Clinical Orthopaedics and Related Research®最新文献

{"title":"How Accurate Are Fulcrum Bending Radiographs in Estimating Postoperative Outcomes in Adolescent Idiopathic Scoliosis? A Systematic Review and Meta-analysis.","authors":"Victoria Yuk Ting Hui, Samuel Tin Yan Cheung, Jason Pui Yin Cheung, Prudence Wing Hang Cheung","doi":"10.1097/CORR.0000000000003468","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003468","url":null,"abstract":"<p><strong>Background: </strong>Fulcrum bending radiographs can be used to assess coronal flexibility in patients with adolescent idiopathic scoliosis (AIS) to estimate postoperative correction. To obtain fulcrum bending radiographs, patients are passively bent over a radiolucent fulcrum at the apex of the curve. Available studies have disagreed about the accuracy in estimating postoperative correction, although these studies differed in terms of patients' baseline characteristics as well as other methods. Moreover, factors associated with accuracy were never explored. By pooling (meta-analyzing) results from these studies, we hoped to address these gaps in knowledge.</p><p><strong>Questions/purposes: </strong>In a meta-analysis, we asked: (1) Can fulcrum bending radiographs accurately estimate postoperative curve correction in patients with AIS? (2) What factors are associated with the accuracy of fulcrum bending estimation on postoperative coronal correction? (3) Is fulcrum flexibility associated with other surgical outcomes such as shoulder and coronal balance?</p><p><strong>Methods: </strong>PubMed, Embase, Medline, Journals@Ovid, Web of Science, and Scopus were searched from their inception up to August 27, 2024. Studies that (1) included patients with AIS undergoing single-stage posterior spinal fusion surgery without anterior release, (2) used fulcrum bending radiographs, (3) assessed radiographic surgical outcomes, and (4) had a minimum follow-up of 2 years were included. Studies that did not evaluate the use of fulcrum bending radiographs, those that did not report a p value, and studies with poor methodological quality were excluded. Our initial search yielded 433 articles, of which 172 remained after duplicate articles were removed. A total of 161 articles were excluded as the studies included patients who did not have AIS (n = 14), did not undergo surgery (n = 14), or did not undergo posterior spinal fusion (n = 23) or the studies did not evaluate the use of fulcrum bending radiographs (n = 59); had an insufficient follow-up duration of < 2 years (n = 15); did not evaluate the relationship between fulcrum bending radiographs and postoperative outcomes (n = 1); were reviews, commentaries, articles, conference proceedings, or non-English studies (n = 33); were animal studies (n = 1); or had poor methodological quality (n = 1). This left 11 studies for analysis. The Newcastle-Ottawa Quality Assessment Scale was used to evaluate the quality of evidence in three domains, including participant selection, comparability, and outcome measurement. Eleven included studies were of good quality except one with poor-quality evidence that was subsequently excluded from analysis. A random-effects meta-analysis was used to pool the data because of substantial statistical heterogeneity (I2 > 50%) in the included studies. The estimation of absolute correction was pooled using standardized mean differences, referred to as the mean difference; a value > 0","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708918","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®: Bicruciate-stabilized TKA Does Not Result in Improved Patient-reported Outcomes Compared With Posterior-stabilized TKA: A Randomized Controlled Trial in Bilateral Simultaneous TKA.","authors":"Michael D Ries","doi":"10.1097/CORR.0000000000003480","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003480","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794737","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 Are the Medium-term Reciprocal Changes in Cervical Sagittal Alignment After Posterior Correction for Lenke 5C Adolescent Idiopathic Scoliosis?","authors":"Yiwei Zhao, You Du, Yang Yang, Haoran Zhang, Chenkai Li, Dihan Sun, Ziquan Li, Jianguo Zhang, Shengru Wang","doi":"10.1097/CORR.0000000000003448","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003448","url":null,"abstract":"<p><strong>Background: </strong>Abnormal cervical sagittal alignment (CSA), typically cervical kyphosis, is more common in patients with adolescent idiopathic scoliosis (AIS) than in teenagers without AIS. Changes in CSA after posterior spinal fusion for AIS have been observed and may be associated with patient-reported clinical outcomes and age-related cervical disc degeneration. Previous studies have shown inconsistent postoperative reciprocal changes in CSA in patients with single structural thoracolumbar/lumbar (TL/L) AIS (Lenke 5C classification). However, little is known about the medium-term reciprocal changes in CSA after selective posterior TL/L fusion surgery.</p><p><strong>Questions/purposes: </strong>We sought to determine the following: (1) What proportion of patients with Lenke 5C AIS have abnormal CSA before surgery? (2) What were the changes in CSA after selective posterior TL/L fusion surgery in the overall Lenke 5C AIS cohort and in subgroups classified by thoracic kyphosis? (3) What global sagittal parameters were associated with CSA preoperatively and at the latest follow-up? (4) What is the correlation between CSA and Scoliosis Research Society Outcomes Questionnaire (SRS-22) scores?</p><p><strong>Methods: </strong>We queried our institutional database and identified 186 patients diagnosed with Lenke 5C AIS who underwent selective posterior TL/L fusion surgery from April 2010 to February 2018. Of these, 13% (25) of patients were lost to follow-up before 5 years, and 8% (15) of patients were excluded based on exclusion criteria, leaving 79% (146) of patients for analysis in this retrospective study. During this period, we typically offered selective posterior TL/L fusion surgery to patients with Lenke 5C AIS when the main TL/L Cobb angle exceeded 35°. All patients who were offered surgery for this diagnosis opted to have the procedure. Briefly, the surgical procedure consisted of pedicle screw insertion, multiple-level Ponte osteotomy, and segmental direct vertebral body derotation to correct the deformity. Ninety percent (132 of 146) of the patients were female, with a mean ± SD age of 15 ± 2 years. The mean follow-up time was 7 ± 1 years. All patients had a single structural TL/L curve, with a mean preoperative main TL/L Cobb angle of 43° ± 9°. Radiologic measurements included coronal deformity parameters, cervical sagittal parameters, and global sagittal parameters. SRS-22 scores were used to evaluate clinical outcomes. The preoperative cervical sagittal parameters were analyzed to assess the abnormal CSA proportion. Cervical sagittal parameters were compared preoperatively, postoperatively, and at the latest final follow-up. Based on the degree of thoracic kyphosis, patients were classified into a hypokyphotic group (thoracic kyphosis < 20°) and a normokyphotic group (thoracic kyphosis ≥ 20°), with further comparison of CSA within subgroups. Multiple linear regression analysis was performed to assess the correlation betwee","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673315","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 Proximal Femur Reconstruction With a Vascularized Fibula and Allograft Successful at Reconstructing a Tumor Resection in Children 6 Years of Age or Younger?","authors":"Marc H Isler","doi":"10.1097/CORR.0000000000003467","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003467","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735718","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 Is the Clinical Efficacy of Combined Semitendinosus Autograft Reconstruction and Scar Tissue Repair for Chronic Irreparable Patellar Tendon Rupture?","authors":"Kunhao Chen, Min Zhu, Chenghao Zhang, Jiayao Zhang, Yuyan Zhang, Shuang Li, Jian Li, Tingwu Qin, Qi Li","doi":"10.1097/CORR.0000000000003471","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003471","url":null,"abstract":"<p><strong>Background: </strong>Chronic patellar tendon rupture is a rare but serious injury that can lead to significant functional impairment if not treated effectively. Traditional repair methods often result in rerupture because of tendon defects, adhesions, and poor tissue quality. Although tendon graft reconstruction is the first-line treatment, the role of combining the remaining scar tissue with tendon grafting in improving patient-reported outcomes has not been fully explored.</p><p><strong>Questions/purposes: </strong>(1) What improvements in patient-reported outcomes and radiographic results were observed after reconstruction of chronic patellar tendon ruptures with semitendinosus autograft combined with scar tissue repair? (2) What ROM was achieved after recovery, and were patients free from extensor lag? (3) What surgical complications were associated with this technique?</p><p><strong>Methods: </strong>This retrospective case-series study included 47 patients with chronic patellar tendon rupture treated from January 2010 to December 2023 diagnosed by clinical assessment, MR imaging, and surgical exploration during the procedure. Among the 47 patients, 23 patients met the following inclusion criteria: (1) radiographic patella alta (Caton-Deschamps Index [CDI] > 1.3 or modified Insall-Salvati Index [ISI] > 2) with MRI confirmation of patellar tendon rupture and (2) treatment with semitendinosus autografts reconstruction and scar tissue repair. Two patients were lost to follow-up before the minimum study follow-up time of 1 year, and for patients with bilateral rupture, we included the more affected side, leaving 21 of 47 patients with 21 knees ultimately included in the final analysis. For each included patient, we collected preoperative baseline and final follow-up data, which included patient-reported outcome measures (PROMs) such as International Knee Documentation Committee (IKDC) score and Lysholm score, knee ROM, extensor lag, patellar height assessed by CDI and ISI, and any surgical complications. All patients had at least 12 months of follow-up (median [range] 65 months [12 to 161]). Follow-up data were obtained from clinical visits, phone interviews, and medical records.</p><p><strong>Results: </strong>Patient-reported outcomes demonstrated improvements, with the IKDC score increasing from a mean ± SD 46 ± 6 preoperatively to 92 ± 5 postoperatively (mean difference -46 [95% confidence interval (CI) -49 to -43]; p < 0.01). Radiographic evaluation confirmed normal restoration of patellar height, with the CDI improving from a mean ± SD 1.9 ± 0.3 to 1.1 ± 0.1 and the modified ISI from 2.4 ± 0.3 to 1.5 ± 0.2. Postoperative knee ROM improved from 100° ± 31° to 140° ± 2° (mean difference -40° [95% CI -54° to -25°]; p < 0.01). Extensor lag resolved in 16 of 21 patients (21 of 21 preoperatively versus 5 of 21 postoperatively), with a mean deficit of 1° ± 2°, representing a mean improvement of 33° (95% CI 22° to 43°; p < 0.01). One of ","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735840","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®: Among People Presenting for Musculoskeletal Specialty Care, Is There an Association of Accommodation of Aging and Other Mindset Factors With Levels of Comfort and Capability?","authors":"Trevor A Lentz","doi":"10.1097/CORR.0000000000003466","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003466","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662970","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 Oritavancin Be Used for Treatment and/or Suppressive Antimicrobial Therapy of Bone and Joint Infections Caused by Vancomycin-resistant Enterococcus faecium?","authors":"Martin Krsak, Taylor Morrisette, Laura Damioli, Brandon Flues, Eugene W Liu, Anna Y Zhou, Abdulwhab Shremo Msdi, Caleb McLeod, Saagar Akundi, Mark Redell, Kyle C Molina","doi":"10.1097/CORR.0000000000003449","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003449","url":null,"abstract":"<p><strong>Background: </strong>Vancomycin-resistant enterococcus (VRE) infections pose substantial challenges for the treatment and suppression of bone and joint infections. Oritavancin, a long-acting lipoglycopeptide antibiotic, has shown promising in vitro activity against VRE. Limited data are available on using oritavancin for bone and joint infections caused by VRE, both for treatment (therapy to eliminate active infection) and suppressive antimicrobial therapy (long-term antibiotic administration to prevent infection recurrence in patients at high risk for that complication).</p><p><strong>Questions/purposes: </strong>(1) What proportion of patients in a small case series achieve freedom from infectious symptoms with use of oritavancin for treatment of VRE bone and joint infections? (2) What proportion of patients achieve freedom from infection recurrence with use of oritavancin when used for suppressive antimicrobial therapy of VRE bone and joint infections? (3) What proportion of patients develop adverse drug events associated with oritavancin use in VRE bone and joint infections?</p><p><strong>Methods: </strong>We describe a retrospective, multicenter, observational case series of patients who received oritavancin for treatment and/or suppressive antimicrobial therapy of VRE bone and joint infection, including osteomyelitis, native septic arthritis, myositis, and prosthetic joint infection, between December 2014 and April 2024. The minimum surveillance period was 1 year, unless infection recurrence or an adverse drug event was documented before 1 year. Patients were excluded if they had a life expectancy of less than 7 days, dual use of VRE antibiotics, or brain or spinal cord abscesses related to VRE, although no patients met these exclusion criteria in our study group. Clinical signs and symptoms of infection, corresponding microbiological cultures, and adverse drug events were assessed throughout follow-up. Eleven patients (6 treatment, 5 suppressive antimicrobial therapy) with VRE (all Enterococcus faecium) bone and joint infection in which at least one dose of oritavancin was used were included. No patients were excluded because of insufficient follow-up time. In the treatment group, the median (range) age was 60 years (48 to 66), 4 of 6 patients were male, and patients had received prior therapy for VRE with either linezolid or daptomycin. Infections were hardware-associated osteomyelitis in 2 of 6 patients, osteomyelitis in 3 of 6, and prosthetic joint infection in 1 of 6. In the suppressive antimicrobial therapy group, the median (range) age was 61 years (25 to 68), and 3 of 5 patients were female. Four of 5 patients had hardware-associated infections, including 3 of 5 with hardware-associated osteomyelitis and 1 of 5 with prosthetic joint infection of the hip.</p><p><strong>Results: </strong>In the treatment group, 2 of 6 patients remained symptom free at a minimum follow-up of 3 years (range 3.0 to 3.25), and 2 patients develo","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662968","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 Transhumeral Osseointegration After Amputation Improve Patient-reported Outcomes and Prosthesis Use?","authors":"Nathaniel Elliot Schaffer","doi":"10.1097/CORR.0000000000003450","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003450","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662973","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: Value-based Healthcare: The Impact of Consolidation in Healthcare on the Field of Orthopaedic Surgery.","authors":"Alison Klika, David J Jacofsky, Wael K Barsoum","doi":"10.1097/CORR.0000000000003460","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003460","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735862","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®: Can We Accurately Predict Adult Height in Pediatric Patients Who Undergo Treatment for Sarcoma?","authors":"Joel L Mayerson","doi":"10.1097/CORR.0000000000003462","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003462","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810474","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}