Archives of Orthopaedic and Trauma Surgery最新文献

Introduction

Periprosthetic Joint Infection (PJI) remains one of the most challenging complications in arthroplasty, often leading to diagnostic uncertainty and suboptimal treatment decisions. Synovial calprotectin has emerged as a promising biomarker, with the lateral flow test (LFT) offering real-time results for intraoperative decision-making. This meta-analysis aimed to evaluate the diagnostic accuracy of intraoperative synovial calprotectin LFT in detecting PJI.

Materials and methods

A systematic review and meta-analysis were conducted according to PRISMA guidelines. Thirteen studies comprising 990 patients were included. Pooled sensitivity, specificity, positive and negative predictive values (PPV, NPV), likelihood ratios (LR+, LR−), diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated using a random-effects model. Subgroup analyses were performed based on test kit type and calprotectin cutoff values.

Results

The pooled sensitivity and specificity of synovial calprotectin LFT were 88% (95% CI: 82–92%) and 89% (95% CI: 83–93%), respectively, with an AUC of 0.94. The DOR was 56.1 (95% CI: 28.4-110.8). The ≥ 50 mg/L cutoff subgroup demonstrated superior diagnostic performance across all metrics. Despite subgroup analysis, heterogeneity remained high (I² = 74.1%), likely due to differences in reference standards, joint types, and study design.

Conclusions

Intraoperative synovial calprotectin LFT is a highly accurate and rapid diagnostic tool for PJI, with strong applicability in real-world surgical settings. Its cost-effectiveness and ease of use support its integration as a valuable adjunctive marker within standard diagnostic algorithms, providing supplementary evidence when conventional criteria remain inconclusive.

Introduction

Tibial plateau fractures are associated with a range of meniscal and ligamentous injuries that are relevant to the outcome. Standard diagnostics include radiographs and computed tomography (CT). Magnetic resonance imaging (MRI) is not routinely recommended, although it visualizes meniscal and ligamentous injuries with high sensitivity and specificity. The aim of the study was to analyze tibial plateau fractures for meniscal and ligamentous injuries and to determine whether predictability could be achieved using CT. The study also examined whether the detection of meniscal and ligamentous injuries depended on the experience of the trauma surgeon.

Method

Initially, 30 CT scans and subsequently 30 MRIs were evaluated by three residents and three consultants. To prevent rater recall of MRI–CT findings for a given patient, findings were presented in a randomized order with a two-week interval between CT and MRI assessments. A standardized questionnaire was used to evaluate soft-tissue injuries, fracture classification, surgical strategy, and the treatment of associated meniscal and ligamentous injuries for each CT and MRI. The radiologists’ MRI report was defined as the reference standard.

Results

The incidence of meniscal and ligamentous injuries associated with tibial plateau fractures was 93% (n=30). The regions most affected by soft-tissue injuries were the posterolateral corner, the anterior cruciate ligament, and both collateral ligaments. Sixty additional soft-tissue injuries were identified upon evaluation of MRI scans. The greatest improvement in diagnostic accuracy for meniscal and ligamentous injuries due to MRI was observed in cases of posterior cruciate ligament tears. Differences between consultants and residents were particularly evident in the detection of soft-tissue injuries in the lateral meniscus (63% vs. 48%, n=30, p=0.036) and the collateral ligament (70% vs. 56%, n=30, p=0.045).

Conclusion

Predicting meniscal and ligamentous injuries in tibial plateau fractures based solely on CT scans is insufficient, irrespective of the surgeon’s experience. The benefit and indication for MRI should be assessed on an individualized basis. The fracture extent, suspicion of soft-tissue injury, the treatment goal, and patient factors all influence this decision.

Purpose

This study aimed to compare the clinical and functional outcomes of modified V-Y quadricepsplasty with those of medial parapatellar (MP) arthrotomy in the context of revision total knee arthroplasty (rTKA). It is hypothesized that there is no significant difference in clinical, radiological, and strength outcomes between V-Y quadricepsplasty and the medial parapatellar approach.

Materials and methods

A retrospective comparative cohort study was conducted on 31 patients (19 who underwent an MP arthrotomy and 12 who underwent a modified V-Y quadricepsplasty) who had undergone rTKA. The clinical outcomes included knee range of motion (ROM), muscle strength, and functional scores (HSS, LEFS, WOMAC). Radiographic evaluations were conducted to assess mechanical axis deviation (MAD) and patellar height.

Results

Both groups were comparable in demographics. Clinical outcomes, including active ROM (89.5° ± 22.2° vs. 89.4° ± 8.9°; p = 0.985), extension deficit (0.41° ± 1.44° vs. 4.7° ± 7.5°; p = 0.061), flexion (93.7° ± 24.4° vs. 106.3° ± 16.7°; p = 0.099), and functional scores (HSS: 82.6 ± 12.1 vs. 85.8 ± 9.2, p = 0.408; LEFS: 43.4 ± 11.8 vs. 45.2 ± 12.2, p = 0.691; WOMAC: 24.3 ± 12.9 vs. 20.7 ± 17.3, p = 0.543) were similar between groups. Strength measurements showed no significant differences in peak extension (38.3 ± 16.8 Nm vs. 39.3 ± 12.9 Nm; p= 0.848) and peak flexion torque (22.6 ± 6.7 Nm vs. 24.8 ± 6.8 Nm; p = 0.392). Radiographic assessments showed no significant differences in MAD (15.4 ± 19.5 mm vs. 15.8 ± 13.6 mm; p = 0.951) and patellar height (1.1 ± 0.14 vs. 1.14 ± 0.25; p = 0.669). No complications were observed.

Conclusions

Modified V-Y quadricepsplasty offers outcomes comparable to MP arthrotomy in rTKA, with the advantage of extended exposure for complex cases without compromising recovery. However, given the limited sample size and the exploratory nature of this study, these findings should not be interpreted as evidence of equivalence between the two approaches.

Level of evidence

Level IV, Retrospective cohort.

Purpose

Implant-associated infections (IAIs) remain a major challenge in orthopaedic surgery, causing substantial morbidity, mortality, and healthcare costs. Antimicrobial implant coatings have emerged as a promising preventive strategy, but their comparative clinical benefit remains unclear. This study aimed to evaluate the effectiveness of antimicrobial coatings in preventing IAIs and to compare their clinical performance to uncoated implants.

Methods

A systematic review and network meta-analysis was conducted in accordance with PRISMA guidelines. Medline, Embase, Scopus, and Web of Science were systematically searched for comparative studies evaluating antimicrobial implant coatings for the prevention of orthopaedic IAIs. The primary outcome was the incidence of postoperative IAIs, while secondary outcomes included complications, site-specific infections, causative organisms, use of antibiotic prophylaxis, operative time, time to infection, and implant survival. Random-effects network meta-analysis, subgroup analyses, and assessment of publication bias were performed to synthesize and compare treatment effects across coating types.

Results

Twenty-six studies encompassing 3,592 patients were included, of whom 1,576 received coated and 2,016 uncoated implants. Coating technologies included Defensive Antibacterial Coating (DAC) hydrogel, gentamicin, iodine, silver, antibiotic-loaded calcium sulfate, and gold-silver-palladium alloy. Overall, infection rates were lower in coated implants (26.9% vs. 73.1%). Network meta-analysis demonstrated that DAC-hydrogel (OR = 0.10, 95% CI: 0.03–0.28, p < 0.001), gentamicin (OR = 0.27, 95% CI: 0.09–0.80, p = 0.018), iodine (OR = 0.34, 95% CI: 0.12–0.95, p = 0.039), and silver (OR = 0.67, 95% CI: 0.48–0.95, p = 0.026) significantly reduced infection risk. Coated implants were also associated with fewer postoperative complications (OR = 0.28, 95% CI: 0.09–0.85, p = 0.025), delayed infection onset (IRR = 0.24, 95% CI: 0.06–0.95, p = 0.042), and no increase in operative time.

Conclusion

There is enough statistical evidence to suggest that antimicrobial implant coatings may reduce implant-associated infections and postoperative complications without increasing operative time. High-dose local antibiotic carriers, such as DAC-hydrogel and gentamicin, are associated with the largest reductions in infection risk, supporting their potential protective role in high-risk procedures.

Introduction

This study aimed to evaluate the surgical outcomes of MOWHTO in patients categorized based on joint space width (JSW) patterns observed in extension and flexion positions and to identify factors associated with these outcomes.

Methods

This retrospective study involved 172 patients who underwent MOWHTO between 2016 and 2021. Patients were classified into four groups based on the median values of preoperative medial JSW in extension and flexion positions, measured on standing AP and Rosenberg views, respectively: the extension osteoarthritis (OA) group, the flexion OA group, the minimal JSN group, and the severe JSN group. Perioperative parameters, including demographic data, meniscal status, cartilage grade (International Cartilage Repair Society grading system), knee alignment, and posterior tibial slope (PTS), were analyzed. Clinical outcomes were assessed between groups using the Lysholm score, recorded preoperatively and during follow-ups.

Results

Among all enrolled patients, the mean follow-up duration was 3.54 years; the Lysholm score significantly improved from 48.31 preoperatively to 89.32 at 2 years postoperatively. No significant differences in Lysholm scores(P = .795) were observed between the groups postoperatively. PTS showed a negative correlation with extension JSW(R = -.315, P < .001) and a positive correlation with preoperative varus deformity(R = .258, P = .004), as measured with the hip-knee-ankle angle. Additionally, preoperative PTS values differed significantly among the groups, with the flexion OA group exhibiting higher PTS(p < .001).

Conclusion

MOWHTO is an effective surgical procedure regardless of knee JSW in extension or flexion positions. PTS was identified as a distinguishing factor for flexion JSN.

Level of evidence

: Level IV, retrospective therapeutic case series.

Introduction

The recovery patterns following arthroscopic rotator cuff repairs are influenced by several factors, including the size of the tear and the degree of patient compliance. This study aimed to ascertain whether a correlation exists between the size of the rotator cuff tear before surgery and the subsequent recovery of the rotator cuff following arthroscopic repair.

Materials and methods

We retrospectively reviewed 744 patients who underwent arthroscopic rotator cuff repair. Based on the inclusion and exclusion criteria, 132 patients were finally included. Muscle strength, range of motion (ROM), pain, and clinical scores were assessed preoperatively and postoperatively. Demographic and perioperative factors were assessed, and factors significantly correlated with muscle strength recovery were entered into multivariate binary logistic regression to obtain odds ratios.

Results

In small and medium tears, muscle strength from preoperative levels significantly recovered at 6 and 12 months, respectively. In contrast, no significant improvement in muscle strength was observed in large-to-massive tears. Pain scores initially improved at the 6-month mark for medium and large-to-massive tears, whereas small tears demonstrated improvement from the 12-month mark. A history of more than three shoulder injections may have an adverse effect on abduction strength recovery following arthroscopic rotator cuff repair. Furthermore, the potential risk of poor abduction and external rotation strength recovery exists when the requisite tension for rotator cuff repair > 35 N.

Conclusions

The study demonstrated that the tear size exhibited a robust correlation with the pace and prospective outcome of muscle strength recovery. Conversely, pain, ROM, and clinical score were not significantly associated with the tear size. A history of more than three shoulder injections prior to surgery and increased requisite tension power for cuff repair are associated with a higher likelihood of not recovering as much muscle strength as the uninjured shoulder.

Level of evidence

Level III.

Objective

This prospective, comparative diagnostic accuracy study was designed to assess the diagnostic value of weight-bearing computed tomography (WBCT) with three-dimensional reconstruction in detecting ligamentous injuries associated with chronic ankle instability (CAI) and to compare its efficacy with that of conventional magnetic resonance imaging (MRI). The goal was to assess the potential of WBCT as a more precise imaging modality to guide clinical decision-making.

Methods

Twenty patients with clinically suspected CAI, recruited between January 2024 and March 2025, underwent both WBCT (Planmed Verity; load equivalent to 100% body weight) and MRI (GE 1.5T; standard imaging protocols). Two senior musculoskeletal radiologists independently evaluated ligament integrity using a blinded protocol. Arthroscopic or intraoperative findings were used as the reference standard. Diagnostic parameters, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated for each method. Interobserver agreement was quantified using the Kappa statistic.

Results

WBCT demonstrated significantly higher sensitivity for detecting anterior talofibular ligament (ATFL) injuries compared to MRI (90% vs. 70%, P < 0.05), particularly in cases with osseous abnormalities such as talar dome lesions and syndesmotic widening (P < 0.01). WBCT also yielded superior interobserver agreement (Kappa = 0.82) relative to MRI (Kappa = 0.68).

Conclusion

WBCT with three-dimensional reconstruction offers enhanced diagnostic accuracy and reproducibility in assessing ATFL injuries, especially in the presence of functional instability or coexisting bony pathology. These findings support the use of WBCT as a complementary modality to MRI in the comprehensive evaluation of CAI.

Introduction

Modern uncemented total knee arthroplasty (TKA), is considered an alternative to the traditional cemented fixation, especially for younger and highly active patients; however, questions remain regarding its comparative complication profile, specifically in the early postoperative period. The purpose of this study was to determine the rate of postoperative complications associated with both cemented and uncemented TKA by using a large, national database.

Materials and methods

We conducted a retrospective cohort study using the TriNetX Research Network, which aggregates deidentified electronic health record (EHR) data from over 127 million patients. Adults who underwent their first primary TKA between October 1, 2012, and October 1, 2020, with a minimum of three years follow-up were included in the analysis. After applying inclusion/exclusion criteria, 4135 cemented TKAs were 1:1 matched to 4135 uncemented TKAs using a propensity score matching based on demographic variables and comorbidity. Follow up assessments were made at 90 day, 1 year, and 3 year intervals included prosthetic joint infection (PJI), revision procedures, aseptic loosening, periprosthetic fracture, dislocation, and all-cause complications, defined as the sum of the prosthetic joint infection (PJI), revision procedures, aseptic loosening, periprosthetic fracture, dislocation.

Results

In the matched sample (n = 4,135 per group), cemented TKA was associated with lower rates of PJI at 90 days (OR 0.525, 95% CI 0.334–0.824) and 1 year (OR 0.695, 95% CI 0.505–0.956). Cemented fixation was also associated with reduced all-cause complications at 90 days (OR 0.568, 95% CI 0.361–0.824), 1 year (OR 0.671, 95% CI 0.511–0.882), and 3 years (OR 0.765, 95% CI 0.697–0.963). No clinically significant differences existed between the two groups regarding aseptic loosening or periprosthetic fractures.

Conclusions

Using a large, propensity matched group of patients, we found that Cemented TKA demonstrated statically significant lower rates of PJI and all-cause complications compared with Uncemented TKA. These findings suggest potential differences in short-term outcomes between fixation types, although causality cannot be inferred due to the observational nature of the study and limitations inherent to database research, including coding variability and the absence of implant-level detail. Future studies should include design aspects of the implants, as well as surgeon-specific characteristics and extended follow up.