Clinical Orthopaedics and Related Research®最新文献

{"title":"Letter to the Editor: Value-based Healthcare: Making PROMs Work for Musculoskeletal Care.","authors":"David N Bernstein,Daniel G Tobert","doi":"10.1097/corr.0000000000003655","DOIUrl":"https://doi.org/10.1097/corr.0000000000003655","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"11 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: The Forward Movement: Amplifying Black Voices on Race and Orthopaedic-Reclaiming True Merit.","authors":"Ethan Lichtblau","doi":"10.1097/CORR.0000000000003659","DOIUrl":"10.1097/CORR.0000000000003659","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Short-term Squatting Mechanics After Arthroscopic Treatment for Femoroacetabular Impingement in Adolescents.","authors":"Jonathan Rylander","doi":"10.1097/CORR.0000000000003656","DOIUrl":"10.1097/CORR.0000000000003656","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Which Graft Is Associated With Better Outcomes in ACL Reconstruction? A Systematic Review and Network Meta-analysis of Randomized Controlled Trials.","authors":"Chao Fan Chen, Shi Yuan Qian, Tao Li, Lei Yao, Yang Xu, Li Wang, Jian Li","doi":"10.1097/CORR.0000000000003585","DOIUrl":"10.1097/CORR.0000000000003585","url":null,"abstract":"<p><strong>Background: </strong>In clinical practice, different surgical methods, including autografts, allografts, and artificial ligaments, have been used in reconstruction after ACL injuries. However, the available evidence is conflicting in terms of which approach has yielded better patient-reported outcomes, joint stability, and risk of graft reinjury. A network meta-analysis allows the comparison of approaches that have not been compared head-to-head in individual RCTs. Although several network meta-analyses have been performed on this topic, they are hampered by methodological limitations.</p><p><strong>Questions/purposes: </strong>We performed an updated network meta-analysis of RCTs to answer the following questions: Considering different grafts applied in ACL reconstruction, which graft is superior in terms of (1) patient-reported outcomes (International Knee Documentation Committee [IKDC] objective score, Lysholm score, and Tegner score), (2) knee stability results (Lachman test, pivot-shift test, and KT-1000/2000 arthrometer side-to-side difference), and (3) risk of graft reinjury?</p><p><strong>Methods: </strong>We searched the PubMed, Embase, Cochrane Library, and Web of Science databases from January 2000 to November 2024 for completed studies. We reviewed 30,976 papers, and 27 met inclusion criteria, which were as follows: RCTs published in English, RCTs that involved ACL reconstruction with different grafts (autografts, allografts, and artificial ligaments) with fully described surgical techniques, RCTs that reported on at least one of the relevant outcome measures (preoperative and postoperative IKDC objective score, Lysholm score, Tegner score, Lachman test, pivot-shift test, KT-1000/2000 arthrometer side-to-side difference, and risk of graft reinjury), and RCTs that reported a minimum follow-up period of 12 months with at least 80% follow-up completeness. The Cochrane risk-of-bias tool (RoB 2.0) was used to assess the quality of the included studies, with 18 studies judged as being at a low risk of bias and 9 studies assessed as being at an unclear risk of bias. In total, 2572 patients were treated with 16 different types of grafts. The mean length of follow-up was 47 months. The mean age of the included patients was 28 years, and 71% of the patients were male. A Bayesian network meta-analysis was performed via the \"gemtc\" and \"coda\" packages of R Studio, version 4.2.1, and the \"networkplot\" command of Stata 15 software was used to plot network relationships for direct and indirect comparisons between different interventions. The surface under the cumulative ranking curve (SUCRA) was calculated to rank the intervention effects of different interventions. A SUCRA value approaching 1 (100%) indicates a greater probability that the corresponding treatment is superior in terms of efficacy or safety. The most common treatment comparisons were the single-bundle 4-strand semitendinosus with gracilis tendon autograft versus the bone-p","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: How Does Anterior Vertebral Body Tethering Compare to Posterior Spinal Fusion for Thoracic Idiopathic Scoliosis? A Nonrandomized Clinical Trial.","authors":"Zeeshan Solangi,Rachana Mehta,Ranjana Sah","doi":"10.1097/corr.0000000000003657","DOIUrl":"https://doi.org/10.1097/corr.0000000000003657","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"31 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Does Augmenting Irradiated Autografts With Free Vascularized Fibula Graft in Patients With Bone Loss From a Malignant Tumor Achieve Union, Function, and Complication Rate Comparably to Patients Without Bone Loss and Augmentation When Reconstructing Intercalary Resections in the Lower Extremity?","authors":"John H Healey","doi":"10.1097/CORR.0000000000003642","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003642","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"483 9","pages":"1696-1698"},"PeriodicalIF":4.4,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12373068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945333","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":"Is Malignancy Associated With Arthroplasty? A Meta-analysis.","authors":"Thomas Johnstone, Jamasb J Sayadi, Jagmeet S Arora, Shannon D Francis, Nada R Khattab, Jeong Hyun Ha, Raffi Avedian, Gordon Lee","doi":"10.1097/CORR.0000000000003654","DOIUrl":"10.1097/CORR.0000000000003654","url":null,"abstract":"<p><strong>Background: </strong>Although implants have been linked to malignancies in other medical contexts, such as the relationship between anaplastic large cell lymphoma and breast implants, the potential association between orthopaedic implants and cancer remains unclear. Several studies have investigated this question, but findings have been inconsistent. A comprehensive meta-analysis is needed to clarify whether total joint arthroplasty increases the risk of malignancy.</p><p><strong>Questions/purposes: </strong>(1) Is receiving a THA or TKA associated with an increased risk of cancer? (2) Are certain implant types (such as metal-on-metal or cemented) associated with increased cancer risk? (3) Is follow-up duration associated with changes in observed cancer risk estimates?</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted using PubMed, Embase, and SCOPUS to identify studies assessing cancer incidence rates in patients who received hip or knee arthroplasty compared to patients in control groups who did not receive arthroplasty. Databases were queried from inception through the final search date (November 23, 2024). Eligible studies reported or allowed derivation of an effect estimate comparing overall cancer incidence rates in recipients of THA or TKA with an external reference population. From 1838 screened articles, 16 studies were included, all of which provided extractable effect estimates that were entered into one or more of our meta-analyses. Included studies consisted primarily of record-linkage studies connecting national, longitudinally maintained arthroplasty registers to similarly longitudinal national mortality and cancer registers. Study quality was assessed using the Newcastle-Ottawa Scale, which awards up to nine points across three categories, with higher scores indicating lower risk of bias. The 16 included studies scored between 6 and 8 (mean ± SD 7.1 ± 0.8), reflecting generally high methodological quality. The primary analysis included data from 977,465 patients of both sexes and all age groups who underwent hip or knee arthroplasty and were followed up for over 7,415,134 person-years. Effect estimates were pooled with a random-effects model because heterogeneity was present (between-study σ2 = 0.016 versus within-study σ2 = 0.002; Q = 1195, p < 0.001), and a funnel plot showed no evidence of publication bias. To explore associations between implant type and cancer risk for patients undergoing THA, we conducted separate meta-analyses for studies reporting on metal-on-metal bearing surfaces and those reporting on cemented fixation. To assess latency effects, we compared cancer incidence rates in patients with more or less than 10 years of follow-up and conducted a meta-regression to evaluate the association between follow-up duration and cancer risk. We did not perform an a priori power analysis.</p><p><strong>Results: </strong>Patients who underwent THA or TKA did not have an increased","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cemented Fixation in Arthroplasty for Hip Fractures Does Not Increase Cardiopulmonary Complications: A Secondary Analysis of the HIP ATTACK Trial.","authors":"Christiaan H Righolt, Flavia K Borges, Jhase Sniderman, Thomas R Turgeon, P J Devereaux, Mohit Bhandari, Ernesto Guerra Farfan, Abdel-Rahman Lawendy, Ameen Patel, Vikas Tandon, Wojciech Szczeklik, Sandra Ofori, Valerie Harvey, Eric R Bohm, Gavin C A Wood","doi":"10.1097/CORR.0000000000003645","DOIUrl":"10.1097/CORR.0000000000003645","url":null,"abstract":"<p><strong>Background: </strong>Cemented fixation in arthroplasty to treat hip fractures is now widely recommended, but it is not universally used. Some surgeons may feel that the risk of bone cement implantation syndrome and its cardiopulmonary sequalae are too high, in part, because the evidence provides little detail on postoperative myocardial injury and other medical complications after cement use.</p><p><strong>Questions/purposes: </strong>We aimed to use data from the HIP ATTACK trial (an RCT in which patients with a hip fracture were randomized to accelerated time to surgery versus normal timing of surgery) for a secondary analysis to answer the following questions on arthroplasty for patients with hip fractures: (1) Are patients who undergo cemented hip arthroplasty for hip fractures more likely to experience cardiopulmonary events than patients who undergo uncemented hip arthroplasty? (2) Are patients who undergo cemented hip arthroplasty for hip fractures more likely to experience myocardial injury, identified by elevated troponin levels, than patients who undergo uncemented hip arthroplasty?</p><p><strong>Methods: </strong>We performed a post hoc analysis of the HIP ATTACK trial for a subset of patients who were treated with THA or hemiarthroplasty for a femoral neck fracture because the trial collected postoperative troponin levels to allow us to identify myocardial injury. The HIP ATTACK trial consisted of 2970 patients. We limited our source cohort to the 1049 patients who underwent hip arthroplasty and were not lost to follow-up (four patients who had undergone arthroplasty were lost to follow-up). We excluded two patients with unknown fixation and six patients with \"other arthroplasty.\" We limited our analysis to femoral neck fractures, which excluded 75 more patients. Of the 966 patients who received hip arthroplasty, 61% (593) had cemented fixation. Patients with cemented fixation were older than patients with cementless fixation (median [IQR] 82 (74 to 88) versus 79 (71 to 86); p = 0.003). Race was self-reported by patients and differed between patients with cemented and cementless fixation. A higher proportion of patients who received cementless fixation had undergone THA (compared with hemiarthroplasty) than patients in the cemented fixation group (24% [91] versus 11% [66]; p < 0.001). We used logistic regression to estimate the association between cement use and a composite outcome consisting of all-cause mortality and various cardiopulmonary outcomes. We included cardiopulmonary outcomes possibly associated with bone cement implantation syndrome; there were only a small number of patients who had only nonsevere outcomes. We had 80% power to detect an OR of ≥ 1.6. We adjusted for all baseline differences between both groups except for anesthesia (as it was not associated with the outcome) and duration of surgery (as it is a function of cement use).</p><p><strong>Results: </strong>After controlling for age, sex, race, and re","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does the JK Classification Have Good Reliability for Making Treatment Choices and Prognosticating Outcomes in Radial Polydactyly?","authors":"Won Sun Lee, Ahmed Ali A Hashroof, Young Ho Shin, Jae Kwang Kim","doi":"10.1097/CORR.0000000000003650","DOIUrl":"10.1097/CORR.0000000000003650","url":null,"abstract":"<p><strong>Background: </strong>The Wassel-Flatt classification has been widely used to categorize radial polydactyly, but it has limitations in describing variations such as the hypoplastic and triphalangeal types. To address these limitations, the modified Wassel-Flatt classification was introduced. However, this classification also has drawbacks in categorizing of Type VII and fails to include angular-type hypertrophied epiphysis of the distal phalanx. Therefore, the JK classification, a revised version of the modified Wassel-Flatt classification, was recently proposed. However, its reliability and usefulness in prognosticating for postoperative outcomes, when compared with other classifications, have not been thoroughly investigated.</p><p><strong>Questions/purposes: </strong>(1) What are the interobserver and intraobserver reliability values for the JK classification, and how do these compare with the Wassel-Flatt and the modified Wassel-Flatt classifications? (2) Which classification types were associated with higher risk of reoperation? (3) Does the JK classification offer prognostically useful information, as measured by Japanese Society for Surgery of the Hand (JSSH) scores?</p><p><strong>Methods: </strong>Between October 2017 and March 2020, a total of 129 patients with radial polydactyly underwent surgery by a single surgeon in our institution, and these patients were considered eligible candidates for this study. Of those, we excluded patients older than 5 years of age at the time of surgery (one patient), those with < 24 months of postoperative follow-up (16 patients), and those with incomplete medical records (two patients). Ultimately, 85% (110) of patients were included in our evaluation of interobserver and intraobserver reliability as well as in our assessment of reoperation risk and JSSH scores. The mean ± SD age at surgery was 8.8 ± 4.8 months, and the mean follow-up period was 30 ± 4.2 months. Fifty-eight percent (64 of 110) were boys and 42% (46) were girls. Patients were categorized using the Wassel-Flatt, modified Wassel-Flatt, and JK classification systems. Interobserver and intraobserver reliability were assessed using Cohen and Fleiss kappa coefficients. Reoperation risk was compared across the different classifications. Postoperative clinical outcomes were evaluated using the JSSH scoring system with patient categorization based on the JK classification.</p><p><strong>Results: </strong>The JK classification demonstrated almost perfect interobserver (κ = 0.86 [95% confidence interval (CI) 0.81 to 0.89]) and intraobserver (κ = 0.94 [95% CI 0.88 to 0.99]) reliability. The modified Wassel-Flatt classification also exhibited almost perfect interobserver (κ = 0.82 [95% CI 0.78 to 0.86]) and intraobserver (κ = 0.92 [95% CI 0.85 to 0.98]) reliability. The Wassel-Flatt classification showed substantial interobserver reliability (κ = 0.68 [95% CI 0.62 to 0.74]) and almost perfect intraobserver reliability (κ = 0.85 [95% CI 0.77 ","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Art in Science: Quilting Bees and the American Red Cross.","authors":"Stuart A Green","doi":"10.1097/CORR.0000000000003649","DOIUrl":"10.1097/CORR.0000000000003649","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}