Journal of Orthopaedic Surgery and Research最新文献

{"title":"Clinical and psychosocial impact of limited mobility during the interstage period of two-stage revision arthroplasty for prosthetic joint infection: a state-of-the-art review.","authors":"Hari K Parvataneni, Chancellor F Gray, Hernan A Prieto, Larry Yost, Emilie N Miley","doi":"10.1186/s13018-026-07096-5","DOIUrl":"10.1186/s13018-026-07096-5","url":null,"abstract":"<p><strong>Background: </strong>Two-stage revision arthroplasty remains the gold-standard treatment in the United States for patients diagnosed with periprosthetic joint infection (PJI) of the hip and knee. However, during treatment, patients have an extended interstage period between prosthesis removal and reimplantation which is frequently characterized by substantial reductions in mobility, prolonged rehabilitation, and a high incidence of medical and psychosocial complications. This review examines the physical, psychological, and social effects of immobility during the interstage period.</p><p><strong>Methods: </strong>A comprehensive literature review was conducted to identify studies addressing mobility limitations, functional assessment tools, and associated outcomes in patients undergoing two-stage revision arthroplasty for PJI. Studies were included if they reported on clinical complications and psychosocial outcomes affected by the prolonged interstage period and mobility limitations.</p><p><strong>Results: </strong>Patients undergoing two-stage revision often experience significant immobility lasting several months, which can be influenced by pain, soft-tissue compromise, and spacer type. Prolonged inactivity can contribute to muscle atrophy, joint stiffness, and impaired range of motion and is often associated with an increased risk of venous thromboembolism, pressure injuries, and bleeding complications related to extended thromboprophylaxis use. Psychologically, patients frequently report heightened anxiety and depression during the interstage period, compounded by uncertainty regarding infection eradication. Socially, patients have restricted independence, are dependent on caregivers, and have occupational disruption that further diminishes their overall quality of life (QoL). Current studies demonstrate wide variability in how mobility is assessed, hindering cross-study comparison and limiting targeted rehabilitation strategies.</p><p><strong>Conclusions: </strong>The interstage period of two-stage revision arthroplasty is a critical, yet understudied phase marked by significant physical, psychological, and social challenges that are not fully captured by traditional orthopedic patient-reported outcome measures . Standardized measurement of mobility is needed to assess the impact of limited mobility during the interstage period. Also, novel treatment approaches that shorten or eliminate the interstage period have the potential to mitigate complications, enhance functional recovery, and improve overall QoL for patients undergoing staged management of PJI.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421739","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":"Neuromuscular characteristics of individuals with chronic ankle instability during unilateral landing tasks: a meta-analysis of electromyographic studies.","authors":"Mahsa Hakimi Poor, Reza Rajabi, Mohammad Hossein Alizadeh, Shahrzad Zandi, Ebrahim Ebrahimi","doi":"10.1186/s13018-026-07106-6","DOIUrl":"10.1186/s13018-026-07106-6","url":null,"abstract":"<p><strong>Background: </strong>Chronic ankle instability (CAI) is a prevalent consequence of lateral ankle sprain. Electromyographic (EMG) investigations examining neuromuscular control during unilateral landing tasks have produced inconsistent findings, particularly during the critical post-initialcontact (post-IC) phase. This systematic review and meta-analysis aimed to synthesize current evidence on post-IC muscle activation patterns in individuals with CAI during unilateral landing tasks.</p><p><strong>Methods: </strong>This PRISMA-compliant review (PROSPERO: CRD420261415793) searched PubMed, Scopus, and Web of Science from inception to June 2026. Cross-sectional studies comparing EMG activity between individuals with CAI and healthy controls during unilateral landing tasks were included. Study quality was assessed using Joanna Briggs Institute checklists; random-effects meta-analysis was performed with Comprehensive Meta-Analysis software, evaluating heterogeneity (I², Q-test) and publication bias (Egger's test).</p><p><strong>Results: </strong>Seventeen studies involving 757 participants met the inclusion criteria. Compared with healthy controls, individuals with CAI demonstrated significantly lower post-IC activation of the peroneus longus (p = 0.005), gluteus medius (p = 0.027), and biceps femoris (p = 0.010), alongside significantly greater activation of the soleus (p = 0.036) and rectus femoris (p = 0.013). No significant differences were observed for the tibialis anterior (p = 0.453), medial gastrocnemius (p = 0.552), or lateral gastrocnemius (p = 0.845). Substantial heterogeneity was identified for several muscles, particularly the peroneus longus, tibialis anterior, soleus, and rectus femoris (I² = 76-90%). Subgroup analyses suggested potential sex-related differences in peroneus longus activation patterns.</p><p><strong>Conclusions: </strong>Individuals with CAI exhibit distinct neuromuscular alterations during the post-IC phase of unilateral landing tasks, characterized by reduced activation of key lateral ankle and proximal stabilizing muscles and increased activation of muscles associated with joint stiffening and impact attenuation. Rehabilitation strategies should extend beyond the ankle to target proximal muscle function and landing mechanics to optimize dynamic stability and reduce recurrent injury risk.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421751","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":"Three-dimensional printed artificial vertebral body versus titanium mesh cage and nanohydroxyapatite/polyamide-66 cage in anterior cervical corpectomy and fusion: a retrospective cohort study with a minimum 5-year follow-up.","authors":"Chunke Dong, Ziyi Zhao, Jun Zhou, Shuai Cao, Wenhao Li, Jiafan Ye, Hongyu Wei","doi":"10.1186/s13018-026-07076-9","DOIUrl":"10.1186/s13018-026-07076-9","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Anterior cervical corpectomy and fusion (ACCF) is a commonly performed procedure for cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL), but the choice of reconstructive device after corpectomy remains unsettled. Titanium mesh cages (TMCs) and nanohydroxyapatite/polyamide-66 (n-HA/PA66) cages are both widely used in clinical practice, although subsidence and postoperative loss of cervical alignment remain important concerns. Three-dimensional printed artificial vertebral bodies (3DP-AVBs) have been introduced as an alternative reconstructive option. This study assessed the long-term radiographic and clinical outcomes of 3DP-AVB, n-HA/PA66, and TMC reconstruction after single-level ACCF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective cohort study included 101 patients with CSM or OPLL who underwent single-level ACCF at two centres. Reconstruction was performed using a 3DP-AVB (n = 33), an n-HA/PA66 cage (n = 34), or a TMC (n = 34). Clinical and radiographic data were reviewed with a minimum follow-up of 5 years. Radiographic outcomes included fusion status, subsidence, fused segment height (FSH), and cervical sagittal alignment. Clinical outcomes included the Visual Analog Scale (VAS), Japanese Orthopaedic Association (JOA) score, and Neck Disability Index (NDI). Complications and revision procedures were also recorded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;At final follow-up, the 3DP-AVB group had less loss of FSH than the n-HA/PA66 and TMC groups (1.99 ± 0.73 vs. 2.80 ± 0.70 vs. 3.07 ± 0.81 mm; P &lt; 0.001) and better preservation of cervical sagittal alignment (C2-7 Cobb angle, 19.47 ± 3.31° vs. 15.19 ± 3.25° vs. 15.75 ± 3.54°; P &lt; 0.001). The unweighted subsidence rate was lower in the 3DP-AVB group (15.2% vs. 32.4% vs. 44.1%; P= 0.036), whereas IPTW-weighted analysis showed a numerically lower but nonsignificant trend (17.9% vs. 35.7% vs. 45.8%; P = 0.067). Fusion was achieved in all patients by 12 months. All three groups improved after surgery. Differences in JOA and NDI were observed at 3 months and remained significant at final follow-up (final JOA, 15.09 ± 1.28 vs. 13.59 ± 1.37 vs. 13.53 ± 1.44; final NDI, 10.03 ± 1.57 vs. 11.88 ± 1.45 vs. 11.88 ± 1.61; both  P &lt; 0.001). VAS scores were similar among groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In patients undergoing single-level ACCF, 3DP-AVB reconstruction was associated with better preservation of fused segment height and cervical sagittal alignment during long-term follow-up than n-HA/PA66 or TMC reconstruction. Although subsidence was less frequent in the 3DP-AVB group in the unweighted analysis, the IPTW-weighted comparison showed only a nonsignificant trend and should be interpreted cautiously. All three reconstructive methods achieved fusion and postoperative clinical improvement. Compared with the other two implants, 3DP-AVB may provide greater radiographic durability. Although JOA and NDI scores were s","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412159","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":"Contralateral lower-limb growth after systemic chemotherapy and surgery for high-grade osteosarcoma in children: a retrospective longitudinal MRI study.","authors":"Yu-Hung Tian, Kuan-Lin Chen, Kevin Chi-Yun Kao, Pai-Han Wang, Chao-Ming Chen, Yu-Kuan Lin, Shang-Wen Tsai, Po-Kuei Wu, Cheng-Fong Chen, Wei-Ming Chen","doi":"10.1186/s13018-026-07027-4","DOIUrl":"10.1186/s13018-026-07027-4","url":null,"abstract":"<p><strong>Background: </strong>Osteosarcoma occurs most commonly during adolescence, a period of active skeletal growth. Beyond concerns regarding survival, patients and their families often worry that surgery, perioperative chemotherapy, and the physiological stress of treatment may adversely affect growth. Therefore, the purpose of this study was to evaluate growth patterns in the contralateral limb following treatment for high-grade osteosarcoma.</p><p><strong>Methods: </strong>Consecutive patients 14 years of age or younger treated for high-grade osteosarcoma of the distal femur or proximal tibia between 2012 and 2020, with a minimum follow-up of 5 years and contralateral limb MRI available, were retrospectively reviewed. Serial lower-extremity MRI was used to measure assess longitudinal and transverse skeletal growth. Growth trajectories were analyzed using linear mixed-effects models. Age- and sex-matched percentile curves were used to assess deviations from expected growth.</p><p><strong>Results: </strong>Twenty patients (8 boys, 12 girls; mean age 11.7 ± 2.0 years) were analyzed. Continued contralateral femoral and tibial growth was observed in all patients until physeal closure, without premature growth arrest. Mean annual growth rates were 0.64 ± 0.47 cm/year and 0.41 ± 0.14 cm/year, respectively. Transverse skeletal growth remained proportionate. Nine of twenty patients (45%) demonstrated downward crossing of age- and sex-matched growth percentile bands during skeletal maturation.</p><p><strong>Conclusions: </strong>Pediatric osteosarcoma patients treated with surgery and systemic chemotherapy demonstrated continued growth of the contralateral lower limb without premature physeal closure or disproportionate transverse remodeling. However, downward shifts in growth percentile trajectories were observed, and their clinical significance warrants further investigation. Level of Evidence III, Retrospective cohort study.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412240","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":"Artificial intelligence in shoulder arthroplasty: latest concepts and clinical integration.","authors":"Young Dae Jeon, Jaemin Oh, Ki-Bong Park, Hyeon Jang Jeong, Ji Young Yoon, Joo Han Oh","doi":"10.1186/s13018-026-07104-8","DOIUrl":"10.1186/s13018-026-07104-8","url":null,"abstract":"<p><strong>Background: </strong>Recent advances in artificial intelligence (AI) have redefined shoulder arthroplasty, ultimately improving diagnostic accuracy, refining surgical planning, and personalizing recovery pathways. However, despite promising technical applications, comparative clinical evidence has not yet demonstrated improved routine surgical or patient outcomes in shoulder arthroplasty.</p><p><strong>Review content: </strong>Therefore, this review summarizes the state-of-the-art AI applications in shoulder arthroplasty, highlights their strengths and limitations, and outlines integration strategies that align technological innovation with surgical expertise. Preoperatively, deep learning-based imaging, which refers to machine learning methods that use multilayer neural networks to identify complex patterns in imaging data, has shown strong diagnostic performance in detecting rotator cuff tears and glenohumeral arthritis, while AI-assisted three-dimensional reconstruction and anatomy-based modeling help visualize glenoid deformity and support more intuitive preoperative planning, complementing conventional navigation. Intraoperatively, AI-based phase recognition and robotic assistance may enhance component placement precision while also offering potential benefits in surgical training, workflow standardization, and real-time feedback. In addition, emerging innovations such as mixed reality guidance, multimodal integration, and semi-autonomous assistance continue to expand the potential scope of AI applications in shoulder arthroplasty. Postoperatively, machine learning-driven prognostic models and wearable monitoring systems predict complications and guide tailored rehabilitation, supporting earlier risk identification when required. However, current AI systems are unable to capture surgeon intuition and context-dependent expertise. Nevertheless, emerging strategies such as explainable AI, multimodal integration, federated learning, and semi-autonomous surgical platforms aim to bridge these gaps by enhancing transparency, scalability, and clinical trust.</p><p><strong>Conclusion: </strong>The adoption of AI tools by surgeons depends on their demonstrated reliability across diverse patient anatomies, intraoperative variability, and real-world rehabilitation settings. Thus, technical refinement along with mutual trust with surgeons, supportive regulatory frameworks, and institution-specific implementation strategies are essential for safe integration, particularly because current systems may increase cost, workflow complexity, or delay care when not adequately validated or appropriately implemented.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412213","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":"Four different fixation strategies for ipsilateral femoral neck and shaft fractures: a finite element analysis.","authors":"Yuan Liu, Xiang Zhang, Aïcha Noura Yélèen Traoré, Sujan Shakya, Guichen Liang, Yi Li, Xin Duan","doi":"10.1186/s13018-026-07040-7","DOIUrl":"10.1186/s13018-026-07040-7","url":null,"abstract":"<p><strong>Background: </strong>Ipsilateral femoral neck and shaft fractures are complex injuries that result from high-energy trauma. Despite the availability of multiple fixation strategies, optimal surgical management remains a subject of ongoing debate and comparative biomechanical data are lacking. This study evaluated the stability of four commonly used constructs for internal fixation using patient-specific finite element analysis (FEA) to provide a robust biomechanical rationale for surgical decision-making.</p><p><strong>Methods: </strong>Patient-specific FEA models were reconstructed using computed tomography imaging data of eight patients to simulate a complex injury pattern involving an ipsilateral Pauwels type III femoral neck fracture combined with a comminuted femoral shaft fracture. Four distinct internal fixation strategies were evaluated: proximal femoral nail antirotation, compression plate with cannulated screws, antegrade intramedullary nail with cannulated screws (AN-CS), and long proximal femoral locking plate. Stability parameters were quantified under simulated axial and torsional loading conditions to assess the mechanical performance of each construct.</p><p><strong>Results: </strong>Under both loading conditions, the AN-CS group consistently maintained low levels of femoral and implant displacement while demonstrating a more uniform stress distribution and minimum interfragmentary motion at the femoral neck fracture site.</p><p><strong>Conclusion: </strong>Of the four fixation methods evaluated in this simulation study, the AN-CS construct exhibited the best biomechanical performance overall. The AN-CS fixation effectively balanced interfragmentary stability with a uniform stress distribution, thereby providing a biomechanical basis to guide subsequent clinical decision-making.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405147","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":"Downregulation of miR-6721-5p in the serum of patients with spinal cord injury and its role in regulating microglial inflammation via targeting RTN3.","authors":"Yujun Zhou, Liyu Sun, Haitao Xu, Guidi Su","doi":"10.1186/s13018-026-07091-w","DOIUrl":"https://doi.org/10.1186/s13018-026-07091-w","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord injury (SCI) remains a devastating neurological condition for which treatments are scarce. This work sought to investigate the role of miR-6721-5p in acute traumatic SCI and clarify its downstream mechanisms.</p><p><strong>Methods: </strong>Serum miR-6721-5p was measured in 122 SCI patients and 110 trauma controls, and its diagnostic value was assessed by logistic regression and ROC analysis. In cellular experiments, BV-2 microglial cells were stimulated with LPS to assess the effects of miR-6721-5p on cell viability, inflammation, and oxidative stress. The interaction between miR-6721-5p and RTN3 was validated through luciferase reporter, RNA immunoprecipitation, and rescue experiments.</p><p><strong>Results: </strong>Compared with the control group, patients with SCI showed markedly lower levels of miR-6721-5p. This miRNA correlated negatively with injury severity, CRP, WBC, and NLR. According to the ROC curve, it had a fair ability to discriminate SCI (AUC = 0.887). Multivariate regression analysis identified miR-6721-5p as an independent protective factor. Experiments confirmed RTN3 as a direct target of miR-6721-5p. RTN3 mRNA expression was elevated in SCI patients and inversely correlated with miR-6721-5p levels. In LPS-stimulated BV-2 cells, miR-6721-5p overexpression reversed cell viability reduction and suppressed inflammation and oxidative stress, effects that were reversed by RTN3 overexpression.</p><p><strong>Conclusions: </strong>In patients with SCI, miR-6721-5p is markedly downregulated and may exert protective effects by targeting RTN3 to modulate microglial inflammation and oxidative stress. Results imply that miR-6721-5p holds potential as a biomarker for SCI severity, but further validation in prospective cohorts with matched trauma severity is required.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405036","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":"Increasing age is associated with worse sports function but not daily living function following arthroscopic anterior talofibular ligament repair.","authors":"Nian Sun, Long Li, Yingzhang Cheng, Xiangtian Deng, Bowen Fu, Canjun Zeng, Hao Guo","doi":"10.1186/s13018-026-07079-6","DOIUrl":"10.1186/s13018-026-07079-6","url":null,"abstract":"<p><strong>Background: </strong>Arthroscopic anterior talofibular ligament repair (AATFLR) has been shown to restore ankle function effectively and to provide favourable clinical outcomes in chronic lateral ankle instability (CLAI). The present study was designed to identify variables associated with suboptimal postoperative sports-related functional recovery in patients with CLAI.</p><p><strong>Methods: </strong>Patients who underwent AATFLR between December 2021 and February 2024 were included. Baseline characteristics including age, sex, body mass index, serum uric acid, concomitant avulsion/free bone fragments and osteochondral lesion of the talus were collected. Postoperative outcomes were assessed using the Foot and Ankle Ability Measure-Activities of Daily Living (FAAM-ADL), the FAAM-Sport score, the Karlsson score, the numeric rating scale pain score, and the Tegner score. Multivariable linear regression and ordinal logistic regression analyses were performed to identify variables associated with postoperative functional recovery. Regression coefficients are reported as β.</p><p><strong>Results: </strong>A total of 197 patients were included, with a mean follow-up of 30.0 months. All functional outcomes improved significantly postoperatively (p < 0.001). Multivariate regression analyses demonstrated that increasing age was associated with lower postoperative FAAM-Sport score (β = - 0.51, 95% CI [- 0.78; -0.23], p < 0.001). However, no association was observed between age and the FAAM-ADL score (β = - 0.07, 95% CI [- 0.26; 0.12], p = 0.471). Increasing age significantly reduced odds of achieving higher postoperative Tegner activity levels (OR = 0.947, 95% CI [0.92-0.98], p = 0.002). Female sex was associated with lower postoperative Karlsson score (β = - 6.56, 95% CI [- 10.92; - 2.21], p = 0.003), which did not achieve the minimal clinically important difference. The overall complication rate was 31.0%, consisting predominantly of minor complications.</p><p><strong>Conclusions: </strong>AATFLR significantly improved ankle function and reduced pain in patients with CLAI. Increasing age may be associated with poorer postoperative sports-related functional recovery after AATFLR. However, it may not affect activities of daily living. Sex may not be associated with postoperative functional recovery. Older patients with high athletic demands should be provided with more comprehensive preoperative risk counselling. Level of evidence Level III, retrospective cohort study.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405078","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":"Indirect decompression strategies for single-level lumbar spinal stenosis: a systematic review and meta-analysis of clinical and radiological outcomes of standalone OLIF, ALIF, and interspinous spacers.","authors":"St Fatimah Zahrah Anwar, Karya Triko Biakto, Muhammad Andry Usman, Jainal Arifin, Moh Asri Abidin","doi":"10.1186/s13018-026-07033-6","DOIUrl":"https://doi.org/10.1186/s13018-026-07033-6","url":null,"abstract":"<p><strong>Background: </strong>Lumbar spinal stenosis is a common cause of pain and disability in older adults, increasingly treated with minimally invasive indirect decompression techniques such as standalone oblique lateral lumbar interbody fusion (OLIF), anterior lumbar interbody fusion (ALIF), and interspinous spacers. Although these three approaches are widely used for single-level disease, no randomized trials directly compare their clinical and radiological outcomes, and existing observational data have not been synthesized within a unified indirect decompression framework.</p><p><strong>Methods: </strong>Systematic review following PRISMA 2020 guidelines; searches of PubMed, Scopus, Cochrane CENTRAL, and ProQuest through November 2025. Eight observational studies (N = 465) comparing standalone OLIF, ALIF, or interspinous spacers for single-level LSS were included. Follow-up ranged from 1 week to 36 months.</p><p><strong>Primary outcomes: </strong>Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) at 12 and 24 months.</p><p><strong>Secondary outcomes: </strong>radiological measures and reoperation rates. Risk of bias was assessed using ROBINS-I; evidence certainty via GRADE. This review was prospectively registered with PROSPERO (CRD42023411729).</p><p><strong>Results: </strong>OLIF (3 studies, 102 participants) showed substantial 12-month ODI improvement (- 34.2 points; 95% CI: - 38.3 to - 30.1). ALIF (single 64-patient cohort) showed 24-month ODI improvement of - 37.4 points (95% CI: - 40.8 to - 34.0) with greatest lordosis correction (6.2°). Interspinous spacers (253 participants) achieved initial improvement that deteriorated by 24 months (ODI: - 16.8 points, below MCID threshold), with higher reoperation rates (7.5%) versus ALIF (3.1%) and OLIF (0% in limited data). All radiological parameters significantly favored fusion techniques (p < 0.001).</p><p><strong>Conclusions: </strong>Moderate-quality observational evidence suggests standalone OLIF and ALIF are associated with greater sustained functional improvement than interspinous spacers for single-level LSS beyond 12 months. However, the absence of randomized trials and potential selection bias in treatment allocation preclude definitive causal inferences. Interspinous spacers may be considered for carefully selected high-risk patients with explicit counseling regarding higher reoperation rates. Prospective randomized trials with standardized patient selection criteria are needed.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396922","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":"How the anatomic location affects the surgical outcomes of simple bone cysts in children: a single-center retrospective cohort study.","authors":"Yiming Shen, Lang Jiang, Cheng Jin, Ya Liu, Wendong Liu, Hui Xie, Xiaodong Wang","doi":"10.1186/s13018-026-07053-2","DOIUrl":"10.1186/s13018-026-07053-2","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to investigate the effect of anatomical location on the efficacy of surgical intervention for simple bone cysts (SBC) among children, with a particular focus on comparing differences in clinical characteristics, treatment strategies, and prognosis between humeral and femoral SBCs.</p><p><strong>Methods: </strong>A single-centre retrospective cohort of paediatric patients with SBC undergoing primary surgery (2014-2024) was stratified by location, including humerus, femur, and other sites. Demographic, imaging, and treatment data were collected. Twelve-month postoperative radiographic outcomes (cure/partial residual/recurrence/no response) were analysed using ANOVA and chi-square tests (α = 0.05).</p><p><strong>Results: </strong>In total, 106 patients were included, comprising 57 humeral (53.8%), 36 femoral (34.0%), and 13 other sites (12.2%). Patients with femoral SBC exhibited shorter stature, lower weight, and larger cyst area (all p < 0.05). Humeral SBCs presented more pathological fractures, a higher proportion of active fractures, and thinner cortices (all p < 0.05). At 12 months, 55 patients were cured, 21 exhibited partial residual characteristics, 17 recurred, and 13 showed no response. Anatomical location was significantly correlated with treatment outcome, with humeral cysts revealing higher recurrence rates. Other associated factors included cyst size, cyst index, time from fracture to surgery, distance to growth plate, initial surgical technique, and internal fixation type (all p < 0.05).</p><p><strong>Conclusion: </strong>The anatomical location is a critical factor affecting the postoperative efficacy and recurrence risk of paediatric SBC surgery. Clinical decision-making should integrate location-specific structural risks with the morphological severity of the lesion to optimise surgical timing and technique selection and implement stratified follow-up, thereby improving treatment outcomes for children with high-risk locations.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396843","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}