Clinical Orthopaedics and Related Research®最新文献

{"title":"Virtue Ethics in a Value-driven World: The Impaired Surgeon is More Than a Personal, Personnel Problem.","authors":"Casey Jo Humbyrd","doi":"10.1097/corr.0000000000003700","DOIUrl":"https://doi.org/10.1097/corr.0000000000003700","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"18 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140117","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":"Genetic Variants Related to TGF-β Signaling Pathway Modulate Risk of Meniscus Injury: A Multiancestry Genome-wide Association Study.","authors":"Amith Umesh,Stephan Cordogan,Shae K Simpson,Joshua T Bram,Ruth H Jones,William W Schairer,Andrea Sboner,Olivier Elemento,Daniel W Green,Peter D Fabricant","doi":"10.1097/corr.0000000000003679","DOIUrl":"https://doi.org/10.1097/corr.0000000000003679","url":null,"abstract":"BACKGROUNDNumerous clinical risk factors and moderate heritability have been reported for meniscus injury. However, the genetic etiology of meniscus injury remains understudied. This study was a multiancestry genome-wide association study (GWAS) of meniscus injury aimed at identifying genomic variants that influence risk and elucidating the mechanisms by which they may exert their effects.QUESTIONS/PURPOSES(1) Which single nucleotide polymorphisms (SNPs), genes, and molecular pathways are associated with meniscus injury? (2) How do independent SNPs with genome-wide significance alter the expression of genes within cells related to the meniscus? (3) Can a polygenic risk score (PRS) for meniscus injury discriminate between patients with meniscus injury and controls? (4) Does obesity increase the risk of meniscus injury using a Mendelian randomization framework?METHODSA meta-analysis of 38,062 patients with meniscus injury and 700,343 control participants was performed using GWAS summary statistics from the NIH's All of Us and FinnGen cohorts. All of Us provided an ancestrally diverse cohort for a multiancestry GWAS. Functional Mapping and Annotation of Genetic Variants (FUMA) and Meta-Analysis Gene-Set Mining of GWAS (MAGMA) platforms were used to identify genes of interest and perform expression quantitative trait loci and chromatin interaction mapping of SNPs with genome-wide significance. A PRS was developed for European individuals using the FinnGen GWAS and was validated on a European cohort from All of Us. Mendelian randomization assesses putative causal associations between an exposure and outcomes given random assortment of alleles during meiotic recombination and was used to analyze the risk of obesity and meniscus injury.RESULTSTwelve independent genome-wide significant loci (p < 5 × 10-8) were identified, and genes UQCC1, BMP6, EGR2, CAPZB, SMG6 were associated with meniscus injury after Bonferroni correction for all identified genes (p < 2.6 × 10-6). A subset of genes identified through MAGMA were enriched in the transforming growth factor-β (TGF-β) signaling pathway. Independent SNPs altered expression of genes related to the TGF-β pathway, including GDF5, BMP6, MMP24, and UQCC1. As an independent intronic SNP of UQCC1, rs2425055 was in chromosomal contact with GDF5OS in mesenchymal stem cells and decreased the expression of GDF5OS. A PRS for meniscus injury demonstrated differences in genetic risk between patients with meniscus injury and control participants (area under the curve 0.53 [95% confidence interval (CI) 0.51 to 0.54], OR per SD increase 1.10 [95% CI 1.05 to 1.15]; p = 3.34 × 10-5). Mendelian randomization demonstrated that genetic predisposition to obesity increased the risk of meniscus injury (OR 1.29 [95% CI 1.24 to 1.34]; p = 9.58 × 10-38).CONCLUSIONThe 12 independent genetic variants identified suggest a genetic contribution to meniscus injury risk across multiple ancestries. These SNPs may modulate meniscus injury ris","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"1 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145089857","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":"What Would Be the Effect of Lowering the Threshold of Statistical Significance From 0.05 to 0.005 in Foot and Ankle Randomized Controlled Trials?","authors":"Yoshiharu Shimozono,Yuki Shinya,Shuichi Matsuda","doi":"10.1097/corr.0000000000003689","DOIUrl":"https://doi.org/10.1097/corr.0000000000003689","url":null,"abstract":"BACKGROUNDThe threshold for statistical significance (p < 0.05) has been debated in recent years, with proposals to lower it to p < 0.005 to reduce the frequency of papers concluding with false-positive results, which can result in patients receiving overtreatment, and potentiating the problem of nonreplicable results in medical research. However, to our knowledge the impact of modeling that suggestion-in terms of how many studies might be reclassified as no-difference studies and how much larger studies would need to become to implement that suggestion-has not been assessed in orthopaedic surgery.QUESTIONS/PURPOSESWe used randomized trials in foot and ankle research to answer the question: If the threshold for statistical significance were lowered from p < 0.05 to p < 0.005, (1) what proportion of foot and ankle RCTs would be reclassified as no-difference trials under a stricter p value threshold, and (2) how much larger would studies have needed to be to retain or obtain 80% power at the p < 0.005 level?METHODSWe manually reviewed all articles published between 2019 and 2024 in the top 10 ranked orthopaedic journals and the top three foot and ankle-specific journals, both selected based on their 2023 two-year journal Impact Factor, focusing on foot and ankle studies. Studies were included if they met the following criteria: (1) RCT design, (2) focus on foot and ankle conditions or interventions, (3) published in English, and (4) reported p values for primary outcomes. After screening, a total of 123 RCTs met these criteria and were included in the final analysis. Those studies' p values for primary endpoints were extracted and analyzed under both thresholds. If a study had multiple primary endpoints or evaluated the primary endpoint from multiple domains, all p values were included. We categorized p values into three groups based on the classification proposed by Ioannidis: (1) p < 0.005 as \"statistically significant,\" (2) 0.005 ≤ p < 0.05 as \"suggestive,\" and (3) p ≥ 0.05 as \"nonsignificant.\" For studies with sufficient power analysis data, we calculated the required sample size increase needed to maintain 80% statistical power (1 - beta) at an alpha level of 0.005, using the variance reported in the source studies. The effect size (delta) was inferred from the between-group differences reported in each study. Additionally, multivariable logistic regression analysis was performed to identify factors associated with maintaining statistical significance under the p < 0.005 threshold.RESULTSAmong 281 primary endpoints identified from 123 trials, 44% (124 of 281) were statistically significant using the threshold defined in those articles (p < 0.05). Of these significant endpoints, only 42% (52 of 124) of endpoints met the proposed threshold (p < 0.005), whereas 58% (72 of 124) fell between 0.005 and 0.05. Following the classification proposed by Benjamin et al., these endpoints would be reclassified as \"suggestive\" rather than statistically signi","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"23 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140314","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":"Novel Hip MRI Sequence Provides Consistent Osseous Morphology Dimensions for FAI Evaluation Compared With CT.","authors":"Peyton Sakelaris,Dylan Quintana,Nathan Barber,Megan Mills,Hailey Allen,Justin Ernat,Stephen Aoki,Travis Maak","doi":"10.1097/corr.0000000000003682","DOIUrl":"https://doi.org/10.1097/corr.0000000000003682","url":null,"abstract":"BACKGROUNDPrior studies have reported that imaging evaluation of osseous morphology in femoroacetabular impingement (FAI) is best performed with CT, which exposes patients to ionizing radiation. In recent years, a number of studies have evaluated whether various novel MRI protocols, which do not expose patients to ionizing radiation, can effectively assess osseous morphology in patients with FAI. Our institution incorporated in- and out-of-phase sequences into a routine MRI protocol to better assess acetabular version; however, it is unknown how in- and out-of-phase MRI compares with CT imaging in FAI evaluation.QUESTIONS/PURPOSES(1) How reliably do acetabular version measurements taken from in- and out-of-phase MRI agree with acetabular version measurements taken from CT imaging? (2) How similar are hip morphometric measurements taken from routine MRI sequences as compared with hip morphometric measurements taken from hip-specific CT?METHODSWe conducted a retrospective electronic medical record review of the patients of two attending sports medicine orthopaedic surgeons from May 2014 to May 2024 who were evaluated for symptomatic hips. It is the general practice of these surgeons to obtain both hip-specific CT scans and in- and out-of-phase MRI for patients with suspected FAI. Patients were included if they had a diagnosis of FAI, were older than 12 years of age, underwent hip-specific morphometric CT scanning and in- and out-of-phase MRI of the affected side, and had imaging interpretation performed by fellowship-trained musculoskeletal radiologists at our institution. Hip morphometric measurements were retrospectively recorded from prospectively interpreted radiology reports. Our initial chart review yielded 178 patients (188 hips) with a diagnosis of FAI who underwent both CT and MRI imaging. After the application of inclusion and exclusion criteria, 30 patients (33 hips) lacked an in- and out-of-phase MRI, 11 patients (11 hips) had the imaging performed on contralateral hips, and 42 patients (44 hips) lacked complete morphometric measurements, yielding 95 patients (100 hips) who were included in our study. Our study population comprised 72% (68 of 95) females with a mean ± SD age of 29 ± 9 years and BMI of 25.3 ± 4.7 kg/m2. Of those included, 56 patients had their measurements confirmed by our institution's fellowship-trained musculoskeletal radiologists to assess for intrarater and interrater reliability. The assessed morphometric measurements included: midcoronal angle, midsagittal angle, alpha angle, femoral neck angle, and femoral neck version at the 1, 2, and 3 o'clock positions. These measurements were statistically compared with intraclass correlation coefficients (ICCs) to assess intermodality measurement agreement and thus determine the reliability between in- and out-of-phase MRI and CT. Each morphometric measurement also underwent t-tests to determine the similarity in measurements between in- and out-of-phase MRI and hip-specific","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"77 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145089858","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":"Is Biportal Endoscopic Laminectomy Equivalent to Microscopic Laminectomy in Patients With Lumbar Spinal Stenosis? A Multicenter, Assessor-blind, Randomized Clinical Trial.","authors":"Hyun-Jin Park,Jin-Sung Kim,Sang-Min Park,Kwang-Sup Song,Dae-Woong Ham,Ho-Joong Kim,Min-Seok Kang,Ki-Han You,Seung-Yeon Jeong,Si-Young Park,Choon-Keun Park,Dong-Keun Lee,Hong-Jae Lee","doi":"10.1097/corr.0000000000003695","DOIUrl":"https://doi.org/10.1097/corr.0000000000003695","url":null,"abstract":"BACKGROUNDLumbar spinal stenosis (LSS) impairs quality of life and is commonly treated with microscopic laminectomy. Some have suggested that biportal endoscopic laminectomy may offer advantages through smaller incisions and reduced tissue trauma. However, it remains unclear whether these theoretical advantages translate into meaningful differences in patient-reported outcomes that patients would actually perceive.QUESTIONS/PURPOSESWe performed an RCT in which we asked: (1) Does biportal endoscopic laminectomy result in equivalent functional outcomes as measured by the Oswestry Disability Index (ODI) at 1 year compared with microscopic laminectomy? (2) Are pain relief, quality of life measures, and surgery-related outcomes similar between biportal endoscopic laminectomy and microscopic laminectomy? (3) Are adverse event rates comparable between the two surgical techniques?METHODSWe conducted an assessor-blind RCT at six centers in South Korea. Between July 19, 2021, and April 6, 2023, a total of 120 patients with LSS were randomized to undergo biportal endoscopic laminectomy (n = 60) or microscopic laminectomy (n = 60). At 1 year, 90% (54 of 60) of patients in the biportal endoscopic laminectomy group and 86.7% (52 of 60) of patients in the microscopic laminectomy group were accounted for and fully analyzed. No crossover occurred between treatment groups, and the primary analysis followed a modified intention-to-treat approach. The baseline characteristics were well balanced between the two groups. The primary outcome was the ODI score at 12 months postoperatively. Secondary outcomes included VAS pain scores, quality of life, perioperative parameters, and adverse events, assessed at baseline, 2 weeks, and at 3, 6, and 12 months. This was an equivalence trial using the ODI as the primary outcome for sample size calculation, with an equivalence margin of ± 12.8 points, which represents the minimum clinically important difference for the ODI.RESULTSIn the modified intention-to-treat analysis, we found no difference between the biportal endoscopic laminectomy and microscopic laminectomy groups in terms of ODI scores at 12 months (13 ± 12 versus 18 ± 18, mean difference -5 points [95% confidence interval -10 to 1]; p = 0.12), demonstrating equivalence between the techniques. Secondary outcomes including VAS pain scores, quality of life measures, functional recovery, satisfaction, surgical variables, and radiographic parameters were also similar between groups, with no clinically important differences observed. Adverse events were similar between biportal endoscopic laminectomy and microscopic laminectomy.CONCLUSIONThis study found biportal endoscopic laminectomy to be equivalent to microscopic laminectomy in functional outcomes at 12 months. However, the observed differences do not represent clinically meaningful benefits that patients would perceive. Until high-quality evidence demonstrates patient-important advantages, we recommend against the wide ","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"1 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140116","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®: Is Malignancy Associated With Arthroplasty? A Meta-analysis.","authors":"Joshua J Jacobs","doi":"10.1097/corr.0000000000003696","DOIUrl":"https://doi.org/10.1097/corr.0000000000003696","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"68 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140118","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®: Cemented Fixation in Arthroplasty for Hip Fractures Does Not Increase Cardiopulmonary Complications: A Secondary Analysis of the HIP ATTACK Trial.","authors":"Nicholas J Giori","doi":"10.1097/CORR.0000000000003694","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003694","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091228","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 Tendon Region, Donor, and the Presence of Disease Affect Protein Composition of the Achilles Tendon?","authors":"Filippo Spiezia, Francesco Oliva, Nicola Maffulli","doi":"10.1097/CORR.0000000000003686","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003686","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250056","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®: Fifth Metatarsal Stress Fractures Are Associated With Increased Bone Density and Altered Alignment on Weightbearing CT.","authors":"Kathleen A McHale","doi":"10.1097/corr.0000000000003690","DOIUrl":"https://doi.org/10.1097/corr.0000000000003690","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"16 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145089860","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":"Can Nutritional and Inflammatory Markers Be Combined to Develop an Accurate Survival Model for Surgical Decision-making in Patients With Lung Cancer Bone Metastases?","authors":"Yuan Yan,Wenjie Yang,Chongquan Huang,Yonghan Chen,Guoqing Zhong,Shi Cheng,Yu Zhang","doi":"10.1097/corr.0000000000003693","DOIUrl":"https://doi.org/10.1097/corr.0000000000003693","url":null,"abstract":"BACKGROUNDTargeted and immunotherapies have improved the survivorship of patients with lung cancer and bone metastases. However, most existing models were developed during the chemotherapy era and do not accurately reflect survival outcomes in the current therapeutic context, leading to limited clinical applicability. Additionally, a wide range of inflammatory and nutritional markers has been identified as useful for cancer survival assessment. The most effective selection or combination of these markers for evaluating survival in patients with lung cancer and bone metastases, especially within the framework of modern multimodal treatments, has not yet been systematically investigated.QUESTIONS/PURPOSES(1) What combination of inflammatory and nutritional markers can better evaluate survival in patients with lung cancer and bone metastases? (2) Can an accurate lung cancer-specific bone metastasis model be constructed by integrating the above marker combination with the latest advancements in targeted and immunotherapies to guide clinical decision-making?METHODSBetween January 1, 2019, and June 1, 2024, we treated 319 patients with bone metastases from lung cancer at Guangdong Provincial People's Hospital, a tertiary academic medical center in Guangzhou, PR China. We considered patients with severe pain, pathological fracture, skeletal instability, or spinal cord/nerve compression as potentially eligible. Of the potentially eligible patients, 7% (23 of 319) were excluded due to repeated admissions, 4% (14 of 319) declined surgical intervention, 0.6% (2 of 319) died within 1 week postoperatively, 0.6% (2 of 319) were lost before the minimum follow-up period, and 0.3% (1 of 319) had incomplete datasets, leaving 87% (277 of 319) of patients for analysis. Of those, 277 underwent surgical procedures, including open spinal decompression (44% [123 of 277]), tumor resection with replacement or internal fixation (25% [68 of 277]), and minimally invasive procedures (31% [86 of 277]). The mean age was 61 ± 11 years, and 63% (174 of 277) of patients were male. The most common histological subtype was adenocarcinoma (82% [228 of 277]), followed by squamous cell carcinoma (14% [38 of 277]). Bone metastases primarily involved the spine (65% [179 of 277]), limbs (22% [62 of 277]), and pelvis (10% [28 of 277]). Candidate variables were selected using stepwise regression based on the minimum Akaike information criterion, and their associations with survival were assessed using Cox regression and restricted cubic splines. A nomogram was developed and validated through calibration curves, a decision curve analysis, and internal validation via bootstrap resampling. Discrimination was assessed through time-dependent receiver operating characteristic (time-ROC) analysis to calculate the area under the curve (AUC).RESULTSThis study identified the systemic inflammation response index (systemic immune-inflammation index [SIRI], neutrophil count × monocyte count/lymphocyte c","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"4 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145089861","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}