Journal of Bone and Joint Surgery, American Volume最新文献

{"title":"Glutamine Promotes Rotator Cuff Healing by Ameliorating Age-Related Osteoporosis.","authors":"Haoyuan Wang, Zhuochang Cai, Mengjie Ying, Wei Song, Xudong Liu, Haifeng Wei, Chongyang Wang","doi":"10.2106/JBJS.24.00779","DOIUrl":"https://doi.org/10.2106/JBJS.24.00779","url":null,"abstract":"<p><strong>Background: </strong>Age-related osteoporosis complicates rotator cuff tear (RCT) treatment, undermining the integrity of surgical anchor fixation during rotator cuff repair (RCR). This study aimed to investigate whether supplementation with glutamine, an intrinsic amino acid crucial in cell metabolism, can enhance rotator cuff healing by ameliorating age-associated osteoporosis.</p><p><strong>Methods: </strong>Forty-eight female Sprague-Dawley rats were divided into 4 groups: (1) young control (sham surgery), (2) aged control (sham surgery), (3) aged-RCT (RCR with fibrin), and (4) aged-RCT-Gln (RCR with glutamine-enriched fibrin). RCR was performed bilaterally on rats in the RCT groups, with subsequent application of the respective fibrin gel at the tendon-bone interface. Evaluations included micro-computed tomography (CT) for bone quality, histology and immunohistochemistry for tissue integrity, and biomechanical testing for tendon-bone complex strength.</p><p><strong>Results: </strong>Micro-CT revealed worse bone quality at the proximal humerus in the aged rats compared with the young rats, confirming spontaneous osteoporosis occurring with age. Glutamine supplementation improved bone quality in the aged-RCT-Gln group compared with the aged-RCT group, with significantly higher mean bone volume/total volume fraction (BV/TV) (28.69% ± 3.1% compared with 21.13% ± 3.9%), trabecular number (Tb.N) (1.88 ± 0.18 compared with 1.55 ± 0.21 mm-1), and trabecular thickness (Tb.th) (0.15 ± 0.03 compared with 0.12 ± 0.02 mm) and lower trabecular separation (Tb.sp) (0.19 ± 0.03 compared with 0.22 ± 0.03 mm). Histological and immunohistological analysis demonstrated enhanced bone regeneration and a more organized tendon-cartilage-bone interface in the aged-RCT-Gln group. Biomechanical analysis also revealed a more resilient tendon-bone complex after glutamine supplementation.</p><p><strong>Conclusions: </strong>Osteoporosis occurred spontaneously at the proximal humerus with age. Glutamine supplementation effectively mitigated age-related osteoporosis and enhanced RCR in elderly rats. These findings support the potential of glutamine, the most abundant amino acid in the body, as a valuable therapeutic intervention for improving RCT outcomes in the aging population, warranting further investigation in clinical settings.</p><p><strong>Clinical relevance: </strong>Glutamine supplementation may be a novel therapeutic strategy to enhance RCR in elderly patients with osteoporosis.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monitoring Sleep-Breathing Disorders in Patients with Idiopathic Scoliosis.","authors":"Erwei Feng, Junduo Zhao, Wenhao Cao, Yang Jiao, Haoyu Cai, Zhen Wang, Xu'an Huang, Yi Xiao, Jianxiong Shen","doi":"10.2106/JBJS.24.00867","DOIUrl":"https://doi.org/10.2106/JBJS.24.00867","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic scoliosis (IS) is the most common spinal deformity and is often accompanied by abnormal respiratory function.</p><p><strong>Methods: </strong>This study investigated the correlations among radiographic parameters, pulmonary function tests, and sleep-breathing monitoring in patients with IS. The clinical data of patients with IS admitted to our hospital for scoliosis surgery between January 2020 and March 2022 were retrospectively collected. Radiographic measurements, including scoliosis and thoracic malformation parameters, were performed. Pulmonary function measurements and sleep-breathing monitoring results were collected for correlation analysis.</p><p><strong>Results: </strong>Overall, 19.8% of the 81 participants were diagnosed with obstructive sleep apnea. The sleep-breathing monitoring results showed a significant correlation between the main thoracic curvature and the lowest oxygen saturation (SpO2) (r = -0.233; p = 0.036). The degree of thoracic kyphosis significantly correlated with FEV1/FVC (forced expiratory volume in 1 second/forced vital capacity) and FEV1. FEV1 was significantly correlated with the oxygen desaturation index (ODI) (r = -0.242; p = 0.03), as was FVC.</p><p><strong>Conclusions: </strong>In this study, 19.8% of the patients with thoracic IS had obstructive sleep apnea. In patients with IS, the severity of pulmonary function decline and SpO2 during sleep-breathing correlated with the severity of thoracic scoliosis, whereas the decline in pulmonary function correlated with the ODI during sleep-breathing.</p><p><strong>Level of evidence: </strong>Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refractures in Children.","authors":"Oskari Pakarinen, Matti Ahonen, Petra Grahn, Ilkka Helenius, Topi Laaksonen","doi":"10.2106/JBJS.24.01014","DOIUrl":"https://doi.org/10.2106/JBJS.24.01014","url":null,"abstract":"<p><strong>Background: </strong>Fractures are common in children, but knowledge about refractures has been limited. This study aimed to determine the rate of radiographically confirmed refractures within 2 years of the primary fracture in children and to analyze the association between fracture stability and refracture risk.</p><p><strong>Methods: </strong>All patients who were <16 years of age and had at least 2 fractures in the same bone between 2014 and 2023 were reviewed from the Helsinki University Hospitals' electronic pediatric treatment register, KIDS Fracture Tool. Patients' radiographs and records were evaluated. Patients with subsequent fractures in different parts of the bone than the primary fracture, patients with pathological fractures, and patients with a systemic condition predisposing to fractures were excluded.</p><p><strong>Results: </strong>Of 20,749 fractures, 163 consecutive fractures in the same bone within 2 years were identified. After exclusions, 100 cases (0.48% of all fractures) remained, with 83 occurring within 1 year and 17 occurring in the second year after the primary fracture. Refracture rates were highest in diaphyseal both-bone forearm fractures (3.76% [43 of 1,144]), diaphyseal tibial fractures (1.01% [7 of 693]), distal forearm fractures (0.55% [27 of 4,949]), and distal humeral fractures (0.49% [11 of 2,227]). The median time to refracture was 73 days (interquartile range [IQR], 56 to 131 days) for the distal forearm, 109 days (IQR, 79 to 169 days) for the diaphyseal tibia, 124 days (IQR, 80 to 178 days) for the diaphyseal forearm, and 426 days (IQR, 243 to 660 days) for the distal humerus. Displaced fractures requiring closed reduction had a significantly higher refracture risk compared with other fractures: relative risk (RR), 8.0 (95% confidence interval [CI], 4.5 to 14) compared with stable fractures; RR, 5.0 (95% CI, 2.9 to 8.7) compared with fractures that had acceptable position but might be unstable and required follow-up; and RR, 3.2 (95% CI, 1.8 to 5.7) compared with fractures requiring fixation and follow-up.</p><p><strong>Conclusions: </strong>The overall refracture rate in children was approximately 0.5%, with the highest rates in both-bone diaphyseal forearm fractures. The median time to refracture varied significantly by anatomic location, and displaced fractures treated with closed reduction were associated with a higher refracture risk.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access to Orthopaedic Devices in Low and Middle-Income Countries: Challenges and Opportunities.","authors":"Myles Dworkin, Pierre Marie Woolley, Faseeh Shahab, McKenna C Noe, Rachid Barry, Dorcas Chomba, Emmanuel Makasa, Nabees Man Singh Pradhan, Jean Claude Byiringiro, Kiran J Agarwal-Harding","doi":"10.2106/JBJS.24.00997","DOIUrl":"https://doi.org/10.2106/JBJS.24.00997","url":null,"abstract":"<p><p>➢ Musculoskeletal injuries constitute a substantial proportion of worldwide disease, with access limited to many due to the availability and cost of devices. A multifaceted approach is needed to improve system-level access to care.➢ Although a number of procurement policies are utilized, providers in low and middle-income countries often struggle with inconsistent supply chains, leading to delays in care or less desirable management strategies.➢ Partnerships between governments, academic institutions, and nongovernmental agencies are needed to improve access to devices by providing funds for patients and creating regulatory bodies to ensure product quality and availability.➢ There should be a focus on local and regional manufacturing as well as job creation within low and middle-income countries to achieve sustainable access to orthopaedic devices.➢ High-quality research initiatives are needed to provide evidence-based solutions. This includes a focus on outcomes-based studies to determine best management practices within the low and middle-income countries' context and operations research to optimize systems for device procurement.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors That Influence Returning to Driving Following Primary Total Knee Arthroplasty: A Prospective Investigation.","authors":"Devon R Pekas, Miguel Perez, Andrea A Yu-Shan, Cody Bailey, Nicholas Peterman, Mehmet E Kilinc, W Garret Burks, Joseph T Moskal, Benjamin R Coobs, Peter J Apel","doi":"10.2106/JBJS.24.01177","DOIUrl":"https://doi.org/10.2106/JBJS.24.01177","url":null,"abstract":"<p><strong>Background: </strong>It is unclear when a patient can return to driving after total knee arthroplasty (TKA). Currently, most surgeons simply restrict all patients from driving for 4 to 6 weeks after TKA despite variability in patient age, general health, and physical capabilities. The primary objective of this study was to create novel clinical prediction calculators to estimate the return-to-driving time following primary TKA.</p><p><strong>Methods: </strong>In this study, 167 patients who were undergoing a primary TKA were prospectively enrolled. Subjects received text message surveys every third day postoperatively to determine when they returned to driving. Subjects completed 8 physical performance maneuvers at their 2, 6, and 12-week postoperative clinical appointments. Additionally, subjects completed return-to-driving surveys and a structured interview. Data on demographic characteristics, operative factors, patient-reported outcomes, and patient factors were collected. Cox proportional hazard and parametric survival models were utilized to create 2 novel calculators for predicting return-to-driving time.</p><p><strong>Results: </strong>There were 156 patients (mean age, 67.7 years [range, 39 to 83 years]) who completed the study. The median return-to-driving time was 18 days (interquartile range [IQR], 12 to 27 days). Univariate analysis demonstrated that male patients returned to driving sooner (18 days) than female patients (25.3 days) (p < 0.001) and that patients who underwent left-sided surgery returned to driving sooner (20.1 days) than patients who underwent right-sided surgery (24.4 days) (p = 0.021). For preoperative factors, age, sex, laterality, and preoperative Knee injury and Osteoarthritis Outcome Score (KOOS) had an effect on return-to-driving time and therefore were included in the novel preoperative clinical prediction calculator. For postoperative factors, age, sex, laterality, preoperative KOOS, and 6 metrics from the physical performance maneuvers had an effect on return-to-driving time and therefore were included in the novel postoperative physical performance-based instrument.</p><p><strong>Conclusions: </strong>Overall, patients undergoing primary TKA returned to driving considerably earlier than previously reported. Patient-related factors and postoperative physical performance significantly affect return-to-driving time. Using the novel preoperative clinical prediction tool, individual patients can be advised when to expect to return to driving. After surgery, the novel postoperative physical performance-based instrument can inform patients when they may be ready to return to driving.</p><p><strong>Level of evidence: </strong>Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preservation Versus Release of Normal Long Head of Biceps Tendon in Repair of Isolated Stage-1 Supraspinatus Tears: Preservation Leads to Slightly Lower Constant-Murley Scores and More Reoperations.","authors":"Julien Berhouet, Adrien Jacquot, François Gadéa, Jacques Guery, Thierry Joudet, Nicolas Bonnevialle, Xavier Ohl, Lionel Neyton, Nicolas Gasse, Johannes Barth, Maxime Antoni, Franck Dordain, David Gallinet, Christophe Charousset","doi":"10.2106/JBJS.24.00423","DOIUrl":"https://doi.org/10.2106/JBJS.24.00423","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to determine whether preserving a normal-appearing long head of the biceps (LHB) tendon leads to better Constant-Murley scores (CMS) than releasing it in patients undergoing arthroscopic repair of an isolated stage-1 supraspinatus tendon tear.</p><p><strong>Methods: </strong>Patients (40 to 70 years old) who were undergoing arthroscopic repair of a minor supraspinatus tendon tear and who had a macroscopically normal LHB were randomized to LHB preservation or LHB release during a prospective clinical trial. The surgeon was free to choose whether to perform tenodesis in patients undergoing LHB release. The primary outcome was the involved shoulder's function based on the absolute CMS score at 6 and 24 months. Secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) shoulder score and Subjective Shoulder Value (SSV). A post-hoc analysis of prospectively collected data was done using 1:1 propensity score matching without replacement. This resulted in 2 age- and sex-matched groups of 95 patients each. Race and ethnicity data were not collected.</p><p><strong>Results: </strong>At 24 months, the mean CMS was significantly better in the LHB release group (mean and standard deviation, 86.8 ± 8.3) than in the LHB preservation group (82.9 ± 10.0) (p = 0.003), 97% of the patients in the LHB release group and 88% in the LHB preservation group had more than the minimal clinically important difference (MCID) for the CMS in rotator cuff repair (p = 0.048), 15% in the LHB preservation group and 3% in the LHB release group (p = 0.01) had an absolute CMS below 70, and the ASES was significantly higher in the LHB release group (91.4 ± 19.2) than in the LHB preservation group (83.6 ± 25.0) (p = 0.02). There were 4 reoperations in the LHB preservation group and no reoperations in the LHB release group.</p><p><strong>Conclusions: </strong>Based on our findings, a macroscopically normal-appearing biceps tendon should be released when treating stage-1 supraspinatus tendon tears.</p><p><strong>Level of evidence: </strong>Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What's Important (Arts & Humanities): Lessons Learned in Medicine and Life.","authors":"Robert C Schenck","doi":"10.2106/JBJS.24.01334","DOIUrl":"https://doi.org/10.2106/JBJS.24.01334","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stacked Cone Constructs for the Treatment of Extensive Tibial Bone Loss in Revision Total Knee Arthroplasty: A Series of 22 Patients.","authors":"Nathanael D Heckmann, Kevin C Liu, Brandon S Gettleman, Annabel Kim, Donald B Longjohn, Daniel A Oakes","doi":"10.2106/JBJS.24.00299","DOIUrl":"https://doi.org/10.2106/JBJS.24.00299","url":null,"abstract":"<p><strong>Background: </strong>Highly porous metaphyseal cones have emerged as a promising fixation strategy to address extensive proximal tibial bone loss in the multiply revised knee. Despite a paucity of literature regarding stacked cone constructs, they have gained popularity. This study reports on the early outcomes of stacked tibial cone constructs that are used during revision total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>A single-institution retrospective observational study was performed to identify patients who had been treated with a stacked cone construct during revision TKA between January 2010 and December 2022. Demographic, operative, clinical, and radiographic data were collected and assessed. Kaplan-Meier estimates were used to assess survival with all-cause reoperation, tibial-sided revision, and radiographic loosening as end points. In total, 22 stacked cone constructs were identified: 15 (68.2%) of the patients were men; the demographics included a mean age of 64.1 years (range, 42.8 to 87.8 years), a body mass index of 34.2 kg/m2 (range, 20.4 to 51.9 kg/m2), a median of 4 prior surgeries (range, 1 to 12 prior surgeries), and a mean follow-up of 22.6 months (range, 6.8 to 79.1 months).</p><p><strong>Results: </strong>Twenty patients received 2-cone constructs, and 2 patients received 3-cone constructs. Patients received the stacked cone constructs during revision TKA for the following indications: periprosthetic joint infection (n = 11), aseptic loosening (n = 9), tibial stem pain (n = 1), and periprosthetic fracture (n = 1). At a median time of 2.9 months (range, 0.4 to 37.3 months), 5 patients underwent reoperation for the following indications: extensor mechanism failure (n = 2), femoral component loosening (n = 1), superficial wound dehiscence (n = 1), and postoperative hematoma (n = 1). At the 3-year follow-up, no patients had undergone revision for tibial component loosening (1 patient had radiographic evidence of loosening at the 15-month follow-up but did not undergo revision).</p><p><strong>Conclusions: </strong>Stacked cone constructs are a viable option during revision TKA when extensive metaphyseal bone loss is encountered.</p><p><strong>Level of evidence: </strong>Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"4-Aminopyridine Promotes BMP2 Expression and Accelerates Tibial Fracture Healing in Mice.","authors":"Govindaraj Ellur, Prem Kumar Govindappa, Sandeep Subrahmanian, Gerardo Figueroa Romero, David A Gonzales, David S Margolis, John C Elfar","doi":"10.2106/JBJS.24.00311","DOIUrl":"https://doi.org/10.2106/JBJS.24.00311","url":null,"abstract":"<p><strong>Background: </strong>Delayed bone healing is common in orthopaedic clinical care. Agents that alter cell function to enhance healing would change treatment paradigms. 4-aminopyridine (4-AP) is a U.S. Food and Drug Administration (FDA)-approved drug shown to improve walking in patients with chronic neurological disorders. We recently showed 4-AP's positive effects in the setting of nerve, wound, and even combined multi-tissue limb injury. Here, we directly investigated the effects of 4-AP on bone fracture healing, where differentiation of mesenchymal stem cells into osteoblasts is crucial.</p><p><strong>Methods: </strong>All animal experiments conformed to the protocols approved by the Institutional Animal Care and Use Committee at the University of Arizona and Pennsylvania State University. Ten-week-old C57BL/6J male mice (22 to 28 g), following midshaft tibial fracture, were assigned to 4-AP (1.6 mg/kg/day, intraperitoneal [IP]) and saline solution (0.1 mL/mouse/day, IP) treatment groups. Tibiae were harvested on day 21 for micro-computed tomography (CT), 3-point bending tests, and histomorphological analyses. 4-AP's effect on human bone marrow mesenchymal stem cell (hBMSC) and human osteoblast (hOB) cell viability, migration, and proliferation; collagen deposition; matrix mineralization; and bone-forming gene/protein expression analyses was assessed.</p><p><strong>Results: </strong>4-AP significantly upregulated BMP2 gene and protein expression and gene expression of RUNX2, OSX, BSP, OCN, and OPN in hBMSCs and hOBs. 4-AP significantly enhanced osteoblast migration and proliferation, collagen deposition, and matrix mineralization. Radiographic and micro-CT imaging confirmed 4-AP's benefit versus saline solution treatment in mouse tibial fracture healing (bone mineral density, 687.12 versus 488.29 mg hydroxyapatite/cm3 [p ≤ 0.0021]; bone volume/tissue volume, 0.87 versus 0.72 [p ≤ 0.05]; trabecular number, 7.50 versus 5.78/mm [p ≤ 0.05]; and trabecular thickness, 0.08 versus 0.06 mm [p ≤ 0.05]). Three-point bending tests demonstrated 4-AP's improvement of tibial fracture biomechanical properties versus saline solution (stiffness, 27.93 versus 14.30 N/mm; p ≤ 0.05). 4-AP also increased endogenous BMP2 expression and matrix components in healing callus.</p><p><strong>Conclusions: </strong>4-AP increased the healing rate, biomechanical properties, and endogenous BMP2 expression of tibiae following fracture.</p><p><strong>Level of evidence: </strong>Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Minimal Clinically Important Difference (MCID) for Total Joint Arthroplasty Outcome Measures Varies Substantially by Calculation Method.","authors":"Matthew J Solomito, Robert Carangelo, Heeren Makanji","doi":"10.2106/JBJS.24.00916","DOIUrl":"https://doi.org/10.2106/JBJS.24.00916","url":null,"abstract":"<p><strong>Background: </strong>As the United States health-care system transitions to a value-based model, the minimal clinically important difference (MCID) has become an important metric for assessing perceived benefit in clinical settings. However, there is substantial ambiguity surrounding the MCID value because the calculation method used can lead to substantial changes in the clinical interpretation of surgical success.</p><p><strong>Methods: </strong>A total of 1,113 patients who underwent either total knee arthroplasty (TKA) or total hip arthroplasty (THA) between June 2021 and June 2023 and completed their patient-reported outcomes (the KOOS JR [Knee injury and Osteoarthritis Outcome Score for Joint Replacement] or HOOS JR [Hip disability and Osteoarthritis Outcome Score for Joint Replacement]) preoperatively and at 1 year postoperatively were reviewed for this study. The MCID values for the HOOS JR and KOOS JR were determined using 16 statistically appropriate methods, and the resulting MCID values were applied to the study group to assess how differences in methods changed the number of patients who met the MCID at 1 year postoperatively.</p><p><strong>Results: </strong>The study cohort consisted of 570 patients who underwent TKA and 543 who underwent THA. The overall cohort was 62.2% female, had a mean age of 69.3 ± 8.3 years, and was 92.3% Caucasian, 2.9% African American, and 4.8% other race (i.e., Asian, multiracial, or \"other\"). The MCID values varied substantially among the methods evaluated. The mean MCID was 11.5 ± 9.2 (range, 0.5 to 36.6) for the KOOS JR and 12.2 ± 8.9 (range, 0.6 to 34.3) for the HOOS JR. Distribution-based methods led to smaller but more variable MCID values, whereas anchor-based methods were noted to have larger but more consistent MCID values.</p><p><strong>Conclusions: </strong>Different statistical approaches resulted in substantial variation in the MCID threshold value, which affected the number of patients who reached the MCID. This study demonstrates the ambiguity of the MCID and casts some doubt regarding its utility for assessing the surgical benefit of total joint arthroplasty.</p><p><strong>Level of evidence: </strong>Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}