内恢复髋关节旋转中心？

IF 2.1 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery

Pub Date : 2026-02-02 DOI: 10.1007/s00402-026-06194-7

Felix Olk, Bernd Bittersohl, Jürgen Babisch, Hagen Mittelstädt, Marcus Jäger, Rüdiger Krauspe, Christoph Zilkens

引用次数: 0

Understanding the role of diabetes mellitus on symptomatic neuroma development and identifying the ideal patient for prophylactic surgical management. 了解糖尿病在症状性神经瘤发展中的作用并确定预防性手术治疗的理想患者。

IF 2.1 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery

Pub Date : 2026-02-02 DOI: 10.1007/s00402-025-06140-z

Casey A Hamlet, Tiam Mana Saffari, Varoon T Phondge, Sheldon S Lin, J Patrick O'Connor, Edward S Lee

Introduction: Symptomatic neuromas result from disorganized nerve growth at the site of amputation, causing pain that affects recovery and quality of life. In patients with diabetes mellitus (DM), nerve regeneration is impaired, compounded by comorbidities such as obesity, hypertension, and hyperlipidemia. Surgical approaches including targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) have shown promise for managing symptomatic neuroma, but their effectiveness in diabetic patients is uncertain due to unique challenges in nerve regeneration. This narrative review explores the protective effects of DM on symptomatic neuroma formation and to evaluate the implications for surgical intervention.

Materials and methods: A systematic search of PubMed was conducted, and relevant studies discussing symptomatic neuroma formation in amputees were included.

Results: Symptomatic neuromas were reported in 9.5-50% of amputees involving 9.5% of upper extremity, and 3.8% of lower extremity amputees. Younger age and proximal amputations were identified as significant risk factors. While it is suggested that Interleukin (IL)-10 and brain-derived neurotropic factor (BDNF) levels are involved in protecting against symptomatic neuroma formation, IL-1β and IL-6 promote neuroma formation. Although evidence is mixed, some evidence suggests that DM and diabetic peripheral neuropathy decrease symptomatic neuroma formation by impairing axonal regeneration, altering the extracellular matrix and modulating inflammatory responses.

Conclusions: Although surgical approaches such as TMR and RPNI have shown potential in reducing neuroma-related pain, further studies are needed to ensure that this benefit extends to diabetic patients whose disease puts them at increased risk of postoperative complications. Additional studies are required to confirm these findings and optimize surgical strategies for high-risk patient populations.

症状性神经瘤是由截肢部位神经生长紊乱引起的，引起疼痛，影响康复和生活质量。在糖尿病（DM）患者中，神经再生受损，并发肥胖、高血压和高脂血症等合并症。包括靶向肌肉神经再生（TMR）和再生周围神经界面（RPNI）在内的手术方法已显示出治疗症状性神经瘤的希望，但由于神经再生方面的独特挑战，它们在糖尿病患者中的有效性尚不确定。这篇叙述性综述探讨了DM对症状性神经瘤形成的保护作用，并评估手术干预的意义。材料与方法：系统检索PubMed，纳入截肢者症状性神经瘤形成的相关研究。结果：9.5 ~ 50%的截肢者报告有症状性神经瘤，其中上肢9.5%，下肢3.8%。年龄较小和近端截肢被认为是重要的危险因素。白细胞介素(IL)-10和脑源性神经营养因子（BDNF）水平参与预防症状性神经瘤的形成，而IL-1β和IL-6则促进神经瘤的形成。尽管证据不一，但一些证据表明，糖尿病和糖尿病周围神经病变通过损害轴突再生、改变细胞外基质和调节炎症反应来减少症状性神经瘤的形成。结论：虽然手术入路如TMR和RPNI已经显示出减少神经瘤相关疼痛的潜力，但需要进一步的研究来确保这种益处延伸到糖尿病患者，因为糖尿病患者的疾病使他们术后并发症的风险增加。需要进一步的研究来证实这些发现，并优化高危患者的手术策略。

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引用次数: 0

Intraoperative torsion control with radiological cortical thickness parameters in distal tibial shaft fractures: a cadaveric study. 胫骨远端骨折术中扭转控制与放射学皮质厚度参数：一项尸体研究。

IF 2.1 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery

Pub Date : 2026-02-02 DOI: 10.1007/s00402-025-06178-z

Lena Keppler, Richard Zaccaria, Christian Zeckey, Konstantin Küßner, Eduardo M Suero, Carl Neuerburg, Maximilian Weigert, Wolfgang Böcker, Alexander M Keppler

引用次数: 0

Tibiofemoral rotation is significantly higher in patients with patellofemoral maltracking and torsional deformity. 髌股畸形和扭转畸形患者的胫股旋转明显更高。

IF 2.1 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery

Pub Date : 2026-02-02 DOI: 10.1007/s00402-026-06198-3

Sina Gräber, Felix Hüttner, Andrzej Jasina, Parisa Pourostad, Turgay Efe, Thomas Tischer, Jörg Harrer, Christoph Lutter, Felix Ferner

引用次数: 0

The role of the gastrocnemius flap in implant retention strategies for acute periprosthetic joint infection following total knee arthroplasty: a systematic review 腓肠肌瓣在全膝关节置换术后急性假体周围关节感染的植入物保留策略中的作用：一项系统综述。

IF 2.1 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery

Pub Date : 2026-01-28 DOI: 10.1007/s00402-026-06199-2

Daniele Grassa, Guido Bocchino, Cesare Stefanelli, Giacomo Capece, Rocco Maria Comodo, Alessandro El Motassime, Riccardo Totti, Giulio Maccauro, Raffaele Vitiello

Background

Acute periprosthetic joint infection (PJI) represents a major cause of early failure following total knee arthroplasty (TKA). In selected cases, implant retention strategies such as debridement, antibiotics, and implant retention (DAIR), including modified techniques such as debridement, antibiotic pearls, and retention of the implant (DAPRI), may be considered. However, the success of these approaches is strongly influenced by the condition of the surrounding soft tissues. In the presence of compromised or tenuous wound conditions, soft tissue reconstruction may play a critical adjunctive role. This review aims to evaluate the role of the gastrocnemius flap as an adjunct to implant retention strategies in the management of acute PJI following TKA.

Methods

A systematic review was conducted in accordance with PRISMA guidelines. After screening 27 studies, five retrospective case series met the inclusion criteria, comprising a total of 73 patients with a mean follow-up of 48.7 months.

Results

The medial gastrocnemius flap was the most used technique, accounting for approximately 70% of cases. Infection clearance rates ranged from 66% to 77%, while prosthesis retention was achieved in nearly 79% of patients. Gastrocnemius flap coverage was applied in conjunction with different PJI treatment strategies, including staged revision procedures and implant retention approaches. Early flap application, particularly when combined with debridement and implant retention in the presence of compromised soft tissues, was associated with improved wound healing and limb salvage, although the level of evidence remains limited.

Conclusions

Gastrocnemius flap reconstruction appears to be a useful adjunct in selected patients undergoing implant retention strategies for acute PJI following TKA, particularly in the presence of compromised soft tissue conditions. Nevertheless, the current evidence is based on low-level, non-comparative studies, and definitive conclusions regarding its routine or preventive use cannot be drawn. Further prospective and comparative studies are required to better define indications, timing, and expected outcomes.

背景：急性假体周围关节感染（PJI）是全膝关节置换术（TKA）后早期失败的主要原因。在选定的病例中，可以考虑采用诸如清创、抗生素和种植体保留（DAIR）等种植体保留策略，包括诸如清创、抗生素珍珠和种植体保留（DAPRI）等改良技术。然而，这些方法的成功与否很大程度上受到周围软组织状况的影响。在存在受损或脆弱的伤口条件下，软组织重建可能起关键的辅助作用。这篇综述旨在评估腓肠肌瓣作为一种辅助植入物保留策略在TKA后急性PJI治疗中的作用。方法按照PRISMA指南进行系统评价。筛选27项研究后，5个回顾性病例系列符合纳入标准，共73例患者，平均随访48.7个月。结果腓肠肌内侧皮瓣是最常用的修复方法，约占70%。感染清除率从66%到77%不等，而近79%的患者获得了假体保留。腓肠肌皮瓣覆盖与不同的PJI治疗策略相结合，包括分阶段翻修手术和种植体保留入路。尽管证据水平仍然有限，但早期皮瓣应用，特别是在存在受损软组织的情况下结合清创和种植体保留，与改善伤口愈合和肢体保留有关。结论腓肠肌皮瓣重建对于TKA后急性PJI的患者来说是一种有用的辅助手段，特别是在软组织受损的情况下。然而，目前的证据是基于低水平的非比较性研究，无法得出关于其常规或预防性使用的明确结论。需要进一步的前瞻性和比较研究来更好地确定适应症、时机和预期结果。

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引用次数: 0

Correction: Gastrocnemius release procedures in the treatment of mechanical metatarsalgia: a systematic review 矫正：腓肠肌松解术治疗机械性跖骨痛：系统回顾。

IF 2.1 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery

Pub Date : 2026-01-14 DOI: 10.1007/s00402-025-06177-0

Laura Langone, Antonio Mazzotti, Simone Ottavio Zielli, Alberto Arceri, Federico Sgubbi, Gianmarco Di Paola, Elena Artioli, Cesare Faldini

引用次数: 0

Current concepts of medial unicompartmental knee replacement: part 2—hot topics and further directions 内侧单室膝关节置换术的最新概念：第2部分——热点和未来发展方向。

IF 2.1 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery

Pub Date : 2026-01-07 DOI: 10.1007/s00402-025-06158-3

Simone Cerciello, Lorenzo Proietti, Fabrizio Mocini, Katia Corona, Michele Venosa, Michele Mercurio, Philippe Neyret

Although the results of medial unicompartmental knee arthroplasty (UKA) are extremely positive in most of the cases, several technical aspects are still discussed. Cementation or not is one of them and no clear advantage of one option over the other has emerged; similarly mobile and fixed designs have similar outcomes. Metal back implants although more common than all-poly implants do not have clearly superior outcomes. Similarly technological innovations are leading the research toward more accurate reproduction of unique patients’ anatomy and function with the surgical procedures. Robotics aim at reproducing the pre-arthritic individual joint line and lower limb alignment while custom implants would reproduce the anatomy of the articular surfaces. All these aspects will be discussed in the following article.

虽然内侧单室膝关节置换术（UKA）的结果在大多数情况下是非常积极的，几个技术方面仍在讨论。胶结与否是其中之一，目前还没有明显的优势；类似的移动和固定设计也有类似的结果。金属假体虽然比全聚假体更常见，但没有明显的好结果。同样，技术创新也在引导研究朝着更精确地复制独特患者的解剖结构和功能的方向发展。机器人技术的目标是重现患关节炎前的个体关节线和下肢排列，而定制植入物将重现关节表面的解剖结构。下面的文章将讨论所有这些方面。

引用次数: 0

Which MRI signs truly predict subscapularis tears? A multivariate analysis of 278 arthroscopic cases 哪些MRI征象能真正预测肩胛下肌撕裂？278例关节镜病例的多因素分析。

IF 2.1 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery

Pub Date : 2026-01-07 DOI: 10.1007/s00402-025-06175-2

Michael Marsalli, Ernesto Donoso, Marco Cartaya, Juan de Dios Errázuriz

Purpose

To determine the diagnostic performance of magnetic resonance imaging (MRI) for subscapularis (SSC) tendon tears, identify the strongest independent MRI predictors, and evaluate the accuracy of MRI in predicting tear size.

Methods

A retrospective cohort study of patients who underwent arthroscopic rotator cuff repair was conducted. From a total of 376 surgeries, 278 patients met the inclusion criteria. All patients had a preoperative 1.5-T MRI. A blinded shoulder surgeon and a musculoskeletal radiologist independently evaluated six MRI signs for SSC rupture. Arthroscopic findings served as the gold standard. Diagnostic performance metrics (accuracy and predictive value) were calculated, and a multivariate logistic regression was performed to identify independent predictors.

Results

Arthroscopy confirmed an SSC tear in 99 of 278 patients (35.6%). For the radiologist, overall accuracy was 73%; for the surgeon, it was 70%. Performance was substantially higher for complete tears than for partial tears, with a positive predictive value for partial tears of only 24%. Multivariate logistic regression identified two independent predictors of an SSC tear: tendon hyperintensity on axial images (OR 3.97, p < 0.001) and a “naked” lesser tuberosity on sagittal images (OR 4.83, p = 0.029). A simplified diagnostic model based on these two signs achieved an accuracy of 75.5%, with 74.7% sensitivity and 76.0% specificity.

Conclusion

MRI performance is poor for diagnosing partial SSC tears but good for complete tears. Tendon hyperintensity (axial) and a naked lesser tuberosity (sagittal) are the strongest independent predictors of an SSC tear. A simplified diagnostic model focusing on these two signs may offer a more efficient and accurate approach to preoperative assessment.

目的：确定磁共振成像（MRI）对肩胛下肌（SSC）肌腱撕裂的诊断性能，确定最强的独立MRI预测因子，并评估MRI预测撕裂大小的准确性。方法：对接受关节镜下肩袖修复的患者进行回顾性队列研究。在376例手术中，278例患者符合纳入标准。所有患者术前均行1.5 t MRI检查。一位盲肩外科医生和一位肌肉骨骼放射科医生独立评估了SSC破裂的六种MRI征象。关节镜检查结果作为金标准。计算诊断性能指标（准确性和预测值），并进行多变量逻辑回归以确定独立预测因子。结果：278例患者中有99例（35.6%）经关节镜检查证实SSC撕裂。放射科医生的总体准确率为73%；对于外科医生来说，这个比例是70%。完全撕裂的表现明显高于部分撕裂，部分撕裂的阳性预测值仅为24%。多变量逻辑回归确定了SSC撕裂的两个独立预测因素：轴向图像上的肌腱高强度（OR 3.97, p）。结论：MRI表现对诊断部分SSC撕裂很差，但对完全撕裂很好。肌腱高强度（轴向）和裸小结节（矢状）是SSC撕裂的最强独立预测因子。一个简化的诊断模型侧重于这两个迹象可能提供更有效和准确的方法，术前评估。

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引用次数: 0

Active versus passive rehabilitation after flexor tendon repair: clinical outcomes and shear wave elastography monitoring in a randomized pilot study 屈肌腱修复后主动与被动康复：随机试验研究中的临床结果和横波弹性成像监测。

IF 2.1 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery

Pub Date : 2026-01-07 DOI: 10.1007/s00402-025-06172-5

Merve Demirci, Fatma Hazal Temiz Erguden, Yavuz Sahbat, Onur Bugdayci, Ozgur Baysal, Canan Sanal

Introduction

Flexor tendon injuries of the hand often result in significant functional impairment. Rehabilitation protocols after surgical repair are critical for optimizing outcomes, yet the comparative effects of active versus passive rehabilitation remain debated. Shear wave elastography (SWE) offers an objective imaging method to monitor tendon stiffness, but its role in hand tendon recovery is not well established. This study aimed to compare functional outcomes between active and passive rehabilitation protocols, while exploring the potential utility of SWE in monitoring tendon healing.

Materials and methods

In this randomized controlled pilot trial, patients undergoing flexor tendon repair were assigned to either active (AR) or passive (PR) rehabilitation protocols. Functional outcomes were assessed using grip strength, pinch strength, dexterity tests, and validated questionnaires (SF-12, Duruoz Hand Index, Modified Hand Injury Severity Score). Tendon stiffness was measured longitudinally with SWE. Group comparisons and correlations between stiffness and clinical outcomes were analyzed.

Results

20 patients with 34 tendons completed 12-week follow-up. Both AR and PR groups showed significant functional improvements over time (p < 0.05). No significant intergroup differences were observed in grip strength, pinch strength, dexterity, or patient-reported outcomes. SWE measurements did not significantly differ between groups or time points. Functional recovery was achieved without parallel increases in stiffness, and correlations between SWE and clinical parameters were inconsistent.

Conclusions

Both active and passive rehabilitation protocols supported early functional recovery following flexor tendon repair. SWE provided objective monitoring of tendon healing but did not consistently correlate with functional outcomes. These findings highlight the multifactorial nature of tendon recovery and suggest that SWE may complement, but not replace, clinical assessment in postoperative rehabilitation. Larger cohorts and extended follow-up are needed.

Trial registration

ClinicalTrials.gov identifier: NCT05598918. Registered on 28 October 2022.

手部屈肌腱损伤通常会导致严重的功能损伤。手术修复后的康复方案对优化结果至关重要，但主动与被动康复的比较效果仍存在争议。剪切波弹性成像（SWE）提供了一种监测肌腱刚度的客观成像方法，但其在手部肌腱恢复中的作用尚未得到很好的证实。本研究旨在比较主动和被动康复方案的功能结果，同时探索SWE在监测肌腱愈合方面的潜在效用。材料和方法：在这项随机对照试验中，接受屈肌腱修复的患者被分配到主动（AR）或被动（PR）康复方案。功能结果通过握力、捏力、灵巧性测试和有效问卷（SF-12、Duruoz手部指数、修正手部损伤严重程度评分）进行评估。用SWE纵向测量肌腱刚度。分析组间比较及僵硬度与临床结果的相关性。结果：20例患者34根肌腱完成12周随访。随着时间的推移，AR组和PR组均显示出显著的功能改善(p)。结论：主动和被动康复方案均支持屈肌腱修复后的早期功能恢复。SWE提供了肌腱愈合的客观监测，但与功能结果并不一致。这些发现强调了肌腱恢复的多因素性质，并表明SWE可以补充，但不能取代术后康复的临床评估。需要更大的队列和更长时间的随访。试验注册：ClinicalTrials.gov标识符：NCT05598918。于2022年10月28日注册。

{"title":"Active versus passive rehabilitation after flexor tendon repair: clinical outcomes and shear wave elastography monitoring in a randomized pilot study","authors":"Merve Demirci, Fatma Hazal Temiz Erguden, Yavuz Sahbat, Onur Bugdayci, Ozgur Baysal, Canan Sanal","doi":"10.1007/s00402-025-06172-5","DOIUrl":"10.1007/s00402-025-06172-5","url":null,"abstract":"<div><h3>Introduction</h3><p>Flexor tendon injuries of the hand often result in significant functional impairment. Rehabilitation protocols after surgical repair are critical for optimizing outcomes, yet the comparative effects of active versus passive rehabilitation remain debated. Shear wave elastography (SWE) offers an objective imaging method to monitor tendon stiffness, but its role in hand tendon recovery is not well established. This study aimed to compare functional outcomes between active and passive rehabilitation protocols, while exploring the potential utility of SWE in monitoring tendon healing.</p><h3>Materials and methods</h3><p>In this randomized controlled pilot trial, patients undergoing flexor tendon repair were assigned to either active (AR) or passive (PR) rehabilitation protocols. Functional outcomes were assessed using grip strength, pinch strength, dexterity tests, and validated questionnaires (SF-12, Duruoz Hand Index, Modified Hand Injury Severity Score). Tendon stiffness was measured longitudinally with SWE. Group comparisons and correlations between stiffness and clinical outcomes were analyzed.</p><h3>Results</h3><p>20 patients with 34 tendons completed 12-week follow-up. Both AR and PR groups showed significant functional improvements over time (<i>p</i> < 0.05). No significant intergroup differences were observed in grip strength, pinch strength, dexterity, or patient-reported outcomes. SWE measurements did not significantly differ between groups or time points. Functional recovery was achieved without parallel increases in stiffness, and correlations between SWE and clinical parameters were inconsistent.</p><h3>Conclusions</h3><p>Both active and passive rehabilitation protocols supported early functional recovery following flexor tendon repair. SWE provided objective monitoring of tendon healing but did not consistently correlate with functional outcomes. These findings highlight the multifactorial nature of tendon recovery and suggest that SWE may complement, but not replace, clinical assessment in postoperative rehabilitation. Larger cohorts and extended follow-up are needed.</p><h3>Trial registration</h3><p>ClinicalTrials.gov identifier: NCT05598918. Registered on 28 October 2022.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145909975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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