Journal of Orthopaedic Surgery and Research最新文献

{"title":"Cross-cultural adaptation and validation of the short version of anterior cruciate ligament return to sport after injury scale to Persian Language.","authors":"Fereshteh Kazemi Pakdel, Ahmad Kazemi Pakdel, Mohammad Ali Sarbazi Zarandi, Safoora Sabaghian Rad, Hamed Zarei","doi":"10.1186/s13018-025-05920-y","DOIUrl":"10.1186/s13018-025-05920-y","url":null,"abstract":"<p><strong>Background: </strong>Many athletes who have anterior cruciate ligament reconstruction (ACL-R) surgery strive to resume their sport at the level they played before the injury. The purpose of this study was to analyze the short Anterior Cruciate Ligament-Return to Sport after Injury scale (ACL-RSI) version's cultural adaptation and validity to Persian language.</p><p><strong>Methods: </strong>To evaluate test-retest reliability, 140 participants completed the Persian short version of the ACL-RSI twice, with a 7- to 10-day interval between assessments. Also, Internal consistency, and construct validity were assessed.</p><p><strong>Results: </strong>The findings indicate that the measure demonstrates excellent test-retest reliability (intraclass correlation coefficients = 0.92 [0.86 - 0.95]) and strong internal consistency (Cronbach's alpha = 0.91). Also, the standard error of measurement and minimum detectable change were determined to be 5.11 and 10.69, respectively. The Persian short version of the ACL-RSI exhibited a strong correlation with the ACL-RSI (P <.001, r =.77), a moderate correlation with the Injury Psychological Readiness to Return to Sport Questionnaire (I-PRRS) (P =.03, r =.51) and a strong negative correlation with the Tampa Scale of Kinesiophobia (TKS) (P <.001, r = -.73). Additionally, this short version of the ACL-RSI demonstrated a strong correlation with the International Knee Documentation Committee Subjective Knee Form (IKDC) (P <.001, r =.68) and with the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales (P <.001, r =.61-0.69).</p><p><strong>Conclusion: </strong>The Persian short version of the ACL-RSI is recommended as a reliable and valid tool for assessing psychological readiness for athletes returning to sport following ACL-R.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"525"},"PeriodicalIF":2.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal resistance training parameters for improving bone mineral density in postmenopausal women: a systematic review and meta-analysis.","authors":"Fang Zhao, Wenbo Su, Yaowei Sun, Jing Wang, Bin Lu, Hezhang Yun","doi":"10.1186/s13018-025-05890-1","DOIUrl":"10.1186/s13018-025-05890-1","url":null,"abstract":"<p><strong>Background: </strong>This meta-analysis aims to explore the effects of resistance training on bone mineral density (BMD) in postmenopausal women, specifically focusing on different training intensities, durations, frequencies, and periods, across various skeletal sites lumbar spine (LS), femoral neck (FN), total hip (TH), and trochanter (Troch).</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library for studies evaluating the impact of resistance training programs on BMD in postmenopausal women, covering all records up to March 2025. Two reviewers independently screened the studies, extracted data, assessed the risk of bias using the Cochrane Handbook, and performed the meta-analysis using RevMan 5.4 and Stata 18 software.</p><p><strong>Results: </strong>17 randomized controlled trials involving 690 subjects were included. The results indicate that resistance training significantly improves BMD at the LS (SMD = 0.88, 95% CI [0.21, 1.56], P = 0.01, I² = 91%), FN (SMD = 0.89, 95% CI [0.40, 1.39], P = 0.0004, I² = 87%) and TH (SMD = 0.30, 95% CI [0.10, 0.50], P = 0.003, I² = 25%). However, no significant effect was observed on Troch bone density (SMD = 0.23, 95% CI [-0.01, 0.47], P = 0.06, I² = 19%). Subgroup analysis further revealed that high-intensity training (≥ 70% 1RM) had a significant effect on the TH and FN (P < 0.05); training three times per week significantly improved bone mineral density at the LS, FN, TH, and Troch (P < 0.05); intervention durations of ≥ 48 weeks had a significant impact on FN and TH (P < 0.05); and sessions lasting 40 min had a significant effect on LS (P < 0.05).</p><p><strong>Conclusion: </strong>Resistance training can beneficially influence BMD in postmenopausal women, particularly at the LS, FN, and TH. A high-intensity training regimen (≥ 70% 1RM) performed three times per week with a longer training duration may be optimal. However, significant heterogeneity among the included studies for LS and FN bone density may affect the accuracy of the pooled results, thereby limiting the generalizability of these findings. More high-quality clinical trials are needed to confirm these findings.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"523"},"PeriodicalIF":2.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and economic effectiveness of Schroth therapy in adolescent idiopathic scoliosis: insights from a machine learning- and active learning-based real-world study.","authors":"Erdal Ayvaz, Merve Uca, Ednan Ayvaz, Zafer Yıldız","doi":"10.1186/s13018-025-05900-2","DOIUrl":"10.1186/s13018-025-05900-2","url":null,"abstract":"<p><strong>Background: </strong>Adolescent idiopathic scoliosis (AIS) is a prevalent musculoskeletal condition affecting approximately 2-3% of the adolescent population. Although exercise-based therapeutic interventions are increasingly employed as non-surgical alternatives, their clinical and economic effectiveness remains underexplored in real-world settings. Recent advancements in active learning (AL) and machine learning (ML) techniques offer the potential to optimize treatment protocols by uncovering hidden predictors and enhancing model efficiency.</p><p><strong>Methods: </strong>This retrospective study evaluated the clinical and cost-effectiveness of exercise-based therapy in 128 AIS patients treated between 2020 and 2023 at a tertiary public hospital. Patients were followed for 3 to 36 months. Clinical outcomes were assessed based on changes in Cobb angle, Visual Analogue Scale (VAS) scores for pain, and SRS-22r functional outcomes. Direct medical costs were extracted from institutional records to estimate the incremental cost-effectiveness ratio (ICER) and quality-adjusted life years (QALYs). In parallel, ML models, including Random Forest regression and AL strategies, were applied to predict treatment outcomes and enhance data labeling efficiency.</p><p><strong>Results: </strong>Exercise-based therapy resulted in a mean Cobb angle reduction of 6.8° (SD = 3.1), with significant improvements in pain and function (p < 0.001). The ICER was estimated at $1,730 per additional degree of Cobb angle correction, with a projected QALY gain of 0.03 per patient. While treatment duration was statistically non-significant in traditional regression analyses (p > 0.1), ML models identified it as a top predictor of both Cobb angle correction and pain reduction. The Random Forest model achieved an MAE of 0.84 and an RMSE of 1.06 for pain reduction predictions, while AL improved classification accuracy from 65 to 85% across five iterations by selectively labeling the most uncertain cases. Sensitivity analyses confirmed the robustness of economic findings.</p><p><strong>Conclusion: </strong>Exercise-based therapy, combined with ML and AL techniques, appears to be a clinically effective and economically sustainable intervention for AIS management. ML models identified important predictors overlooked by classical methods, particularly highlighting the importance of treatment duration. These findings may inform evidence-based strategies for integrating personalized, data-driven approaches into conservative scoliosis treatment protocols and optimizing musculoskeletal healthcare resource allocation.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"530"},"PeriodicalIF":2.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12117940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"LncRNA CRNDE ameliorates bone fracture by regulating cell viability and apoptosis of osteoblasts.","authors":"Yuanfeng Li, Shiqi Ye, Zhen Han, Chengjian Wei, Yingxuan Huang","doi":"10.1186/s13018-025-05943-5","DOIUrl":"10.1186/s13018-025-05943-5","url":null,"abstract":"<p><strong>Background: </strong>Delayed healing is a common postoperative complication among fractured patients, imposing an additional financial burden. This research examined the clinical relationship between CRNDE and delayed fracture healing (DFH) and the potential regulatory mechanisms underlying fracture improvement.</p><p><strong>Methods: </strong>qRT-PCR was utilized to assess the expression of CRNDE and miR-29a-3p in serum and cellular samples, and to evaluate the expression of genes associated with osteogenic differentiation. The diagnostic and predictive significance of serum CRNDE was analyzed using ROC analysis and logistic regression. Additionally, an hFOB 1.19 osteogenic differentiation model was established. The CCK-8 assay and flow cytometry techniques were used to investigate the effects of silencing CRNDE, as well as the concurrent inhibition of both CRNDE and miR-29a-3p, on the proliferation and apoptosis of hFOB 1.19 cells.</p><p><strong>Results: </strong>CRNDE was down-regulated, while miR-29a-3p was up-regulated in DFH patients. The serum CRNDE could effectively identify DFH patients and predict the DFH occurrence. In the hFOB 1.19 osteogenic differentiation model, silencing CRNDE led to a significant decrease in the expression of osteogenic differentiation markers, a reduction in the proliferation activity of hFOB 1.19 cells, and an increase in apoptosis. There was a negative regulatory interaction between CRNDE and miR-29a-3p. Concurrently inhibiting the expression of both CRNDE and miR-29a-3p could effectively restore the functional activity of hFOB 1.19 cells.</p><p><strong>Conclusion: </strong>Serum CRNDE holds potential as a biomarker for the diagnosis and prediction of DFH. The sponging effect of CRNDE on miR-29a-3p could ameliorate fracture healing.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"521"},"PeriodicalIF":2.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of total hip and knee arthroplasty for end-stage hemophilic arthropathy in patients with hemophilia: a retrospective study.","authors":"AErGen BaHeTe, YuLiang Shao, PengDe Kang","doi":"10.1186/s13018-025-05924-8","DOIUrl":"10.1186/s13018-025-05924-8","url":null,"abstract":"<p><strong>Purpose: </strong>Hemophilic Arthropathy (HA) frequently affects the hip and knee joints, with total hip arthroplasty (THA) or total knee arthroplasty (TKA) serving as primary treatment methods for end-stage hemophilic arthropathy. This study aims to retrospectively analyze the functional outcomes and satisfaction levels of hemophilia patients undergoing TKA or THA.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 64 hemophilic patients who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA) between 2014 and 2024 (including 42 TKA and 30 THA procedures) and performed follow-up evaluations. Clinical outcomes assessed included range of motion (ROM), functional scores (HSS scores for knees, HHS scores for hips, VAS scores, and Barthel Index), overall patient satisfaction, radiographic outcomes (operative side X-rays), and the incidence of postoperative complications.</p><p><strong>Results: </strong>Total joint arthroplasty (TJA) can relieve pain, improve joint function, significantly enhance patients' quality of life, and achieve extremely high satisfaction.</p><p><strong>Conclusions: </strong>TJA is an effective surgical option for patients with end-stage hemophilic arthropathy. Following joint arthroplasty, patients with hemophilic osteoarthritis experience improved joint pain and range of motion, as well as enhanced quality of life.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"519"},"PeriodicalIF":2.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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 Regarding \"Effects of Jintiange on the healing of osteoporotic fractures in aged rats\".","authors":"Yunzhuan Luo, Xin Liu, Zujian Xu","doi":"10.1186/s13018-025-05929-3","DOIUrl":"10.1186/s13018-025-05929-3","url":null,"abstract":"","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"527"},"PeriodicalIF":2.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12117867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of external fixator-assisted acute angulation on arterial diameter: a cadaveric model.","authors":"Akif Mirioglu, Kaan Ali Dalkir, Hakki Can Olke, Bugra Eraslan, Bugra Kundakci, Melih Bagir, Mehmet Ali Deveci","doi":"10.1186/s13018-025-05948-0","DOIUrl":"10.1186/s13018-025-05948-0","url":null,"abstract":"<p><strong>Background: </strong>Open fractures with bone and soft tissue loss pose significant challenges in orthopedic surgery. External fixator-assisted techniques, such as acute angulation and shortening, have been proposed to facilitate wound closure. However, the vascular implications of these techniques remain unclear. This cadaveric study aimed to evaluate the effect of acute angulation on arterial narrowing at the proximal tibia and distal femur, identifying angulation thresholds and comparing the vascular tolerance between these anatomical sites.</p><p><strong>Methods: </strong>Eight lower extremities from four fresh-frozen cadavers were used. Osteotomies were performed at the distal femoral and proximal tibial metaphyses. An Ilizarov circular external fixator provided controlled angulation in varus, valgus, procurvatum, and recurvatum directions. A contrast agent was used for vascular visualization under fluoroscopy. Angulation was gradually increased until arterial narrowing was observed, and the critical angles were recorded.</p><p><strong>Results: </strong>In the proximal tibia, the mean angulation thresholds for arterial narrowing were 45.5° in varus, 26.5° in valgus, 33.8° in procurvatum, and 13.5° in recurvatum. In the distal femur, arterial narrowing occurred at 27° in varus, 32.3° in valgus, 52° in procurvatum, and 22° in recurvatum. Varus angulation was significantly better tolerated at the tibia (p = 0.0286), while procurvatum (p = 0.0294) and recurvatum (p = 0.0286) were better tolerated at the femur. No significant difference was found in valgus angulation (p = 0.559).</p><p><strong>Conclusions: </strong>The tibia demonstrated higher tolerance for varus angulation, while the femur allowed greater procurvatum and recurvatum before vascular compromise. Recurvatum deformities in the tibia resulted in the earliest arterial narrowing, suggesting a higher risk of vascular complications. These findings provide critical insight for surgeons performing external fixator-assisted soft tissue coverage, helping optimize angulation strategies to prevent vascular complications.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"520"},"PeriodicalIF":2.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concerns and questions regarding \"Focusing on spinal stenosis: emerging discoveries concerning Alendronate-induced risks and genetic drug targets\".","authors":"Elham Mohebi, Ehsan Alimohammadi","doi":"10.1186/s13018-025-05921-x","DOIUrl":"10.1186/s13018-025-05921-x","url":null,"abstract":"","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"526"},"PeriodicalIF":2.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12117950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demineralized bone matrix combined with concentrated growth factors promotes intervertebral fusion in a novel rat extreme lateral interbody fusion model.","authors":"Han Wu, Shaorong Li, WeiJian Wang, Jiaqi Li, Wei Zhang","doi":"10.1186/s13018-025-05954-2","DOIUrl":"10.1186/s13018-025-05954-2","url":null,"abstract":"<p><strong>Background: </strong>Whether demineralized bone matrix (DBM) combined with concentrated growth factors (CGF) can accelerate intervertebral fusion remains uncertain. This study developed a novel rat model for extreme lateral interbody fusion (XLIF) and evaluated the fusion outcomes of DBM combined with CGF using imaging and histological analysis.</p><p><strong>Methods: </strong>A total of 70 male SD rats (3 months old, average body weight 300 ± 50 g) were included in this study. Among them, 10 rats were used for the anatomical study of the lumbar spine. The remaining 48 rats were randomly divided into four groups (n = 12 per group): Group A (control), Group B (titanium plate fixation), Group C (DBM + titanium plate fixation), and Group D (DBM + CGF + titanium plate fixation). The remaining 12 rats were used as donors to prepare fresh CGF. Eight weeks after surgery, the rats were euthanized and lumbar spine specimens were collected, with interbody fusion evaluated by manual palpation. Subsequently, specimens from groups B, C, and D were analyzed by micro-CT and histological examinations to comprehensively assess the fusion outcome.</p><p><strong>Results: </strong>The anatomical and surgical techniques for the rat XLIF model are described. Titanium plates (7 mm × 2.5 mm × 0.8 mm) and screws (3 mm × 1 mm) were designed based on the anatomical measurements. In Group A, spontaneous fusion occurred in 1 case; the remaining 11 cases showed intervertebral mobility. In Group B, 3 cases achieved fusion; in Group C, 8 cases; and in Group D, 11 cases. Micro-CT revealed fusion index scores (FIS) of 2.21 ± 0.51 for Group B, 3.62 ± 0.67 for Group C, and 4.57 ± 0.56 for Group D. Histological examination showed limited bone formation in Group B, with fibrous connective tissue filling the intervertebral space. Group C showed more bone formation, but some cartilage and fibrous tissue remained. Group D demonstrated abundant new bone formation and robust histological fusion, with substantial bridging between vertebrae.</p><p><strong>Conclusion: </strong>The rat XLIF model for interbody fusion has been successfully established and validated. Using this model, it was preliminarily demonstrated that DBM combined with CGF can effectively promote intervertebral fusion in rats.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"529"},"PeriodicalIF":2.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12117761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, attitudes, and practices toward postoperative rehabilitation among females with rotator cuff injury: a cross-sectional study.","authors":"Peng Xiao, Guilong Zhang, Wenlong Wu, Yong Huang, Bingjie Guan, Xiaoyu Tang","doi":"10.1186/s13018-025-05928-4","DOIUrl":"10.1186/s13018-025-05928-4","url":null,"abstract":"<p><strong>Objective: </strong>Rotator cuff injuries are common shoulder disorders, particularly affecting middle-aged and older women, and postoperative rehabilitation plays a vital role in restoring function and preventing recurrence. To investigate the knowledge, attitudes, and practices (KAP) related to postoperative rehabilitation among female patients who had undergone rotator cuff repair surgery.</p><p><strong>Design: </strong>A cross-sectional study.</p><p><strong>Methods: </strong>This cross-sectional study was conducted between January and July 2024 at two orthopedic centers in Chengdu, China, using convenience sampling. Demographic data and KAP scores were collected using a validated self-administered questionnaire (Cronbach's α = 0.851). The primary outcome measures were knowledge, attitude, and practice scores, assessed using a validated KAP questionnaire. Data were analyzed using descriptive statistics, group comparisons via t-tests or ANOVA, Spearman correlation analysis, and structural equation modeling (SEM) to examine the relationships between knowledge, attitudes, and practices.</p><p><strong>Results: </strong>A total of 499 female participants who met the inclusion criteria were enrolled with a response rate of 99.60%. Among the participants (mean age: 59.8 ± 7.2 years), the mean scores for knowledge, attitude, and practice were 14.59 ± 4.24, 35.17 ± 5.70, and 27.91 ± 4.71, respectively. Knowledge demonstrated positive correlations with practice (rs = 0.106, p = 0.018), while attitude showed strong correlation with practice (rs = 0.572, p < 0.001). SEM analysis showed that practice was directly influenced by knowledge (β = 0.084, 95% CI: 0.013-0.155, p = 0.021), attitude (β = 0.514, 95% CI: 0.441-0.587, p < 0.001), surgery (β = -0.170, 95% CI: -0.301 to -0.039, p = 0.011), training (β = -0.125, 95% CI: -0.207 to -0.044, p = 0.002), and therapy (β = -0.129, 95% CI: -0.212 to -0.046, p = 0.002). Additionally, income (β = 0.035, p = 0.010) had indirect effect on attitude. Knowledge (β = 0.067, p = 0.005), exercise (β = 0.097, p < 0.001), and therapy (β = -0.113, p < 0.001) had indirect effects on practice.</p><p><strong>Conclusion: </strong>Females with rotator cuff injuries demonstrated adequate knowledge and positive attitudes but exhibited suboptimal practices towards postoperative rehabilitation. These findings suggest the need for targeted interventions to bridge the gap between knowledge and practice, with particular focus on enhancing positive attitudes, which were the strongest predictors of rehabilitation adherence. Healthcare providers should consider implementing comprehensive educational programs that address both knowledge transfer and behavioral change strategies to improve patient outcomes.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"516"},"PeriodicalIF":2.8,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}