International Orthopaedics最新文献

{"title":"Diagnostic value of postoperative magnetic resonance imaging in predicting clinical outcomes after meniscal repair: A retrospective cohort study.","authors":"Yunus Emre Bulum, Necati Çiçek, Muhammed Enes Karataş, Raşit Emin Dalaslan, Oğuz Şükrü Poyanlı","doi":"10.1007/s00264-026-06831-1","DOIUrl":"https://doi.org/10.1007/s00264-026-06831-1","url":null,"abstract":"<p><strong>Background: </strong>Magnetic resonance imaging (MRI) is widely used to evaluate meniscal healing after surgical repair; however, the extent to which postoperative MRI findings reflect clinically meaningful recovery remains uncertain. This study aimed to examine the relationship between MRI-based healing appearance and patient-reported functional outcomes after meniscal repair.</p><p><strong>Methods: </strong>This retrospective observational study included adult patients who underwent arthroscopic meniscal repair between January 2018 and December 2024 at a tertiary care centre. Patients with at least 12 months of follow-up, available postoperative MRI, and complete clinical outcome data were included. Postoperative MRI was obtained at a mean of 18.6 ± 7.4 months after surgery (range: 12-36 months). Meniscal healing on MRI was classified as complete healing, partial healing, or failed healing/retear. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC), Lysholm, and Tegner scores. Clinical success was defined as IKDC ≥ 80 and Lysholm ≥ 85. The association between MRI healing status and clinical outcomes was evaluated using group comparisons and correlation analyses.</p><p><strong>Results: </strong>A total of 240 patients (mean age 27.4 ± 6.8 years; 71.7% male) were analyzed. MRI demonstrated complete healing in 40.8% of patients, partial healing in 31.7%, and failed healing or retear in 27.5%. Mean IKDC, Lysholm, and Tegner scores differed significantly across MRI groups (all p ≤ 0.002), with lower scores observed in patients with MRI-defined failure. However, 63.6% of patients classified as having failed healing on MRI met the criteria for clinical success. MRI healing status showed moderate correlations with IKDC (r = 0.42), Lysholm (r = 0.39), and Tegner (r = 0.31) scores (all p < 0.001). The MRI-IKDC correlation was higher in patients who underwent concomitant anterior cruciate ligament reconstruction than in those who underwent isolated meniscal repair.</p><p><strong>Conclusions: </strong>Postoperative MRI appearance after meniscal repair is associated with patient-reported and functional outcomes, but the strength of this relationship is limited. MRI-defined structural abnormalities may persist despite satisfactory clinical recovery, indicating that MRI has restricted specificity for identifying clinically meaningful failure. These findings suggest that MRI should be interpreted in conjunction with clinical assessment rather than used as a standalone indicator of postoperative success.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior tibial plateau fractures: distinguishing valgus and varus patterns to guide surgical management.","authors":"Akito Hiraoka, Nick Assink, Nicolas De Ridder, Frank F A Ijpma, Harm Hoekstra","doi":"10.1007/s00264-026-06827-x","DOIUrl":"https://doi.org/10.1007/s00264-026-06827-x","url":null,"abstract":"<p><strong>Background: </strong>Tibial plateau fractures (TPFs) remain challenging injuries due to their complex three-dimensional morphology, frequent posterior column involvement, and high incidence of associated soft-tissue lesions.</p><p><strong>Purpose: </strong>Flexion-type fractures represent a distinct and often under recognized entity that is inadequately addressed using traditional classification systems. Flexion-valgus and flexion-varus mechanisms generate fundamentally different fracture configurations and soft-tissue injury profiles, with important implications for surgical management and prognosis. This narrative review provides a practical, literature- and experience-based overview of the distinguishing features of flexion-valgus and flexion-varus tibial plateau fractures, focusing on fracture morphology, associated ligamentous and meniscal injuries, and key treatment principles.</p><p><strong>Results: </strong> Flexion-valgus injuries predominantly involve the posterolateral tibial plateau, commonly presenting as split-depression or rim impaction fractures, and are frequently associated with anterior cruciate ligament (ACL) and lateral meniscal pathology. In contrast, flexion-varus injuries typically result in posteromedial shear fractures with metaphyseal comminution, often extending into the posterolateral central segment, demonstrating significantly higher rates of concomitant ligamentous and meniscal injuries, poorer functional outcomes, and increased risk of conversion to total knee arthroplasty (TKA).</p><p><strong>Conclusion: </strong>Accurate recognition of the underlying injury mechanism and fracture morphology, distinguishing flexion-valgus from flexion-varus injuries, is essential to guide preoperative planning, surgical exposure, fixation strategy, and soft-tissue management, with the goal of optimising clinical outcomes.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconstruction strategy and outcomes for anterior impaction pilon fractures.","authors":"Go Nishizawa, Kentaro Futamura, Yuta Izawa, Masahiro Nishida, Naoya Inagaki, Mitsuru Saito","doi":"10.1007/s00264-026-06828-w","DOIUrl":"https://doi.org/10.1007/s00264-026-06828-w","url":null,"abstract":"<p><strong>Background: </strong>Anterior impaction pilon fractures (AIPs) are a distinct subtype of tibial pilon fractures caused by axial loading of the ankle in dorsiflexion and are associated with severe anterior plafond comminution, anterior talar subluxation, and a high risk of post-traumatic osteoarthritis (PTOA). Optimal surgical strategies for AIP remain unclear.</p><p><strong>Methods: </strong>This retrospective case series included 23 consecutive patients with AIP treated surgically between 2013 and 2023 with a minimum follow-up of one year. The treatment strategy consisted of anatomical reduction of the impacted anterior tibial plafond and rafting fixation using an anterolateral distal tibial plate, with supplementary fixation and bone grafting as required. Anterior talar subluxation was assessed using the lateral talar station (LTS) as the difference between injured and contralateral ankles immediately postoperatively (ΔLTS-1) and at one year (ΔLTS-2). Clinical outcomes included bone union, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score, ankle range of motion, PTOA graded by the modified Kellgren-Lawrence scale, and complications.</p><p><strong>Results: </strong>Mean ΔLTS-1 and ΔLTS-2 were 0.77 ± 1.8 mm and 0.5 ± 2.3 mm, respectively, with no significant difference (p = 0.33). Bone union was achieved in all cases. PTOA developed in 9 patients, with a mean modified Kellgren-Lawrence grade of 0.8 ± 1.2. The mean AOFAS score was 91.6 ± 9.6. Deep infection occurred in three patients, and five required soft-tissue reconstruction.</p><p><strong>Conclusion: </strong>Anatomical reduction of the anterior plafond combined with stable anterolateral rafting fixation maintained talar alignment and produced favourable short-term clinical outcomes in patients with AIP.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"In-house three dimensional-printed cutting guides improve surgical accuracy in children who underwent resection of malignant bone tumours of lower limb and reconstruction with allograft\".","authors":"Sang-Soo Lee, Velkuru Sai Karthik, Nalluri Akhil","doi":"10.1007/s00264-026-06811-5","DOIUrl":"https://doi.org/10.1007/s00264-026-06811-5","url":null,"abstract":"","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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 concerning the article: \"The diabetic shoulder: association between diabetes mellitus and adhesive capsulitis: a systematic review and meta-analysis\".","authors":"YiBo Dong, LongYun Yi, HongBo To","doi":"10.1007/s00264-026-06832-0","DOIUrl":"https://doi.org/10.1007/s00264-026-06832-0","url":null,"abstract":"","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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 concerning the article: \"Risk of ossification of the posterior longitudinal ligament (OPLL) following gout diagnosis: a nationwide cohort study\".","authors":"YiBo Dong, LongYun Yi, HongBo Tu","doi":"10.1007/s00264-026-06833-z","DOIUrl":"https://doi.org/10.1007/s00264-026-06833-z","url":null,"abstract":"","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bunionette or artistic convention? Reconsidering fifth toe varus in the Renaissance sculpture Adam by Tullio Lombardo.","authors":"Michele Augusto Riva, Bianca Ganazzoli, Marco Crippa, Giovanni Zatti, Marco Turati","doi":"10.1007/s00264-026-06825-z","DOIUrl":"https://doi.org/10.1007/s00264-026-06825-z","url":null,"abstract":"<p><strong>Purpose: </strong>The representation of anatomical variations in Renaissance art offers a unique opportunity to explore the historical perception of normality and deformity. This study aims to analyse a previously undescribed anatomical feature in the marble statue of Adam (c. 1490-1495) by Tullio Lombardo.</p><p><strong>Methods: </strong>A detailed visual and morphological analysis of the statue was performed, focusing on the lateral aspect of the forefoot. The observed features were compared with current clinical descriptions of bunionette deformity and interpreted within the broader context of Renaissance anatomical representation.</p><p><strong>Results: </strong>The statue shows a prominence of the fifth metatarsal head associated with a varus deviation of the fifth toe, consistent with a bunionette (tailor's bunion). The anatomical precision of Lombardo's work suggests that this feature is unlikely to be accidental or due to technical limitations, but rather represents a deliberate inclusion within an otherwise idealized figure. Comparable variations in foot anatomy have been reported in other Renaissance artworks.</p><p><strong>Conclusion: </strong>Although bunionette deformity is currently associated with mechanical stress and external factors, its presence in an idealized nude figure suggests that such variations may not have been perceived as pathological in their original context. This case highlights the limitations of applying modern diagnostic categories to historical representations and supports the view that minor anatomical variations could be incorporated into Renaissance depictions of the human body without implying disease.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiofrequency neurolysis versus surgical neurectomy for Morton's Neuroma.","authors":"Javier Adán-Laguna, Laura Villarroya Martínez, Germán Puyuelo Martínez, Juan Segura-Nuez, Carlos Pindado García, Carlos Martín-Hernández, Laura Ezquerra Herrando","doi":"10.1007/s00264-026-06824-0","DOIUrl":"https://doi.org/10.1007/s00264-026-06824-0","url":null,"abstract":"<p><p>Morton's neuroma is one of the most common forefoot pathologies. In recent years, radiofrequency ablation has emerged as a minimally invasive alternative to surgical excision, aiming to relieve symptoms while reducing morbidity.</p><p><strong>Purpose: </strong>To compare the efficacy and safety of radiofrequency neurolysis and surgical excision for the treatment of Morton's neuroma at our institution.</p><p><strong>Methods: </strong>A single-center, observational, retrospective, and longitudinal study was conducted including patients treated between 2012 and 2022. Clinical data from patients who underwent either surgical excision or radiofrequency ablation were analyzed. Demographic characteristics, pain intensity assessed using the Visual Analog Scale (VAS), complication rates, and reintervention rates were recorded, with a minimum follow-up of two years. Statistical analysis was performed using SPSS version 25.</p><p><strong>Results: </strong>A total of 192 procedures were identified (110 surgical excisions and 82 radiofrequency ablations). For analyses focused on demographic and baseline characteristics, repeated procedures performed in the same patient were grouped, resulting in 144 unique cases (92 excisions and 52 radiofrequency ablations). Both techniques resulted in significant pain reduction. Surgical excision achieved greater VAS improvement (- 5.57) compared with radiofrequency ablation (- 4.3). Complications were more frequent after surgical excision (13%) than after radiofrequency ablation (3.7%). In the radiofrequency group, 26% of patients required subsequent surgical excision and 33% underwent repeat ablation. The use of radiofrequency increased from 20% during 2012-2017 to 57% during 2018-2022.</p><p><strong>Conclusions: </strong>Radiofrequency ablation is a safe and effective treatment for Morton's neuroma, although its analgesic effect appears less durable than surgical excision. Its low complication rate and outpatient applicability make it a valuable alternative, particularly in selected patients.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Systemic Inflammatory Response Index (SIRI) as a predictor of early surgical site infection following instrumented lumbar spine surgery.","authors":"Juan Diego Montenegro, Victoria San Gil, Mercè Folguera, Cesar Fierro, Berta Escudero-Cisneros, Jorge H Nuñez","doi":"10.1007/s00264-026-06820-4","DOIUrl":"https://doi.org/10.1007/s00264-026-06820-4","url":null,"abstract":"<p><strong>Background: </strong>Evaluate the association between preoperative SIRI and early postoperative SSI and to assess its diagnostic performance.</p><p><strong>Methods: </strong>Retrospective cohort study was conducted including 500 consecutive adult patients who underwent posterior fusion lumbar spine surgery for degenerative pathology. Preoperative neutrophil, lymphocyte, and monocyte counts were used to calculate SIRI. The primary outcome was early acute deep postoperative SSI. Associations were analyzed using univariate and penalized multivariate logistic regression. Discriminatory performance was assessed using receiver operating characteristic curve analysis.</p><p><strong>Results: </strong>Early postoperative SSI occurred in 27 patients (5.4%). Patients who developed infection had significantly higher preoperative SIRI values than those without infection (median 1.78 [IQR, 1.02-3.41] vs. 1.12 [IQR, 0.62-2.04]; p = 0.031). In the multivariate logistic regression model, log-transformed SIRI remained independently associated with infection (adjusted OR 1.93; 95% CI 1.02-3.67; p = 0.044). Preoperative SIRI demonstrated moderate discriminatory ability for early SSI, with an AUC of 0.66 (95% CI, 0.54-0.77; p = 0.03). The optimal cutoff value of 1.29 yielded a sensitivity of 63.0% and a specificity of 68.3%.</p><p><strong>Conclusions: </strong>Preoperative SIRI is independently associated with early postoperative SSI following instrumented lumbar spine surgery for degenerative pathology. Although its discriminatory performance is moderate, SIRI represents a simple, inexpensive, and readily available adjunctive marker for preoperative risk stratification, particularly useful for identifying patients at low risk of postoperative infection.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology, clinical correlates, and management of focal periphyseal oedema (FOPE) in adolescent knees: retrospective analysis of one thousand, two hundred and one knees.","authors":"Benjamin Petry, Ismail Khosravi, Jürgen Wansch, Michael Ban, Balazs Sztankay-Böck, Isabella Dornauer, Rainer Biedermann, Daniel Junker","doi":"10.1007/s00264-026-06818-y","DOIUrl":"https://doi.org/10.1007/s00264-026-06818-y","url":null,"abstract":"<p><strong>Background: </strong>Focal periphyseal edema (FOPE) is a characteristic magnetic resonance imaging (MRI) finding in adolescent knee joints with open physes. Although described as a benign and likely self-limiting condition, large population-based studies are scarce. The aim of this study was to retrospectively analyse the incidence and the epidemiological background of this MRI finding, and to correlate FOPE lesions with clinical symptoms and treatment.</p><p><strong>Methods: </strong>This retrospective case-control study included a total of 1201 knee MRI scans from 897 patients, performed between 2007-2016 at our institution in patients aged ten to 16 years. MRIs were screened for the presence of FOPE and other pathologies. FOPE severity was categorised as mild, moderate and severe, based on lesion size and MRI appearance. Patients' medical records were screened for symptoms, trauma history and treatment.</p><p><strong>Results: </strong>Out of the 1201 MRI scans, 97 FOPE lesions (10.8%) in 93 patients (10.4%) were identified. FOPE was significantly more frequent in girls than in boys (p = 0.007). FOPE was the main MRI finding in 53.6% of patients. Mild FOPE was most common (53.6%). Severe FOPE occurred only when FOPE was the main pathology (p = 0.005). Most FOPE patients (74.2%) were treated conservatively.</p><p><strong>Conclusion: </strong>FOPE lesions are a common MRI finding in adolescents presenting with knee pain. They tend to be more severe when occurring as the sole finding and have a significantly higher incidence in females. In this large clinical cohort, FOPE was mainly managed conservatively, supporting its interpretation as a benign, self-limiting differential diagnosis of adolescent knee pain.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}