Clinical Orthopaedics and Related Research®最新文献

{"title":"Reply to the Letter to the Editor: How Can the Environmental Impact of Orthopaedic Surgery Be Measured and Reduced? Using Anterior Cruciate Ligament Reconstruction as a Test Case.","authors":"Ian D Engler","doi":"10.1097/CORR.0000000000003486","DOIUrl":"10.1097/CORR.0000000000003486","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1165-1166"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: How Much Does Prosthetic Joint Infection and Its Successful Treatment Affect Patient-reported Quality of Life?","authors":"Glenn D Wera","doi":"10.1097/CORR.0000000000003432","DOIUrl":"10.1097/CORR.0000000000003432","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1171-1172"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asymmetry in the Onset of Paraspinal Muscles Activity Differs in Adolescents With Idiopathic Scoliosis Compared With Those With a Symmetrical Spine.","authors":"Frederique Dupuis, Phoebe T T Ng, Phoebe Duncombe, Wolbert van den Hoorn, Maree T Izatt, Robert D Labrom, Kylie Tucker","doi":"10.1097/CORR.0000000000003364","DOIUrl":"10.1097/CORR.0000000000003364","url":null,"abstract":"<p><strong>Background: </strong>Adolescent idiopathic scoliosis (AIS) is characterized by an asymmetrical formation of the spine and ribcage. Recent work provides evidence of asymmetrical (right versus left side) paraspinal muscle size, composition, and activation amplitude in adolescents with AIS. Each of these factors influences muscle force generation. The timing of paraspinal muscle activation may also contribute to an asymmetry in the timing of forces applied to the spine.</p><p><strong>Questions/purposes: </strong>The main objectives were to determine (1) whether the timing and asymmetry of erector spinae muscle activation during a rapid bilateral arm raise task differs between adolescents with AIS and those without AIS and (2) whether the magnitude of erector spinae activation asymmetry in AIS is associated with scoliosis curve severity (Cobb angle) or skeletal development level (Risser stage). Finally, (3) we investigated potential kinematic confounders to determine whether symmetry of bilateral rapid arm movements differed between those with and without AIS, and whether any asymmetry in arm movement was associated with erector spinae activation asymmetry.</p><p><strong>Methods: </strong>All patients were made aware of the project through flyers at one outpatient spine clinic and a scoliosis rehabilitation clinic in Brisbane, Australia. They were invited between August 2022 and September 2023 to contribute if they met the selection criteria. This cross-sectional study included females with AIS who agreed to participate (n = 24, mean ± SD age of 14 ± 2 years). They all had a primary right-thoracic curve, diagnosed by an orthopaedic specialist. Twenty age- and sex-matched controls (age 13 ± 2 years) who did not have AIS were recruited from the local community. Volunteers (from either group) were excluded if they had any history of spinal surgery, neurological disorders, or musculoskeletal disorders (other than AIS). The experimental task required participants to perform a bilateral rapid arm flexion in response to a visual cue. Muscle activation was recorded using surface electrodes, placed bilaterally on the anterior deltoid and erector spinae adjacent to the C7, T9 (the curve apex for AIS), T12, and L5 vertebrae. Muscle activation onsets were determined from 6 of 10 trials with the quickest deltoid onset for each participant. A linear mixed model (with fixed factors) was used to determine whether activation asymmetry (left-right onset difference) differed between groups (AIS, control) and vertebral level (C7, T9/apex, T12, and L5). Where a group difference in onset asymmetry was identified, the relation of the Cobb angle and Risser stage with the magnitude of asymmetry was evaluated in the AIS cohort using a linear mixed model. Task kinematics, including peak angular arm movement velocity and deltoid onset relative to the light signal, were analyzed using a linear mixed model with group and side as fixed factors.</p><p><strong>Results: </","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1112-1121"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum to: Does the Presence of Missing Data Affect the Performance of the SORG Machine-learning Algorithm for Patients With Spinal Metastasis? Development of an Internet Application Algorithm.","authors":"Chi-Ching Huang, Kuang-Ping Peng, Hsiang-Chieh Hsieh, Olivier Q Groot, Hung-Kuan Yen, Cheng-Chen Tsai, Aditya V Karhade, Yen-Po Lin, Yin-Tien Kao, Jiun-Jen Yang, Shih-Hsiang Dai, Chuan-Ching Huang, Chih-Wei Chen, Mao-Hsu Yen, Fu-Ren Xiao, Wei-Hsin Lin, Jorrit-Jan Verlaan, Joseph H Schwab, Feng-Ming Hsu, Tzehong Wong, Rong-Sen Yang, Shu-Hua Yang, Ming-Hsiao Hu","doi":"10.1097/CORR.0000000000003513","DOIUrl":"10.1097/CORR.0000000000003513","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"483 6","pages":"1175-1176"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: How Can the Environmental Impact of Orthopaedic Surgery Be Measured and Reduced? Using Anterior Cruciate Ligament Reconstruction as a Test Case.","authors":"T Derek V Cooke","doi":"10.1097/CORR.0000000000003400","DOIUrl":"10.1097/CORR.0000000000003400","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1162"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Do Patients Perceive Success and Satisfaction After Vertebral Body Tethering and Fusion for Adolescent Idiopathic Scoliosis? A Qualitative Study.","authors":"Lisa A Royse, Dinara Saparova, Melanie E Boeyer, Daniel G Hoernschemeyer","doi":"10.1097/CORR.0000000000003373","DOIUrl":"10.1097/CORR.0000000000003373","url":null,"abstract":"<p><strong>Background: </strong>Adolescent idiopathic scoliosis (AIS) is the most common spinal deformity among children. Although posterior spinal fusion (PSF) is a commonly used treatment for curves ≥ 45°, anterior vertebral body tethering (VBT) has recently gained traction as an alternative for some patients. Surgeons have established radiographic definitions of success for PSF, with similar efforts underway for VBT. However, these definitions may not align with patient perceptions of success or their satisfaction with achieved outcomes.</p><p><strong>Questions/purposes: </strong>To enhance patient-centered care and inform subsequent comparative effectiveness research, we asked: (1) How do patients who have undergone VBT or PSF define and perceive treatment success ≥ 3 years after surgery? (2) What are patients' perceptions of their outcomes, specifically regarding satisfaction with symptom relief, side effects, physical function, and physical appearance?</p><p><strong>Methods: </strong>Using an approach informed by concepts from phenomenology to capture patients' lived experiences, we conducted semistructured interviews using an interview guide. Inclusion criteria required patients to have (1) progressive AIS with moderate deformity (< 60°) at surgery, (2) undergone VBT or PSF with at least 3 years of follow-up, and (3) reached full skeletal maturity. Patients unable to communicate or schedule interviews were excluded. From 96 eligible patients (VBT n = 47, PSF n = 49), we recruited 40 (20 per cohort). The sample size was guided by qualitative studies in the field and aimed to achieve saturation, defined as the point at which minimal new information and no new coding categories were identified. Participants were treated at a single urban Midwest hospital by the same physician. The VBT cohort (median age 18 years [range 16 to 22]) was 85% women/girls, while the PSF cohort (median age 21 years [range 18 to 27]) was 70% women. Interviews were analyzed using a collaborative content analysis approach in which two researchers independently identified key ideas, assigned codes, and resolved discrepancies through consensus to develop themes and subthemes aligned with the research questions.</p><p><strong>Results: </strong>Patients from both cohorts defined success as achieving pain relief, maintaining physical function, improving appearance, ensuring long-term deformity correction, and alleviating concerns about future health risks. Patient priorities varied; some prioritized flexibility to swim competitively or play musical instruments, while others prioritized pain-free living or improved physical appearance. Overall, both groups expressed satisfaction with symptom relief, physical function, and appearance improvements despite ongoing pain, side effects, and physical limitations.</p><p><strong>Conclusion: </strong>These findings may be used as a guide for preoperative counseling and highlight the importance of incorporating patient perspectives int","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1124-1138"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decreased Association Between Patellar Axial Malalignment and Patellar Height and Increased Association Between Patellar Axial Malalignment and Tibial Tubercle-Trochlear Groove During Weightbearing.","authors":"Yurou Chen, Wei Tian, Jia Li, Bo Sheng, Furong Lv, Shixin Nie, Fajin Lv","doi":"10.1097/CORR.0000000000003357","DOIUrl":"10.1097/CORR.0000000000003357","url":null,"abstract":"<p><strong>Background: </strong>Nonweightbearing preoperative assessments avoid quadriceps contraction that tends to affect patellar motion and appear to be inaccurate in quantifying anatomic factors, which can lead to incorrect corrections and postoperative complications.</p><p><strong>Questions/purposes: </strong>(1) Does the relationship of patellar axial malalignment and other anatomic factors change during weightbearing? (2) What anatomic factor was most strongly correlated with recurrent patellar dislocation during weightbearing?</p><p><strong>Methods: </strong>This prospective, comparative, observational study recruited participants at our institution between January 2023 and September 2023. During this time, all patients with recurrent patellar dislocations received both weightbearing and nonweightbearing CT scans; control patients who received unilateral CT scans because of injuries or benign tumors received both weightbearing and nonweightbearing CT scans. Between January 2023 and September 2023, 52 patients were treated at our institution for patellar dislocation. We included those who had experienced at least two dislocations. The exclusion criteria were as follows: (1) traumatic dislocation, (2) prior knee surgery, (3) osteoarthritis (≥ Kellgren-Lawrence Grade 3), and (4) abnormal walking and standing postures confirmed by the orthopaedic surgeon and an inability to complete weightbearing CT with their body in a neutral position (meaning their body weight was evenly placed on both knees) because of severe pain. After applying prespecified exclusions, 63% (33 patients) of the original number were included, and data for 33 patients (65 knees) with weightbearing CT data and 28 patients (52 knees) with nonweightbearing CT data were obtained. Because of ethical requirements, the control group included patients who underwent unilateral CT scanning (for an injury or a benign tumor), and weightbearing CT and nonweightbearing CT covered both knees. Control knees were confirmed to have normal patellofemoral function by physical examination by an orthopaedic surgeon involved with the study. The control group consisted of the normal knees (52 knees underwent both weightbearing CT and nonweightbearing CT) and the affected but uninvolved knees (47 knees underwent weightbearing CT and 6 knees underwent nonweightbearing CT), and a total of 52 patients (99 knees) with weightbearing CT data and 31 patients (58 knees) with nonweightbearing CT data were included. There were no differences between the recurrent patellar dislocation and control groups in terms of gender, side, and BMI. Although the patients in the control group were older than those in the study group, most patients in both groups were at or at least near skeletal maturity. Patellofemoral measurements were evaluated with the Insall-Salvati ratio extension , Blackburne-Peel ratio extension , Caton-Deschamps ratio extension , bisect offset index, lateral patellar tilt angle, tibial tubercle","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1096-1109"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Resilience Change in Patients Undergoing Shoulder Surgery? A Retrospective Comparative Study Utilizing the Brief Resilience Scale.","authors":"Daniel J Song, Emily R McDermott, Daniel Homeier, David J Tennent, Jay K Aden, Justin J Ernat, John M Tokish","doi":"10.1097/CORR.0000000000003368","DOIUrl":"10.1097/CORR.0000000000003368","url":null,"abstract":"<p><strong>Background: </strong>Resilience refers to the ability to adapt or recover from stress. There is increasing appreciation that it plays an important role in wholistic patient-centered care and may affect patient outcomes, including those of orthopaedic surgery. Despite being a focus of the current orthopaedic evidence, there is no strong understanding yet of whether resilience is a stable patient quality or a dynamic one that may be modified perioperatively to improve patient-reported outcome scores.</p><p><strong>Questions/purposes: </strong>(1) Does resilience change postoperatively? (2) How do outcome measures change postoperatively in relation to resilience grouping? (3) For patients who do have resilience instability (change in resilience of ≥ 1 SD between any two follow-up points), how were patient-level factors, surgical characteristics, and outcome measures associated with instability?</p><p><strong>Methods: </strong>In this single-surgeon, retrospective, comparative study, we identified all patients who underwent shoulder surgery between March 2021 and March 2023 from the medical records of one US military teaching hospital, resulting in 144 initial patients. Data on resilience (measured by the Brief Resilience Scale) and outcomes (assessed using the Numeric Rating Scale [NRS] and the Single Assessment Numeric Evaluation [SANE]) were collected for all patients and maintained in a longitudinal outcomes score database. Patients younger than 18 years of age (1% [1 of 144]) who underwent surgery for fracture, acute tendon rupture (8% [11 of 144]), or revision surgery (3% [4 of 144]); had concomitant shoulder conditions (such as, instability or rotator cuff tear) (1% [2 of 144]); or had incomplete follow-up data (4% [5 of 144]) were excluded, leaving 84% (121 of 144) of the original sample size for analysis. Among the patients, 12% (15 of 121) were women, the mean age was 41 ± 15 years, and the most common indication for surgery was instability (40% [48 of 121]) followed by rotator cuff repair (29% [35 of 121]). Based on their preoperative Brief Resilience Scale and its deviation from the mean, patients were stratified into low (> 1 SD below mean), intermediate (within 1 SD above and below mean), and high (> 1 SD above mean) resilience groups. Preoperatively, 19% (23 of 121) of patients were classified as low resilience, 62% (75 of 121) as intermediate resilience, and 19% (23 of 121) as high resilience. The mean ± SD preoperative Brief Resilience Scale score was 25 ± 4. The Brief Resilience Scale is a six-item scale with a calculated summary score ranging from 6 to 30. A higher score is suggestive of greater perceived resilience. There were no differences in the preoperative Brief Resilience Scale score with regard to age, gender, type of surgery performed, or outcome measures. Patient resilience was followed during the postoperative period for a minimum of 6 months, and instability in the scale was evaluated. Instability in resilien","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1049-1059"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kinematic Alignment Does Not Result in Clinically Important Improvements After TKA Compared With Mechanical Alignment: A Meta-analysis of Randomized Trials.","authors":"Nicholas Nucci, Moyukh Chakrabarti, Zachary DeVries, Seper Ekhtiari, Sebastian Tomescu, Raman Mundi","doi":"10.1097/CORR.0000000000003356","DOIUrl":"10.1097/CORR.0000000000003356","url":null,"abstract":"<p><strong>Background: </strong>There is debate as to whether kinematic TKA or mechanical alignment TKA is superior. Recent systematic reviews have suggested that kinematically aligned TKAs may be the preferred option. However, the observed differences in alignment favoring kinematic alignment may not improve outcomes (performance or durability) in ways that patients can perceive, and likewise, statistical differences in outcome scores sometimes observed in clinical trials may be too small for patients to notice. Minimum clinically important differences (MCIDs) are changes that are deemed meaningful to the patient. A meta-analysis of randomized trials that frames results on this topic in terms of MCIDs may therefore be informative to surgeons and their patients.</p><p><strong>Questions/purposes: </strong>(1) Does kinematic alignment for TKA insertion improve patient-reported outcome measures (PROMs) by clinically important margins (for example, 5 points of 48 on the adjusted Oxford Knee Score [OKS] or 13.7 points of 100 on the Forgotten Joint Score [FJS]) compared with mechanical alignment? (2) Does kinematic alignment for TKA insertion improve ROM by a clinically important margin (defined as 3.8° to 6.4° in flexion) compared with mechanical alignment?</p><p><strong>Methods: </strong>A systematic review of Medline and Embase databases was performed from inception to January 29, 2023, the date of search. We identified RCTs comparing mechanical alignment TKA with kinematic alignment TKA. All English-language RCTs comparing PROMs data in kinematic versus mechanical alignment TKAs performed in patients 18 years or older were included. Studies that were not in English, involved overlapping reports of the same trial, and/or utilized nonrandomized controlled trial methodology were excluded. Conference abstracts or study protocols, pilot studies, and review articles were also excluded. Two reviewers screened abstracts, full-text, and extracted data and assessed included studies for risk of bias using the Cochrane Risk of Bias tool, version 2. Twelve randomized controlled trials (RCTs) were identified, which included 1033 patients with a mean age of 68 years (range 40 to 94) from eight countries who were undergoing primary TKA. Six studies were determined to be low risk of bias, with the remaining six studies determined to be of moderate-to-high risk of bias. As a result, we would expect that the included studies might overestimate the benefit of the newer approach. Outcomes included ROM and PROMs. Where feasible, pooled analysis was completed. PROMs data were extracted from nine pooled studies, with a randomized n = 443 in the kinematic alignment group and n = 435 in the mechanical alignment group. ROM data were extracted from six pooled studies, with randomized n = 248 in the kinematic alignment group and n = 243 in the mechanical alignment group. PROMS were converted to common scales where possible. Multiple versions of the OKS exist; therefore, OKS sc","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1020-1030"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Releasing Forces in Adhesive Capsulitis Are Important Indicators of Shoulder Stiffness and Postoperative Function.","authors":"Hengzhi Liu, Honglu Cai, Jungang Xu, Yuquan Jiang, Canlong Wang, Zheyu Huang, Hongwei Ouyang, Jinzhong Zhao, Weiliang Shen","doi":"10.1097/CORR.0000000000003365","DOIUrl":"10.1097/CORR.0000000000003365","url":null,"abstract":"<p><strong>Background: </strong>Manipulation under anesthesia is a widely used treatment for frozen shoulder, but the factors that influence patient outcomes after manipulation remain unclear. The degree of shoulder stiffness, a critical feature of frozen shoulder, likely reflects the severity of the condition but currently lacks standardized, objective assessment methods.</p><p><strong>Questions/purposes: </strong>(1) What are the releasing forces in patients with frozen shoulder, and do the forces vary across different stages of frozen shoulder? (2) Are there differences in postoperative outcomes of manipulation under anesthesia among patients with frozen shoulder at different stages of the condition? (3) Is a higher releasing force associated with poorer outcomes of manipulation, and what threshold of releasing force is optimal for better outcomes? (4) What clinical factors influence the magnitude of releasing forces?</p><p><strong>Methods: </strong>This prospective cohort study included patients with primary unilateral frozen shoulder who underwent manipulation under anesthesia after at least 3 months of unsuccessful nonsurgical treatment, which was defined as progressive worsening ROM, failure to make progress, or residual functional impairment after 3 months of treatment. Between December 1, 2022, and December 31, 2023, we treated 280 patients with unilateral frozen shoulder, all of whom were considered potentially eligible for this study. The inclusion criteria were: a reduction of passive external rotation in the affected shoulder to less than 50% compared with the contralateral side, at least 3 months of unsuccessful nonsurgical treatment, absence of shoulder trauma, radiographs and MRI showing no other pathologic lesions in the shoulder, and no prior medical history in the contralateral shoulder. The exclusion criteria were patients who had previously undergone shoulder surgery, those who had bilateral frozen shoulder, patients with anesthesia intolerance, and those with incomplete preoperative assessments. One hundred fifty-six patients were enrolled in follow-up assessments at 1, 3, and 6 months after manipulation. The mean ± SD age for enrolled patients was 54 ± 8 years, 35% (55 of 156) of all participants were male, and the mean BMI was 23 ± 3 kg/m 2 . Two percent (3 of 156) withdrew consent, and 4% (7 of 156) were lost to follow-up, leaving 94% (146 of 156) for analysis. The contralateral unaffected shoulder was used as a self-control. During the manipulation process, the force-time curves for the affected and unaffected shoulders were sequentially recorded using a handheld dynamometer, following the order of forward flexion, external rotation, and internal rotation. Two key force values, an initial tear value and a peak value, were extracted from the curve for the affected shoulder, while only the peak value was recorded for the unaffected shoulder. Passive ROM, the Oxford shoulder score (OSS), and the VAS were evaluated at the ba","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1033-1046"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}