Journal of Orthopaedic Surgery and Research最新文献

{"title":"Association between video-based Pirani Böhm Sinclair score and treatment recommendations in recurrent clubfoot in walking-age children.","authors":"Åsa Thelaus, Salik Kashif, Eva Broström, Alaric Aroojis, Steven Frick, Stephanie Böhm, Josefine Eriksson Naili","doi":"10.1186/s13018-026-07122-6","DOIUrl":"10.1186/s13018-026-07122-6","url":null,"abstract":"<p><strong>Background: </strong>Management of recurrent clubfoot in walking-age children remains inconsistent, with substantial variation in treatment strategies. The role of clinical scoring systems in guiding treatment decisions in this group is unclear. This study investigated whether the video-based Pirani Böhm Sinclair (PBS)-score is associated with treatment recommendations.</p><p><strong>Methods: </strong>Fifty-five children aged 4-15 years (85 clubfeet) were video-documented. Four international paediatric orthopaedic surgeons independently assessed each case using the PBS-score and recommended management.</p><p><strong>Results: </strong>Higher total PBS-scores were significantly associated with lower odds of recommending observation (OR 0.2, p < 0.002). A threshold around PBS-score 10 marked a consistent shift from observation to active intervention. Median PBS-scores were 8 (7-10) for observation and 13 (11-16) for active treatment. Despite this association, there was substantial variability in the type of intervention recommended. Even when specific clinical findings, such as dynamic supination, were consistently identified, this did not uniformly translate into the same surgical decision.</p><p><strong>Conclusion: </strong>While higher PBS-scores are associated with the decision to intervene, considerable variation in treatment choice persists. These findings highlight the lack of consensus in managing recurrent clubfoot and underscore the need for clearer indications and standardized treatment algorithms. Trial registration Clinical trial number NCT06050564, date of registration 2023-09-11.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"21 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13397732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584587","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":"Prevalence and risk factors of medial meniscal ramp lesions in patients undergoing primary anterior cruciate ligament reconstruction at a tertiary center.","authors":"Ahmad Alajlan, Eyad Alahmeri, Abdulaziz Alabbad, Mohammed Alshwieer, Faisal F Alotaibi, Abdullah A Almutlaq","doi":"10.1186/s13018-026-07105-7","DOIUrl":"https://doi.org/10.1186/s13018-026-07105-7","url":null,"abstract":"<p><strong>Background: </strong>Ramp lesions are injuries of the peripheral meniscocapsular attachment of the posterior horn of the medial meniscus and are commonly associated with anterior cruciate ligament (ACL) tears. Failure to identify these lesions may compromise knee stability and outcomes after ACL reconstruction (ACLR).</p><p><strong>Purpose: </strong>The primary objective of this study was to determine the prevalence of ramp lesions among patients undergoing primary ACLR at a tertiary center in Saudi Arabia. The secondary objective was to identify patient- and injury-related risk factors associated with ramp lesions.</p><p><strong>Study design: </strong>Retrospective cross-sectional study.</p><p><strong>Methods: </strong>This retrospective cross-sectional study included adult patients who underwent primary ACL reconstruction between November 2022 and December 2025. Patients with prior surgery, multiligamentous injuries (except MCL injuries), fractures, or incomplete records were excluded. Ramp lesions were identified intraoperatively. Demographic and clinical variables were analyzed using univariate logistic regression.</p><p><strong>Results: </strong>Among 155 patients, ramp lesion prevalence was 3.9% (6/155). Older age and longer time from injury to surgery were significant predictors (p < 0.05). On continuous analysis, both age (OR = 1.151, 95% CI 1.024-1.294; p = 0.018) and time from injury to surgery (OR = 1.028, 95% CI 1.005-1.052; p = 0.017) remained significant. Sex, BMI, MCL injury, and lateral meniscal injury were not significantly associated.</p><p><strong>Conclusion: </strong>Our findings suggest that older age and longer time from injury to surgery are associated with the occurrence of ramp lesions. Future prospective studies should assess the prevalence of ramp lesions while minimizing information and observer bias and should investigate the interplay among knee morphometry, activity level, and biomechanical forces leading to ramp lesion development across diverse populations. The relatively low prevalence observed in this study may be related to diagnostic limitations, as ramp lesions are often missed when only standard anterior arthroscopic portals are used. Techniques such as posteromedial exploration or trans-notch visualization may improve detection. Differences in surgical technique and surgeon awareness may also influence identification, highlighting the need for systematic intraoperative evaluation.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549201","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":"The lesser trochanter index: detection of increased femoral version in patients with symptomatic hip disease.","authors":"Klaudia Kaczmarek, Andreas Nitsch, Feras Kasabji, Georgi I Wassilew, Jens Goronzy, Maximilian Fischer","doi":"10.1186/s13018-026-07084-9","DOIUrl":"10.1186/s13018-026-07084-9","url":null,"abstract":"<p><strong>Background: </strong>Femoral version (FV) affects hip biomechanics and postoperative outcomes in developmental dysplasia of the hip (DDH) as well as femoroacetabular impingement (FAI). However, its assessment depends on advanced imaging modalities such as CT and MRI with limited clinical utility for cost-effective screening of FV. This study aimed to implement and test the diagnostic accuracy of the lesser trochanter index (LTI) as an indicator for increased femoral FV on pelvic radiographs in patients with symptomatic DDH and FAI.</p><p><strong>Methods: </strong>This prospective, diagnostic cohort study included symptomatic patients with DDH (n = 194 patients) and FAI (n = 22 patients) undergoing hip preservation surgery. Patients underwent a standardized protocol of anteroposterior pelvic radiographs and magnetic resonance imaging (MRI) of the pelvis, hip and lower extremity. FV was measured in accordance to the Murphy method. The lesser trochanter morphology on pelvic radiographs was used to calculate the lesser trochanter index (LTI). It was predefined as positive to detect increased FV (>25/30° Murphy) with a cut-off value of > 1.5.</p><p><strong>Results: </strong>A total of 409 hips in 216 patients were included. Patients with DDH were significant older (30.7 vs. 25.5, p = 0.008), were more frequently female (77.3% vs. 34.8, p < 0.001) and had a significant higher femoral version compared to FAI (28 vs. 21.8, p = 0.013). The LTI > 1.5 showed a high sensitivity (25°/30° FV - 90.9/93.1%), but a low specifity (25°/30° FV - 20.3/18.9%) to detect increased FV. The negative predictive value remained moderate (25°/30° FV - 65.5/81%), while the LTI has only a weak positive predictive value (25°/30° FV - 57.5/42.7%).</p><p><strong>Conclusion: </strong>The LTI represents a clinical useful and widely available indicator of increased FV and can optimize the use of subsequent MRI and CT assessment. However, due to its moderate diagnostic accuracy, the LTI is more a rule- out test, than a diagnostic marker of increased FV and cannot replace advanced imaging modalities.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"21 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549194","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":"Refracture after implant removal of the clavicle: a retrospective cohort analysis.","authors":"Ahmed Ellafi, Eva Coenen, Tobias Resch, Philipp Zehnder, Michael Zyskowski, Lukas Willinger, Peter Biberthaler, Markus Schwarz","doi":"10.1186/s13018-026-07123-5","DOIUrl":"10.1186/s13018-026-07123-5","url":null,"abstract":"<p><strong>Background: </strong>Refracture after implant removal in clavicle fractures is a relevant but insufficiently studied complication. Reported refracture rates vary due to small cohorts and heterogeneous populations. This study aims to determine the incidence of refracture following elective implant removal after confirmed fracture union and to identify potential demographic, clinical, and fracture-related risk factors.</p><p><strong>Methods: </strong>A retrospective cohort of 575 adults who underwent implant removal after radiographically confirmed union between 2011 and 2024 was analyzed. Patients were assigned to a refracture (R) or non-refracture (NR) group. Demographics, fracture characteristics, treatment variables, and time intervals were analyzed.</p><p><strong>Results: </strong>Refractures occurred in 21/575 patients (3.7%). No significant differences were observed between the R and NR groups regarding age, BMI, ASA classification, or tobacco use. The interval between initial fixation and implant removal was shorter in the refracture group but not statistically significant (18.8 ± 8.7 vs. 21.2 ± 18.5 months; p = 0.55). Most refractures occurred at the original fracture site (n = 19; 90.5%) and were mostly midshaft fractures (n = 18; 85.7%). Only the AO 15.2C fracture type showed a significant association with refracture (R: 11.1% vs. NR: 1.9%; p = 0.005). In time-to-event analysis, AO 15.2C fractures were independently associated with refracture (HR 6.70, 95% CI 1.49-30.12; p = 0.013). Refracture-free survival was 97.4% at 1 year and 96.2% at 10 years. Implant removal was most frequently performed due to patient preference (R: 66.7% vs. NR: 50%).</p><p><strong>Conclusion: </strong>Refracture after clavicle implant removal is an uncommon yet clinically relevant complication. The overall refracture rate was 3.7% in the present study. Neither demographic variables nor implant retention time were significantly associated with refracture risk, whereas fracture morphology-specifically complex midshaft fractures (AO 15.2C)-was the only significant risk factor identified. Fracture morphology should therefore be a key consideration when deciding on elective implant removal. Further prospective research is needed to refine guidelines on optimal timing and patient selection.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536176","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":"Association between LIV + 1 bone mineral density asymmetry and distal adding-on phenomenon in adolescent idiopathic scoliosis.","authors":"Chaofan Han, Zihao Ding, Peng Yin, Yong Hai","doi":"10.1186/s13018-026-07126-2","DOIUrl":"10.1186/s13018-026-07126-2","url":null,"abstract":"<p><strong>Objective: </strong>Distal adding-on phenomenon remains a common complication following corrective surgery for adolescent idiopathic scoliosis (AIS). This study aimed to characterize the spatial distribution of vertebral bone mineral density (BMD) across the scoliotic spine and to examine whether preoperative BMD asymmetry at the vertebra immediately distal to the lowest instrumented vertebra (LIV + 1) may serve as a complementary biomechanical risk marker for postoperative distal adding-on within existing LIV-selection frameworks.</p><p><strong>Methods: </strong>This retrospective cohort study included 90 patients with AIS who underwent posterior spinal fusion and had preoperative full-spine computed tomography scans. Patient-specific three-dimensional finite element analysis (3D-FEA) models were constructed to quantify bilateral vertebral BMD along simulated pedicle-screw trajectories. Patients were grouped by Cobb-angle strata and by postoperative adding-on status. ROC analysis was used to evaluate the predictive performance of LIV + 1 BMD asymmetry. Multivariable and Firth penalized logistic regression analyses were performed to assess its association with distal adding-on.</p><p><strong>Results: </strong>The mean whole-spine BMD was 0.85 ± 0.14 g/cm². No significant difference was observed between the overall concave and convex sides (p = 0.510), although region-specific asymmetry patterns were identified. Distal adding-on occurred in 15 patients (16.7%). Patients with adding-on showed greater LIV + 1 BMD asymmetry than those without adding-on (0.14 ± 0.06 vs. 0.11 ± 0.03 g/cm², p = 0.006). LIV + 1 BMD asymmetry demonstrated good discrimination (AUC = 0.865, 95% CI 0.77-0.96), with an optimal cutoff value of 0.112 g/cm². Based on the optimal cutoff, adding-on occurred in 44.8% of patients above this cutoff and 3.3% of patients at or below this cutoff (Fisher's exact OR = 24.0, p < 0.001); the negative predictive value was 96.7%. The between-group effect size was large (Cohen's d = 0.85; Hedges' g = 0.85). In Firth penalized logistic regression, LIV + 1 BMD asymmetry remained associated with adding-on (OR = 1.338 per 0.01 g/cm² increase, 95% CI 1.077-1.664, p = 0.009).</p><p><strong>Conclusion: </strong>Vertebral BMD in AIS exhibits a region-specific asymmetric distribution pattern. Increased preoperative LIV + 1 BMD asymmetry is associated with postoperative distal adding-on and may provide complementary, hypothesis-generating biomechanical information for risk stratification and distal fusion-level planning. These findings should be validated in larger cohorts before BMD asymmetry is used as a stand-alone determinant of LIV selection.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13393246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536168","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":"Association of the preoperative MRI LAMBDA sign with long-term patient-reported outcomes after isolated ATFL surgery: a ten-year retrospective cohort study.","authors":"Pengtao Shi, Shengxuan Li, Chen Yang, Yu Wei, Zhidong Zhao, Qi Quan, Yanpeng Zhao, Min Wei","doi":"10.1186/s13018-026-06977-z","DOIUrl":"https://doi.org/10.1186/s13018-026-06977-z","url":null,"abstract":"<p><strong>Background: </strong>The LAMBDA sign has been reported to be associated with syndesmotic-region injury on MRI, but its relationship with long-term outcomes after isolated ATFL surgery remains unclear.</p><p><strong>Objective: </strong>To evaluate the association between the preoperative MRI LAMBDA sign and long-term patient-reported outcomes in patients undergoing isolated anterior talofibular ligament (ATFL) repair or reconstruction.</p><p><strong>Methods: </strong>We retrospectively reviewed patients who underwent ATFL repair or reconstruction at a single institution between 2014 and 2016. A transparent cohort flow was documented, comparing included and excluded patients to assess for selection bias. The primary endpoint was the Foot and Ankle Outcome Score (FAOS) at final follow-up. At surgery, all patients were diagnosed clinically as having isolated ATFL injuries without chondral lesions, and the syndesmosis was not examined. Preoperative MRIs were reanalyzed, and patients were classified according to the presence or absence of the LAMBDA sign. LAMBDA-positive patients were additionally stratified by distal tibiofibular joint effusion height (DTJEH ≥ 8 mm vs. < 8 mm). Baseline characteristics and long-term patient-reported outcomes (FAOS, Karlsson, Tegner, VAS, satisfication) were collected. Adjusted effects, along with 95% confidence intervals (CIs), were reported. Rater reliability (ICC/κ) for LAMBDA and DTJEH was assessed with CIs and exact methods.</p><p><strong>Results: </strong>Seventy-nine patients were included (mean follow-up, 112.2 ± 8.0 months): 46 LAMBDA-positive and 33 LAMBDA-negative. LAMBDA-positive patients had significantly higher preinjury Tegner scores compared with the negative group (6.0 [6.0-7.0] vs. 5.0 [4.5-6.5]; P < 0.05), but worse long-term outcomes. Specifically, FAOS was lower in the LAMBDA-positive group (80.0 [75.0-85.0] vs. 86.0 [81.5-88.0]; mean difference, -6.1; 95% CI, -9.3 to -3.0; P < 0.001), as were Karlsson scores (80.0 [75.0-85.0] vs. 85.0 [84.0-90.0]; mean difference, -6.1; 95% CI, -9.5 to -2.7; P = 0.001). Additionally, LAMBDA-positive patients showed greater decline in Tegner activity levels (2.0 [1.0-3.0] vs. 1.0 [0.5-2.0]; P < 0.05). However, despite these statistically significant differences, they did not exceed established minimal clinically important difference (MCID) thresholds for FAOS and Karlsson scores (FAOS: 11.7; Karlsson: 10.0).</p><p><strong>Conclusion: </strong>A preoperative MRI LAMBDA sign was associated with slightly inferior long-term patient-reported outcomes after isolated ATFL surgery. Given the limitations of static MRI and the lack of intraoperative syndesmotic evaluation, these findings should be viewed as associations rather than causal relationships. Further studies incorporating dynamic or intraoperative assessments are warranted.</p><p><strong>Level of evidence: </strong>III (retrospective cohort).</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536199","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":"Methodological considerations in the multicenter cohort study of partial-thickness supraspinatus tear repair by Audigé et al.","authors":"Ali Can Koluman, Nezih Ziroglu, Kerem Bilsel","doi":"10.1186/s13018-026-07124-4","DOIUrl":"10.1186/s13018-026-07124-4","url":null,"abstract":"<p><p>This correspondence comments on the multicenter cohort study by Audigé et al. (Journal of Orthopaedic Surgery and Research, 2026) reporting outcomes of arthroscopic repair for partial-thickness supraspinatus tears. We highlight four aspects of the study that, in our view, would benefit from further clarification or additional discussion: (1) limited information regarding the surgical indications for tear completion, which may complicate interpretation of treatment-selection effects; (2) the absence of a technique-specific analysis of adverse events, particularly postoperative stiffness; (3) the unreported methodology used for intraoperative Ellman grade determination, the primary classification variable and the only factor significantly associated with tear completion; and (4) the potential residual influence of differential concomitant acromioplasty across tear-location groups despite statistical adjustment. Addressing these issues would further strengthen the interpretation and clinical applicability of this otherwise valuable prospective multicenter dataset.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"21 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497715","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":"Medial patellofemoral ligament reconstruction in skeletally immature patients: distal versus proximal femoral physis fixation.","authors":"Yi Hua, Hua Wang, Xu Yang","doi":"10.1186/s13018-026-07125-3","DOIUrl":"https://doi.org/10.1186/s13018-026-07125-3","url":null,"abstract":"<p><strong>Purpose: </strong>To compare clinical outcomes and complications of medial patellofemoral ligament (MPFL) reconstruction using femoral fixation proximal versus distal to the physis in skeletally immature patients with patellar instability.</p><p><strong>Methods: </strong>This retrospective study included 23 skeletally immature patients (24 knees) undergoing isolated MPFL reconstruction from January 2021 to August 2024. Patients were divided into proximal (n = 12 knees, mean age 14.1 ± 0.9 years ) and distal (n = 12 knees, mean age 13.8 ± 1.6 years ) physis fixation groups. Preoperative imaging assessed patellar height, trochlear dysplasia, and the tibial tuberosity-trochlear groove (TT-TG) distance. Clinical outcomes (Tegner, Kujala, Lysholm and International Knee Documentation Committee [IKDC]) and complications (re-dislocation, patellar fracture, infection, stiffness, quadriceps weakness and growth disturbance) were compared.</p><p><strong>Results: </strong>The mean follow-up durations were 24.4 ± 4.3 months (range, 17-33) in the proximal group and 22.8 ± 4.7 months (range, 17-30) in the distal group (P = 0.374). Both groups showed significant improvements in all functional outcomes (P < 0.001) with no intergroup differences (P > 0.05). Subjective satisfaction was similar (8.5 vs. 8.3, P = 0.726). Return to sport occurred in 91.7% of both groups. Complication rates were numerically higher in the proximal group (41.7%; mainly knee pain (n = 3, 25%) and quadriceps weakness (n = 2, 16.7%) than in the distal group (24.9%; infection (n = 1, 8.3%), pain (n = 1, 8.3%), weakness (n = 1, 8.3%)(P = 0.667). No redislocations, patellar fractures, stiffness, or growth disturbances occurred.</p><p><strong>Conclusions: </strong>Both proximal and distal femoral physis fixation for MPFL reconstruction yield similar clinical outcomes and complication rates in skeletally immature patients. However, due to the limited sample size of this study, the current conclusion should be interpreted with caution.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497788","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":"Postoperative outcomes after arthroscopic repair of isolated subscapularis tears: a systematic review and meta-analysis.","authors":"Ana Belén Fernández-Cortiñas, Teresa Seoane-Pillado, Yaiza Lopiz, Miguel Hermida, J R Caeiro-Rey, Fernando Marco","doi":"10.1186/s13018-026-07088-5","DOIUrl":"https://doi.org/10.1186/s13018-026-07088-5","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To systematically synthesize pre- and postoperative outcomes of arthroscopic repair for isolated subscapularis (SSC) tears across functional scores, pain, strength, range of motion (ROM), and clinical tests.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt; Systematic review and meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt; A systematic literature search was conducted across PubMed, Cochrane Library, and SCOPUS for studies reporting pre- and postoperative outcomes after arthroscopic repair of isolated SSC tears in adults with a minimum 12-month follow-up. Data on functional outcome scores, pain measures, and subscapularis-specific clinical tests were assessed. Functional outcomes were assessed using validated shoulder scoring systems, including the Constant-Murley Score (CMS), University of California, Los Angeles Shoulder Score (UCLA), American Shoulder and Elbow Surgeons Score (ASES), Simple Shoulder Test (SST), and Subjective Shoulder Value (SSV). These scores generally evaluate a combination of pain, shoulder function, strength, and activities of daily living. Pain was assessed using the Visual Analogue Scale (VAS). Subscapularis-specific function was evaluated using clinical tests such as the lift-off, belly-press, and bear-hug tests. The outcomes were presented as a mean difference between the preoperative and postoperative values using random or fixed effects. Results are reported as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI) and exact P values. Certainty of evidence was evaluated using the GRADE approach. The evidence base consisted predominantly of non-randomized studies at serious risk of bias, with outcomes rated as low or very low certainty.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Seventeen non-randomized studies (Level II-IV evidence) comprising 537 patients were included. In the absence of a control group, mean postoperative functional outcome scores were higher than preoperative values across studies, although individual patient outcomes varied. All included studies were judged to be at serious risk of bias using the ROBINS-I tool, and GRADE certainty of evidence was low to very low for all outcomes. Improvements were reported in multiple domains including shoulder function, strength, ROM, pain, and ability to perform daily activities. The mean differences ranged from 16.9 to 45.8 points for the CMS (pooled MD = 31.4, 95% CI [27.0-35.9]), 14.5 to 16.0 points for the UCLA (pooled MD = 15.4, 95% CI [14.8-15.9]), 33.0 to 58.3 points for the ASES (pooled MD = 48.1, 95% CI [46.8-49.9]), and 4.3 to 5.1 points for the SST (pooled MD = 4.9, 95% CI [4.4-5.5]). Consistent improvement was also observed in the SSV (pooled MD = 48.2, 95% CI [46.7-49.8]). In addition, pain assessed using the Visual Analogue Scale showed a significant postoperative reduction (MD =  - 5.0, 95% CI [- 5.2 to - 4.8]). Subscapularis-specific clinical tests showed a significant decrease in the rate of positive lift-off (RR = 0.","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471113","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":"Association between vertebral endplate defects and low back pain: an integrative omics study revealing the role of lipotoxicity-induced EGFR/COX-2 signalling.","authors":"Liqun Duan, Jiang Jiang, Yuyang Chen, Tianci Yu, Yijun Dong, Wenzhi Zhang, Xi Chen","doi":"10.1186/s13018-026-07111-9","DOIUrl":"https://doi.org/10.1186/s13018-026-07111-9","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>To investigate the association between endplate defects and patient-reported outcomes and to further clarify the role of lipotoxicity-induced EGFR/COX-2 signalling in the pathogenesis of low back pain. As the hub of intervertebral discs, the metabolic status of the endplate remains poorly characterized. Investigating metabolic stress conditions and downstream biological events in the endplate may provide insights into the pathological mechanisms of endplate defects and their association with patient-reported outcomes.</p><p><strong>Methods: </strong>Patients were classified into defect and non-defect groups based on radiographic evidence of endplate defects. Endplate cells were analyzed using lipidomics, transcriptomics, and functional assays. Outcome measures were compared between groups. Pearson's correlation was used to assess relationships among symptoms, immune-positive cells, and lipid content. Multivariate linear analysis evaluated the contribution of different variables to patient-reported symptoms.</p><p><strong>Results: </strong>Preoperative VAS-Back scores (6.6 vs. 4.9, p < 0.01) and ODI scores (61.8 vs. 49.7%, p < 0.05) were significantly higher in the defect group compared to the non-defect group. Integrated analysis revealed that the defect group was characterized by lipid droplets accumulation in endplate cells and activation of the EGFR/COX2 signalling. In vivo animal studies confirmed that lipotoxicity induces endplate defects and activates EGFR/COX2 signalling. Preoperative VAS-Back and ODI scores showed positive correlations with EGFR expression (r = 0.403, p < 0.01; r = 0.466, p < 0.01) and relative lipid content (r = 0.432, p < 0.01; r = 0.358, p < 0.001) in the endplate cells. Multivariate linear analysis identified EGFR-positive cells (p = 0.010), relative triglyceride content (p = 0.049), and the presence of endplate defects (p = 0.046) as significant factors influencing preoperative VAS-Back pain.</p><p><strong>Conclusions: </strong>Patients with endplate defects reported severe symptoms and exhibited upregulation of the lipid droplet-EGFR/COX-2 pathway in endplate cells. Lipotoxicity-associated inflammatory factors significantly contribute to chronic low back pain and influence patient-reported outcomes.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471106","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}