Clinical Orthopaedics and Related Research®最新文献

{"title":"What Is the Sequence of Mechanical and Structural Failure During Stretch Injury in the Rat Median Nerve? The Neuroclasis Classification.","authors":"Christoph A Schroen, Akiro H Duey, Philip Nasser, Damien Laudier, Paul J Cagle, Michael R Hausman","doi":"10.1097/CORR.0000000000003405","DOIUrl":"10.1097/CORR.0000000000003405","url":null,"abstract":"<p><strong>Background: </strong>Peripheral nerve injury commonly results in long-term disability and pain for patients. Recovery after nerve traction or crush injury is unpredictable and depends on the degree of injury. Our inability to accurately assess the severity or degree of injury hampers our ability to predict the chances for recovery or need for surgical intervention in the form of neurolysis, nerve repair, or nerve graft. An investigation into the histologic sequence and mechanics of nerve failure under tension may help in the process of accurately assessing the severity of the nerve injury, the prognosis for recovery, and the need for surgical treatment.</p><p><strong>Questions/purposes: </strong>Using an in vivo rat model, we asked: (1) What is the pattern of mechanical failure during nerve stretch? (2) Is there staggered disintegration of specific anatomic substructures when mechanical failure occurs?</p><p><strong>Methods: </strong>To answer our first research question about the pattern of mechanical failure during nerve stretch, four 12-month-old male Sprague-Dawley rats were enrolled in a load-to-failure experiment generating load-deformation curves of the rat median nerve. Under anesthesia, the median nerves of both forelimbs were surgically exposed and secured under two blunt metal pins 1 cm apart. A metal hook was attached to a load-cell and raised from beneath the nerve at a speed of 0.2 mm/second until complete rupture occurred. Applied forces were monitored in real time via a force-time curve. All experiments were filmed, and the rats were euthanized afterward. Based on load-to-failure experiments, we identified two distinct events of sudden force reduction during stretching in the load-deformation curve of the rat median nerve. We labeled the first of these two events as epineuroclasis and the second as endoneuroclasis. Neuroclasis derives from the Greek term \"neuron\" for nerve, and the suffix \"-clasis\" means breaking or fracture. An additional eight rats were used to investigate whether this staggered mechanical failure was caused by staggered disintegration of specific anatomical substructures. Under anesthesia, eight left median nerves were stretched to the epineuroclasis point and eight right nerves to the endoneuroclasis point. Induction of injury was confirmed by load-time curves, and nerves were held in place for 5 minutes before tension was released. Nerve function was assessed before and after injury using a handheld electrical nerve stimulator. The nerves were harvested for histology (to assess integrity of the epineurium, axons and intraneural vasculature, endoneurial collagen [dis-]organization, as well as molecular collagen damage), and the rats were euthanized immediately after. The uninjured median nerves of two additional rats were harvested for histology as control tissue. Mechanical, functional, and histologic findings were compared between both injury levels and with uninjured nerves.</p><p><strong>Results","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1142-1158"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794742","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":"CORR Insights®: What Is the Sequence of Mechanical and Structural Failure During Stretch Injury in the Rat Median Nerve? The Neuroclasis Classification.","authors":"Kevin J Little","doi":"10.1097/CORR.0000000000003500","DOIUrl":"10.1097/CORR.0000000000003500","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1159-1161"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062522","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":"Do Cumulative Revision Rate and First-time Re-revision Rate Vary Between Short and Standard Femoral Stem Lengths? A Multinational Registry Study.","authors":"Karin Rilby, Mirthe H W van Veghel, Maziar Mohaddes, Liza N van Steenbergen, Peter L Lewis, Johan Kärrholm, Berend W Schreurs, Gerjon Hannink","doi":"10.1097/CORR.0000000000003354","DOIUrl":"10.1097/CORR.0000000000003354","url":null,"abstract":"<p><strong>Background: </strong>Advocates of short-stem THA suggest that these devices preserve proximal femoral bone for future revisions. This contention is as yet unsupported by robust evidence, and ultimately, it will be irrelevant if short-stem THA increases the overall risk of premature revision. To our knowledge, large, registry-based efforts have yet to explore the types of stems used in first-time stem revision as well as the survivorship of short versus standard-length femoral stems in THA.</p><p><strong>Questions/purposes: </strong>(1) Which stems are used in the first stem revision of primary short-stem and standard-stem THAs? (2) What is the overall cumulative revision rate (CRR) of primary short-stem THAs compared with primary standard-stem THAs? (3) What is the overall cumulative re-revision rate of primary short-stem THAs compared with primary standard-stem THAs?</p><p><strong>Methods: </strong>Patients with short-stem THAs, defined as a short stem with mainly metaphyseal fixation, registered in the Australian Orthopaedic Association National Joint Replacement Register (AOANJRR), the Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Interventies [LROI]), or the Swedish Arthroplasty Register (SAR) between January 2007 and December 2022 were included (n = 15,771), as well as a propensity score-matched cohort (1:2) with standard-stem THAs, defined as a stem with a standard length (n = 31,542). Groups were matched on sex, age, year of procedure, diagnosis, bearing material, and surgical approach. After matching, the groups did not differ in terms of age (mean ± SD 63 ± 11 versus 64 ± 11 years), sex (48% [7546 of 15,771] male versus 48% [15,093 of 31,542] male), and diagnosis (93% [14,655 of 15,771] osteoarthritis [OA] versus 94% [29,585 of 31,542] OA). We used those three registries because all are high-quality national arthroplasty registries with high levels of completeness. Also, the AOANJRR is the only registry globally that reports on short-stem THA as its own entity. The type of stem used in revision surgery was classified as standard stem (< 160 mm) or long stem (≥ 160 mm). Overall CRR of primary THAs at 12 years of follow-up and overall CRR of all first-time revisions at 5 years were calculated using Kaplan-Meier survival analyses. Any type of revision was used as endpoint.</p><p><strong>Results: </strong>In first-time stem revisions of the short-stem THAs, a standard stem was used more often (58% [116 of 201]) than in the revision of standard-stem THAs (46% [149 of 322]; p = 0.01). The 12-year overall CRRs between primary short-stem and standard-stem THAs did not differ (4.7% [95% confidence interval (CI) 4.0% to 5.5%] versus 5.1% [95% CI 4.5% to 5.7%], respectively; p = 0.20). The overall CRR for a second revision at 5 years also did not differ when primary short-stem THAs were compared with standard-stem THAs (20.9% [95% CI 16.8% to 25.8%]) versus 20.4% [95% CI 17.3% to 23.9%]; p = 0.80).</p><p><strong>Concl","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1010-1019"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101400","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":"Equity360: Gender, Race, and Ethnicity: How to Have the Obesity Conversation With Patients.","authors":"Mary I O'Connor","doi":"10.1097/CORR.0000000000003507","DOIUrl":"10.1097/CORR.0000000000003507","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"483 6","pages":"998-1000"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215065","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":"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":"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}