Journal of Orthopaedic Surgery and Research最新文献

{"title":"Curcumin-loaded dynamic crosslinked injectable hydrogel for annulus fibrosus repair and disc degeneration prevention.","authors":"Qi Zhang, Mingyang Kang, Rongpeng Dong, Xiaokui Tang, Yang Qu","doi":"10.1186/s13018-026-06909-x","DOIUrl":"https://doi.org/10.1186/s13018-026-06909-x","url":null,"abstract":"<p><strong>Objective: </strong>Annulus fibrosus (AF) defects following discectomy often induce biomechanical instability and inflammatory microenvironment deterioration, key drivers of recurrent herniation and accelerated degeneration. Given the limited self-repair capacity of the AF, this study aimed to develop a novel composite hydrogel integrating immediate mechanical support, tissue adhesion, and sustained anti-inflammatory release to promote functional AF repair.</p><p><strong>Methods: </strong>A composite hydrogel was prepared by incorporating curcumin-loaded liposomes (LIP@CUR) into a Schiff-base-crosslinked network formed between 4-arm polyethylene glycol (4aPEG-OPA) and gelatin. The hydrogel was comprehensively characterized in terms of microstructure, rheological behavior, mechanical properties, degradation profile, and in vitro drug release. Biocompatibility was evaluated using cytotoxicity and hemolysis assays. For in vivo assessment, male Japanese White rabbits (2.5 ± 0.2 kg) were obtained from Wangdu Tonghui Breeding Co., Ltd. (Hebei, China; License No. SCXK (Ji) 2021-006), and an AF defect model was established. Therapeutic efficacy was evaluated by maintaining disc height and by quantifying inflammatory responses (IL-6, TNF-α) and assessing extracellular matrix components (COL I/II) using radiography and histological analyses.</p><p><strong>Results: </strong>LIP@CUR exhibited uniform particle size (159.68 ± 1.98 nm) with ~ 70% encapsulation efficiency. The composite hydrogel demonstrated rapid in situ gelation (~ 60 s) and a compressive modulus (114.06 ± 13.94 kPa) matching native AF tissue, alongside robust tissue adhesion strength (~ 50 kPa). In vitro assessments confirmed low swelling, controllable degradation, and sustained curcumin release without cytotoxicity. In vivo, the hydrogel group effectively maintained intervertebral disc height and improved MRI signal intensity. Histological and semi-quantitative analyses confirmed a significant downregulation of inflammatory cytokines (TNF-α and IL-6, p < 0.001), alongside enhanced collagen deposition, facilitating structural regeneration of the AF defect.</p><p><strong>Conclusion: </strong>This study successfully developed a functionalized composite hydrogel featuring dual-controlled release, mechanical compatibility, and anti-inflammatory activity. By synergistically providing physical closure and modulating the immune microenvironment, this material offers a promising clinical strategy for preventing postoperative disc recurrence and enhancing AF repair.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816491","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":"Periosteal distraction-related treatments for diabetic foot/diabetic foot ulcer: a systematic review and meta-analysis.","authors":"Shaowen Zhong, Quan Sun, Lili Yu","doi":"10.1186/s13018-026-06920-2","DOIUrl":"https://doi.org/10.1186/s13018-026-06920-2","url":null,"abstract":"<p><strong>Background: </strong>Periosteal distraction (PD) has been used as a salvage strategy for diabetic foot (DF) and diabetic foot ulcer (DFU), yet its relative effectiveness compared with other approaches is still unclear.</p><p><strong>Methods: </strong>Up to March 17, 2026, seven databases were searched for comparative studies assessing PD-related treatments in DF/DFU. Twenty-six studies were included for qualitative synthesis, and 14 contributed to the primary comparative evidence set. The studies were organized into three categories: PD-based interventions versus conventional treatment, pure PD versus transverse tibial transport (TTT), and PD-inclusive multimodal regimens versus non-equivalent regimens.</p><p><strong>Results: </strong>A formal pooled meta-analysis could not be performed for Group A, so this group was synthesized descriptively. For Group B, pure PD showed no statistically significant differences from TTT with respect to ABI, pain, or adverse events. For Group C, PD-containing multimodal regimens were linked with beneficial short-term changes in surrogate perfusion-related measures (ABI, skin temperature, toe oxygen) and pain. However, when wound/ulcer healing time was pooled, the results suggested only a non-significant tendency favoring PD-containing multimodal regimens.</p><p><strong>Conclusions: </strong>Current findings do not support a clear superiority of pure PD over TTT. Apparent advantages were mainly seen in PD-containing multimodal regimens and were largely restricted to short-term surrogate outcomes. These findings should not be interpreted as evidence that PD alone has an independent effect, and robust limb-salvage endpoints remain insufficiently reported.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816391","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":"Intramedullary cement augmentation in locking plate fixation for Neer four-part proximal humeral fractures: a technique for preventing early mechanical failure.","authors":"Zhixiang Chen, Chengjun Hao, Bingjun Cui, Lang Wu, Chuangong Wang, Zhenqing Zhang, Shaoyu Han","doi":"10.1186/s13018-026-06898-x","DOIUrl":"https://doi.org/10.1186/s13018-026-06898-x","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Locking plate fixation for Neer four-part proximal humeral fractures is frequently complicated by varus collapse and screw cut-out, leading to mechanical failure, particularly in osteoporotic bone. This study evaluates the clinical and radiographic outcomes of a modified technique involving intramedullary polymethylmethacrylate (PMMA) bone cement augmentation applied during its thread-forming phase to create an internal support structure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this retrospective cohort study, 66 consecutive patients with Neer four-part proximal humeral fractures treated between January 2023 and June 2024 were enrolled and divided into two groups: 31 patients underwent locking plate ORIF with intramedullary PMMA cement augmentation (augmentation group), and 35 patients received conventional locking plate fixation without cement (control group). Patient demographics, surgical details, and perioperative data were recorded. Primary outcomes were radiographic: fracture union time, and changes in the neck-shaft angle (NSA) and humeral head height (HHH). Secondary outcomes included the Constant-Murley Score (CMS), Visual Analog Scale (VAS) for pain, and all complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt; The two groups were well matched demographically (mean age 77.9 ± 3.6 years; P &gt; 0.05). All fractures achieved union, with significantly faster healing in the augmentation group (14.42 ± 1.45 vs. 15.10 ± 1.12 weeks; P = 0.0245). Radiographic stability was markedly superior in the augmentation group: mean loss of NSA was 1.4° ± 1.2° versus 2.8° ± 1.9° (P = 0.001), and mean loss of HHH was 0.6 ± 0.5 mm versus 1.8 ± 1.1 mm (P &lt; 0.001). Critically, no patient (0%) in the augmentation group experienced significant loss of reduction (defined as &gt; 5° change in NSA or &gt; 3 mm loss of HHH), compared to three patients (8.57%) in the control group (P = 0.095). Early postoperative pain was significantly reduced in the augmentation group on day 1 (VAS: 4.35 ± 1.27 vs. 5.20 ± 1.39; P = 0.0065) and day 3 (3.29 ± 0.45 vs. 3.63 ± 0.64; P = 0.0044). Functional recovery was significantly better at 1 month (CMS: 51.61 ± 6.16 vs. 48.54 ± 7.06; P = 0.0447) and 3 months (66.10 ± 10.32 vs. 62.09 ± 8.56; P = 0.0467). The complication rate was low; notably, radiographic avascular necrosis occurred in only one patient (3.23%) in the augmentation group versus five patients (14.29%) in the control group (P = 0.122). No cases of screw cut-out, implant failure, or reoperation were recorded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Intramedullary augmentation with thread-forming phase PMMA cement is a highly effective adjunct to locking plate fixation for Neer four-part proximal humeral fractures. In this cohort, no patient in the augmentation group experienced significant loss of reduction, suggesting that the technique may reduce the risk of early mechanical failure, provide superior radiographic stability, reduce early postoperative pain, accel","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816479","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":"Application of exosomes derived from mesenchymal stem cells in osteoarthritis.","authors":"Qianying Feng, Ruixue Liu, Shitian Feng, Dan Li, Sen Wang, Huigen Feng, Junzheng Yang","doi":"10.1186/s13018-026-06907-z","DOIUrl":"https://doi.org/10.1186/s13018-026-06907-z","url":null,"abstract":"<p><p>Osteoarthritis is a chronic disabling disease characterized by progressive degeneration of articular cartilage. The condition is characterized by an imbalance in the inflammatory response, the degradation of the extracellular matrix, the apoptosis of chondrocytes, and the disorder of the immune microenvironment. The present clinical efficacy of the treatment is unsatisfactory due to the limited self-healing ability of the articular cartilage. In recent years, there has been a growing body of research focusing on the therapeutic potential of exosomes (Exos) derived from mesenchymal stem cells (MSCs). The findings of these studies have demonstrated the significant potential of MSC-derived exosomes as a promising cell-free therapeutic strategy. This article provides a synopsis of the research progress and mechanisms of mesenchymal stem cell-derived exosomes (MSC-Exos) from diverse tissue sources in the treatment of osteoarthritis. Furthermore, the application of MSC-Exos in the treatment of osteoarthritis were also discussed. The review will provide a valuable reference for future research directions in this field.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816496","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 gravity stress radiograph parameters predicting the need for deltoid ligament repair after lateral malleolar fixation in Weber B ankle fractures.","authors":"Jaehyung Lee, Jihun Park, Jae Yong Park","doi":"10.1186/s13018-026-06915-z","DOIUrl":"https://doi.org/10.1186/s13018-026-06915-z","url":null,"abstract":"<p><strong>Background: </strong>Radiographic criteria for deltoid ligament repair in Weber B ankle fractures without a medial malleolar fracture remain unclear. Medial clear space (MCS) on gravity stress radiographs is commonly used to assess medial instability, but the optimal cutoff value and diagnostic accuracy are still debated.</p><p><strong>Methods: </strong>This retrospective comparative study included 55 patients with Weber B ankle fractures without medial malleolar fractures who underwent operative treatment between 2016 and 2021. All patients underwent preoperative gravity stress radiography and intraoperative fluoroscopic stress testing after completion of fracture stabilization. Patients were classified as unstable (deltoid ligament repair due to persistent medial instability) or stable (no repair). Preoperative radiographic parameters-including MCS, medial clear space angle (MCA), superior clear space (SCS), medial-to-superior clear space ratio, fibular lateral shift distance (FLSD), and MCS-FLSD difference-were measured. Diagnostic performance and optimal cutoff values were evaluated using receiver operating characteristic curves and Youden's index.</p><p><strong>Results: </strong>Sixteen patients were classified as unstable and 39 as stable. On preoperative gravity stress radiographs, the unstable group showed significantly greater MCS (8.3 ± 2.6 vs. 5.9 ± 1.9 mm, p = 0.002) and MCA (16.6 ± 3.8° vs. 6.4 ± 3.1°, p < 0.001) than the stable group. MCA demonstrated high discriminative ability, with an area under the curve of 0.98, whereas MCS showed an area under the curve of 0.81. The optimal cutoff values were 6.0 mm for MCS and 11.5° for MCA. At 1 year postoperatively, clinical outcomes were similar between groups.</p><p><strong>Conclusions: </strong>MCA demonstrated high discriminative ability on preoperative gravity stress radiographs and may serve as a useful adjunct to MCS for anticipating the need for deltoid ligament repair after completion of fracture stabilization in Weber B ankle fractures.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816444","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":"Is delayed three-month re-excision safe for patients who have undergone unplanned excision of soft tissue sarcomas?","authors":"Jin Tao, Zhuoyu Li, Li Yuan, Xu Hairong, Hao Lin, Niu Xiaohui, Weifeng Liu","doi":"10.1186/s13018-026-06914-0","DOIUrl":"https://doi.org/10.1186/s13018-026-06914-0","url":null,"abstract":"<p><strong>Background: </strong>The optimal timing for systematic re-excision following the unplanned excision (UE) of soft tissue sarcomas (STS) remains controversial. This study evaluated the impact of delayed versus immediate re-excision on overall survival (OS), progression-free survival (PFS), and local recurrence-free survival (LRFS).</p><p><strong>Methods: </strong>We retrospectively analysed patients who underwent re-excision for primary STS following UE between August 2011 and February 2019. Patients with metastasis at presentation or a follow-up of less than two years were excluded. The cohort was stratified into an early re-excision (RE) group (≤ 3 months from initial UE) and a late RE group (> 3 months). The LRFS, PFS, OS, and the extent of excision were assessed.</p><p><strong>Results: </strong>A total of 104 patients met the inclusion criteria of this study, including 74 cases in the early RE group and 30 cases in the late RE group. At a mean follow-up of 61.0 ± 20.5 months, the 5-year OS was 86.5% and 88.1% in the early RE group and the late RE group, respectively (P=0.501). No significant differences were observed in 5-year LRFS (98.9% vs. 88.8%, P=0.168) or 5-year MRFS (88.6% vs. 81.9%, P=0.764). For a subset of 12 patients in the late RE group who underwent serial MRI, the median maximum edema diameter decreased significantly from 93.8 mm at the initial visit to 54.9 mm prior to delayed re-excision (P=0.001) CONCLUSIONS: Delayed re-excision beyond three months did not negatively impact recurrence or survival rates compared to immediate intervention. Furthermore, this delayed approach allows postoperative edema to subside, potentially reducing the required extent of resection and the subsequent need for complex flap reconstruction.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815501","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":"Nationwide treatment patterns and outcomes of localised soft tissue sarcoma in Austria: real-world data from the Austrian Sarcoma Registry.","authors":"Maria Anna Smolle, Sonja Hasenschwandtner, Andreas Reichinger, Georgios Koulaxouzidis, Florian A Wenzl, Lukas Weiss, Ronald Heregger, Andreas Seeber, Thomas Winder, Hossein Taghizadeh, Bernadette Liegl-Atzwanger, Andreas Leithner, Joanna Szkandera","doi":"10.1186/s13018-026-06894-1","DOIUrl":"https://doi.org/10.1186/s13018-026-06894-1","url":null,"abstract":"<p><strong>Background: </strong>Population-based cancer registries provide incidence and survival data but lack granular treatment-specific information. However, this information can be critical for rare malignancies as soft tissue sarcoma (STS). The Austrian Sarcoma Registry (ASR) has been established to close this gap by capturing detailed clinical and therapeutic data across Austria.</p><p><strong>Methods: </strong>Data of 748 patients (median age 65 years) with localised extremity or trunk STS diagnosed between 1999 and 2024 at six Austrian institutions were retrospectively analysed. Prognostic factors for local recurrence (LR), distant metastasis (DM), and overall survival (OS) were assessed using competing risk regression and Cox regression models.</p><p><strong>Results: </strong>Perioperative RTX and RTX, respectively, had been applied in 57% and 7.6% of patients. Unplanned resections occurred in 30%. At a median follow-up of 46 months, LR and DM rates were 13.9% and 25.3%. Five-year OS was 77.6%. R1/2 resection margins independently associated with higher LR-risk (SHR 5.92; 95% CI 2.61-13.43; p < 0.001). High-grade STS independently associated with increased DM-risk (SHR 4.89, 95% CI 1.20-20.00, p = 0.027). Perioperative RTX was independently associated with improved OS (HR 0.59, 95% CI 0.40-0.88, p = 0.009), while perioperative CTX showed no association with OS (HR 0.86, 95% CI 0.18-4.07, p = 0.846). In addition, advanced patient age, large tumour size, and high-grade STS were associated with worse OS.</p><p><strong>Conclusion: </strong>ASR data demonstrate a survival advantage with surgery plus perioperative RTX, the absence of OS benefit from perioperative CTX in unselected patients, and a strong impact of patient age, tumour size, and grade on prognosis.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816328","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":"K-wire shows striking advantages to plateosteosynthesis for distal metaphyseal radius fracture in children: a retrospective, two-center study.","authors":"Frederik Weil, Lucas Fabarius, Paul Alfred Grützner, Michael Boettcher, Stefan Studier-Fischer, Luisa Weil","doi":"10.1186/s13018-026-06864-7","DOIUrl":"https://doi.org/10.1186/s13018-026-06864-7","url":null,"abstract":"<p><strong>Background: </strong>Metaphyseal distal radius fractures are very common in children. Even though there is a return toward successful conservative treatment, there are still distal radius fractures that require surgical treatment. K-wire osteosynthesis has become the most common surgical procedure. But no gold standard has been defined yet and evidence directly comparing pin and plate fixation in pediatric patients remains limited. Some hospitals prefer plate osteosynthesis for metaphyseal fractures in especially older children. Aim of the study was to compare complications, operative time, radiation exposure, reduction quality, and functional outcomes of K-wire versus plate osteosynthesis in pediatric metaphyseal distal radius fractures.</p><p><strong>Methods: </strong>We retrospectively analyzed children aged 2-15 years treated for metaphyseal distal radius fractures between 2010 and 2022 at two Level I trauma centers. Demographic, radiographic, and surgical data were extracted from hospital records. Postoperative alignment was measured on early radiographs, and complications were graded using the modified Clavien-Dindo-Sink classification. Secondary outcomes included reduction quality, operative and fluoroscopy times, hospital stay, immobilization, and range of motion.</p><p><strong>Results: </strong>Among 554 fractures, 352 (64%) were fixed with K-wires and 202 (36%) with plates. Complications occurred in 11% of K-wire and 20% of plate cases (p = 0.0034); severe events were rare (3% vs. 2.5%, p = 0.09). K-wire fixation was faster (25 (23) vs. 57 (24) min, p < 0.001), dose-area product (107 (294) vs. 172 (220) Gy·cm², p < 0.0001), and hospitalization (1.8 (1.5) vs. 2.4 (1.6) days; p < 0.0001) shorter, but longer immobilization (4 (0.7) vs. 1.9 (1.7) weeks; p < 0.0001). Plate fixation achieved superior reduction (92% vs. 67%, p < 0.0001). Secondary displacement occurred in 3% of K-wire cases, all single-wire constructs; 27% of those with secondary dislocation required revision. No pseudarthroses were observed in both groups.</p><p><strong>Conclusions: </strong>K-wire osteosynthesis offers a safe, efficient, and minimally invasive option with fewer complications, shorter recovery and shorter radiation exposure time. Plate fixation provides better reduction but higher morbidity and longer surgery, and should be reserved for irreducible fractures or older children with little remodeling potential. However, both methods achieved reliable healing and full functional recovery.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816057","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 role of quadriceps strength and quadriceps-focused rehabilitation following medial meniscus posterior root repair: a systematic review.","authors":"Wenqiang Zhao, Qiuyue Liu, Guolei Ren, Jie Xu, Changxu Han","doi":"10.1186/s13018-026-06877-2","DOIUrl":"https://doi.org/10.1186/s13018-026-06877-2","url":null,"abstract":"<p><strong>Background: </strong>Medial meniscus posterior root tear (MMPRT) can lead to biomechanical disruption of the medial compartment and accelerate the progression of osteoarthritis. Although surgical repair may improve pain and functional outcomes, postoperative rehabilitation is also considered important for recovery. The quadriceps plays a central role in knee joint stability, load distribution, and functional recovery, yet its role in rehabilitation following MMPR repair remains unclear. This study aimed to systematically summarize the available evidence regarding quadriceps strength and quadriceps-focused rehabilitation following MMPR repair.</p><p><strong>Methods: </strong>Databases including PubMed, Embase, the Cochrane Library, Web of Science, Scopus, PEDro, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched from inception to June 2025. Studies were included if they involved patients who underwent medial meniscal posterior root (MMPR) repair and received quadriceps-focused rehabilitation. Methodological quality was assessed using the MINORS tool. Because of substantial heterogeneity in reported outcomes, only qualitative synthesis was performed. This study was registered with PROSPERO (CRD420251145452).</p><p><strong>Results: </strong>Three studies involving 93 patients were included. All patients underwent transtibial pull-out repair and were followed for 1 year. Weaker preoperative quadriceps strength was associated with greater postoperative medial meniscal extrusion (MME) and progression of medial joint space narrowing (MJS). Protocols emphasizing quadriceps-focused rehabilitation, including isometric exercises, straight-leg raises, resistance training, and neuromuscular electrical stimulation, were generally associated with improved muscle strength, better functional scores (IKDC, KOOS, and Lysholm), and faster Timed Up and Go (TUG) recovery. In addition, groups with greater quadriceps strength or more quadriceps-focused rehabilitation tended to show less progression of MME and MJS on imaging. All studies had a MINORS score of 11, indicating acceptable clarity of study aims and follow-up, but limitations in prospective design and sample size estimation.</p><p><strong>Conclusion: </strong>Quadriceps-focused rehabilitation may play an important role in recovery following MMPR repair. Greater quadriceps strength was associated with better muscle strength, functional outcomes, and potentially more favorable structural findings. However, the current evidence is limited and mainly based on retrospective studies, so these findings should be interpreted cautiously. Further high-quality, multicenter prospective studies are needed to clarify the optimal role and components of quadriceps-focused rehabilitation after MMPR repair.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774262","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":"MIPO versus ORIF with long proximal humerus locking plate for metadiaphyseal proximal humeral fracture.","authors":"Tahsin Aydın, Fatih İnci, Murat Bozbek, Furkan Türk, İbrahim Alper Yavuz, Yakup Kahve, Özdamar Fuad Öken","doi":"10.1186/s13018-026-06866-5","DOIUrl":"https://doi.org/10.1186/s13018-026-06866-5","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to compare ORIF (open reduction internal fixation) and MIPO (minimal invasive plate osteosynthesis) using long PHLP (proximal humerus locking plate) in treating metadiaphyseal proximal humeral fractures regarding time to union, complications, and clinical outcomes.</p><p><strong>Methods: </strong>This retrospective study was conducted at a single-center Level 1 trauma facility. The study population consisted of patients who underwent long PHLP fixation for metadiaphyseal proximal humeral fractures and completed a minimum follow-up of 1 year. Patients with additional injuries in the same extremity, those treated with implants other than long PHLP, or those managed with surgical techniques other than MIPO or ORIF were excluded. The cohort was divided into two groups: MIPO (32 patients) and ORIF (29 patients). The groups were compared with respect to demographic characteristics (age, sex, mechanism of trauma), radiological outcomes (time to union), and clinical outcomes, including the Disabilities of the Arm, Shoulder and Hand (DASH) score, Constant-Murley score, and complication rates.</p><p><strong>Results: </strong>The mean age was 54.96 (SD 17.1, range 24-85) in the MIPO group and 54.55 (SD 15.03, range 22-84) in the ORIF group. The MIPO group (n = 32) had a significantly shorter mean time to union than the ORIF group (n = 29) [13.8 ± 3.0 vs. 17.3 ± 5.1 weeks; p = 0.003]. At 1 year, DASH scores were lower in the MIPO group [8.6 ± 7.1 vs. 12.8 ± 8.8; p = 0.044]. Constant-Murley scores showed no significant difference between groups [87.8 ± 6.2 vs. 84.5 ± 9.0; p = 0.094]. In the MIPO group, 1 (3.1%) patient had radial nerve impairment and 1 (3.1%) patient had subacromial impingement; in the ORIF group, 1 (3.4%) patient had radial nerve impairment and 2 (6.9%) patients had nonunion.</p><p><strong>Conclusion: </strong>In metadiaphyseal proximal humeral fractures, minimally invasive plate osteosynthesis using a long proximal humeral locking plate was associated with a shorter radiographic time to union than open reduction and internal fixation, although this finding should be interpreted in the context of the different radiographic union criteria applied in the two groups.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774289","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}