Journal of Orthopaedic Surgery and Research最新文献

{"title":"5E management protocol for enhanced recovery after total knee arthroplasty: stratified RCT.","authors":"Wenchao Gu, Feng Fu, Tingting Wang, Jing Hu, Yang Hu, Fang Li, Li Zhang","doi":"10.1186/s13018-026-06985-z","DOIUrl":"10.1186/s13018-026-06985-z","url":null,"abstract":"<p><strong>Background: </strong>Total knee arthroplasty (TKA) is an effective treatment for end-stage knee osteoarthritis; however, postoperative recovery is frequently hindered by inadequate pain control and delayed functional rehabilitation. Conventional perioperative management often focuses primarily on surgical technique and pharmacologic analgesia, while underemphasizing other modifiable factors such as patient education, nutritional status, and psychological well-being. To address these gaps, we developed a structured multimodal perioperative strategy-the 5E management protocol-integrating Education, Exercise, Eat (nutritional optimization), Emotion (psychological support), and Ease (multimodal pain control). The purpose of this randomized controlled trial was to determine whether the 5E protocol improves early postoperative pain control and functional recovery after TKA, and whether its effects are consistent across clinically relevant patient subgroups.</p><p><strong>Methods: </strong>In this single-center randomized controlled trial, 120 patients undergoing primary TKA for osteoarthritis were randomly assigned to either the 5E management protocol (n = 60) or conventional perioperative care (n = 60). Patients in the 5E group received standardized preoperative education, optimized multimodal analgesia, early mobilization, individualized nutritional support, and structured psychological counseling, whereas the control group received routine care. Postoperative pain was assessed using the Visual Analog Scale (VAS) and Numerical Rating Scale (NRS) during postoperative days 1-5. Functional outcomes were evaluated using the Knee Society Score (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) index at 30 days and 180-360 days postoperatively. Stratified subgroup analyses were performed based on body mass index (BMI), diabetic status, and Kellgren-Lawrence (K-L) grade.</p><p><strong>Results: </strong>Patients managed with the 5E protocol demonstrated significantly better pain control during the early postoperative period compared with those receiving conventional care (VAS day 1: 1.95 vs. 3.08; P < 0.001), with similar trends observed across postoperative days 1-5. At 30 days, the 5E group achieved superior functional outcomes, including higher KSS Pain and Function Scores and lower WOMAC scores (KSS Pain: 67.48 vs. 64.23; P < 0.001). Stratified analyses showed consistent benefits of the 5E protocol across BMI categories, diabetic and non-diabetic patients, and K&L grades 3-4. No significant differences were observed between groups at long-term follow-up (180-360 days). Thrombotic complications (Intramuscular venous thrombosis) occurred in 10 of 60 patients (16.7%) in the 5E group and 8 of 60 patients (13.3%) in the control group, with no significant difference between groups (P = 0.798).</p><p><strong>Conclusion: </strong>The 5E management protocol significantly improves early postoperative pain control and sh","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13366800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391211","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":"Pelvic tilt ratio correlates with distinct spinopelvic muscle patterns in adult spinal deformity with sagittal imbalance: a retrospective cohort study.","authors":"Ronghui Cai, Zhongning Xu, Shuquan Zhang, Jingye Wu, Zhao Lang, Jile Jiang, Yuqing Sun, Tenghui Ge","doi":"10.1186/s13018-026-07092-9","DOIUrl":"10.1186/s13018-026-07092-9","url":null,"abstract":"<p><strong>Background: </strong>Pelvic tilt ratio (PTr), defined as pelvic tilt divided by pelvic incidence, may provide an individualized measure of pelvic retroversion in adult spinal deformity (ASD). However, the spinopelvic muscle characteristics associated with different degrees of pelvic retroversion remain unclear. This study aimed to characterize radiographic, clinical, and spinopelvic muscle features stratified by PTr and to identify muscle parameters independently associated with pelvic retroversion in ASD patients with sagittal imbalance.</p><p><strong>Methods: </strong>Ninety-nine surgically treated ASD patients with preoperative sagittal vertical axis > 50 mm and minimum 2 year follow-up were recruited. Radiographic parameters, patient-reported outcomes, and paraspinal and gluteal muscle parameters were compared across three groups by PTr. LASSO-retained muscle variables, adjusted for age, sex, and body mass index (BMI), were entered into a multivariable linear regression model for PTr.</p><p><strong>Results: </strong>The Large PTr group showed more severe sagittal malalignment, worse preoperative back pain, and greater postoperative radiographic correction. Higher PTr was associated with smaller cross-sectional areas in all three paraspinal muscles, higher erector spinae fat infiltration (ES FIR), and lower gluteus medius fat infiltration (Gmed FIR). LASSO retained multifidus total cross-sectional area (MF TCSA), ES FIR, and Gmed FIR for the final model. In multivariable linear regression, smaller MF TCSA (B = -3.305, P < 0.001), higher ES FIR (B = 0.458, P = 0.024), and lower Gmed FIR (B = -0.883, P = 0.003) were independently associated with greater PTr.</p><p><strong>Conclusions: </strong>In ASD patients with sagittal imbalance, higher PTr was associated with more severe deformity, worse preoperative back pain, and a distinct spinopelvic muscle pattern. Smaller MF TCSA, greater ES FIR, and lower Gmed FIR were independently associated with greater PTr.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and radiological factors associated with recurrent shoulder dislocation after conservative treatment of traumatic primary anterior shoulder dislocation.","authors":"Mert Kahraman Marasli, Kaan Berk Karasungur, Omer Furkan Oz, Ali Cavit, Birkan Kibar, Hakan Serhat Yanik","doi":"10.1186/s13018-026-07069-8","DOIUrl":"10.1186/s13018-026-07069-8","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to evaluate the clinical and radiological factors affecting the development of recurrent shoulder dislocation in patients who have been followed up with conservative treatment after the traumatic primary anterior shoulder dislocation (TPASD), and to identify patient subgroups at high risk of recurrence.</p><p><strong>Methods: </strong>Fifty-four patients (40 males and 14 females) aged 18-65 years who presented with first-time traumatic anterior shoulder dislocation and were treated conservatively were retrospectively evaluated. Patients with and without recurrent instability during a minimum follow-up of 12 months were compared regarding age, sex, affected side, Bankart lesion, bony Bankart lesion, greater tuberosity fracture, rotator cuff tear, Hill-Sachs lesion, Hill-Sachs lesion depth, glenoid version, and rotator interval width. Multivariable logistic regression analysis was performed to identify independent predictors of recurrent instability.</p><p><strong>Results: </strong>The recurrence rate was 46.3% after a minimum follow-up of 12 months. Univariate analysis demonstrated significant associations between recurrent instability and younger age, male sex, the presence of bony Bankart lesions, the presence and depth of Hill-Sachs lesions, and the absence of rotator cuff tears. No significant differences were observed regarding affected side, Bankart lesions, greater tuberosity fractures, glenoid version, or rotator interval width. In multivariable logistic regression analysis, the presence of a Hill-Sachs lesion remained an independent predictor of recurrent instability (OR 7.88, 95% CI 1.77-35.08, p = 0.007).</p><p><strong>Conclusion: </strong>Recurrent instability following conservative treatment of first-time traumatic anterior shoulder dislocation is strongly associated with structural bone defects. Although younger age and male sex were associated with recurrence in univariate analyses, multivariable analysis identified the presence of a Hill-Sachs lesion as the strongest independent predictor of recurrent instability. Detailed radiological assessment may therefore facilitate risk stratification and treatment decision-making following TPASD.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387700","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":"Preoperative MRI and clinical indicators for predicting meniscal repairability: a machine learning-based study.","authors":"Peipei Hao, Kun Cheng, Yun Xu, Zhongliu Liu, Jing Yao, Aijun Shen","doi":"10.1186/s13018-026-07095-6","DOIUrl":"https://doi.org/10.1186/s13018-026-07095-6","url":null,"abstract":"<p><strong>Objectives: </strong>To develop and internally validate a radiology-centered machine-learning model using preoperative MRI and clinical characteristics to predict arthroscopic meniscal repairability.</p><p><strong>Methods: </strong>A retrospective cohort of 491 patients who underwent knee MRI followed by arthroscopy between 2018 and 2023 was analyzed. Preoperative predictors included demographic variables, injury mechanism, and a comprehensive set of MRI-derived features. Meniscal morphology, bone marrow edema, joint effusion, cruciate ligament integrity, cartilage degeneration, tear displacement, ramp lesion, and extrusion distance were systematically assessed by two musculoskeletal radiologists. Interobserver agreement was evaluated using Cohen's kappa and intraclass correlation coefficients (ICCs). Least absolute shrinkage and selection operator (LASSO) regression was used to identify the most informative predictors. Logistic regression, random forest, gradient boosting machine (GBM), and support vector machine (SVM) models were trained using five-fold stratified cross-validation with hyperparameter tuning via grid search. Model performance was evaluated using area under the receiver operating characteristic curve (AUC) with 95% confidence intervals, calibration metrics (calibration slope, intercept, and Brier score), and decision curve analysis (DCA).</p><p><strong>Results: </strong>LASSO selected 13 preoperative predictors spanning eight clinically relevant domains. Logistic regression achieved the highest cross-validated performance (AUC = 0.777, 95% CI 0.735-0.819), followed by SVM (AUC = 0.771), random forest (AUC = 0.770), and GBM (AUC = 0.755). Multivariable logistic regression identified ACL injury (OR 0.38, 95% CI 0.25-0.57, p < 0.001), high-grade cartilage degeneration (OR 0.42, 95% CI 0.28-0.63, p < 0.001), greater BMI (OR 1.08 per kg/m², 95% CI 1.03-1.13, p = 0.002), male sex (OR 0.51, 95% CI 0.33-0.78, p = 0.002), and ≥ 3 mm tear displacement (OR 0.44, 95% CI 0.29-0.67, p < 0.001) as independent predictors of non-repairability. Calibration analysis demonstrated good agreement between predicted and observed probabilities (calibration slope 0.95, intercept -0.08, Brier score 0.21). DCA demonstrated that logistic regression and random forest provided the greatest clinical net benefit across practical threshold probabilities.</p><p><strong>Conclusion: </strong>A radiology-based machine-learning model integrating detailed preoperative MRI features can accurately predict meniscal repairability with internally validated performance and may assist surgeons in optimizing arthroscopic decision-making and surgical planning pending prospective external validation.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387688","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":"Novel artificial transverse atlantal ligament reconstruction for atlantoaxial instability: a finite element analysis.","authors":"Qiu Du, Daigui Cao, Jing Peng, Zhiwei Liu, Xu Zhou, Xiaomin Qian, Wenli Ke, Kai Shen","doi":"10.1186/s13018-026-07077-8","DOIUrl":"10.1186/s13018-026-07077-8","url":null,"abstract":"<p><strong>Background: </strong>The transverse atlantal ligament (TAL) serves as a crucial anatomical structure in maintaining atlantoaxial stability. Currently, fusion surgery remains the primary therapeutic approach for atlantoaxial instability (AAI) resulting from TAL rupture. However, this surgical intervention inevitably leads to the loss of atlantoaxial mobility and may accelerate degeneration of adjacent segments. Reconstruction of the TAL may emerge as a potential solution to address these clinical challenges. The objective of this study is to evaluate the functionality and stability of an artificial transverse atlantal ligament (ATAL) .</p><p><strong>Methods: </strong>A normal C0-C3 finite element analysis (FEA) model was developed and validated. Based on this model, additional models were constructed, including a TAL rupture model, a posterior C1-C2 screw and rod fixation model, and four ATAL reconstruction model with varying preload forces. Each model was subjected to anterior-posterior (AP) displacement and range of motion (ROM) tests under a 100 N AP load and a 1.5 Nm rotational moment. The functionality and stability of the C1-C2 segment were analyzed across the models based on the experimental results.</p><p><strong>Results: </strong>Under a 100 N AP load, the AP displacement of the TAL rupture group increased significantly compared with the intact group. In contrast, the AP displacement of the ATAL reconstruction group without preload slightly decreased compared with the intact group. Under a 1.5Nm rotational moment, in the ATAL reconstruction group without preload, compared to the intact group, the C1-C2 flexion, extension, and lateral bending increased by 2.43%, 5.32%, and 20.82%, respectively, while rotation decreased by 1.18%, and compared to the TAL rupture group, the C1-C2 flexion and rotation slightly decreased by 0.76% and 2.04%, respectively, with no significant changes in extension and lateral bending. Compared to the posterior C1-C2 screw and rod fixation group, the C1-C2 ROM in all directions significantly increased in the ATAL reconstruction group.</p><p><strong>Conclusions: </strong>ATAL reconstruction enables the atlantoaxial joint to achieve sufficient stability while effectively preserving its ROM in all directions. This approach represents a paradigm shift from the current reliance on fusion techniques, which severely restrict atlantoaxial mobility, offering a novel therapeutic strategy for addressing AAI caused by TAL rupture.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382231","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 wall/arthroscopy/posterior facet (MAP) strategy for displaced intra-articular calcaneal fractures: evaluation of a novel minimally invasive protocol in a retrospective comparative cohort.","authors":"Yixuan Chen, Jiachen Wu, Shutao Zhang, Tianyi Wu, Daoyu Zhu, Chang Liu, Xin Ma, Mingjie Tang, Zhongmin Shi","doi":"10.1186/s13018-026-06925-x","DOIUrl":"10.1186/s13018-026-06925-x","url":null,"abstract":"<p><strong>Background: </strong>Displaced intra-articular calcaneal fractures (DIACFs) pose substantial challenges due to their complex three-dimensional deformity and the high risk of soft tissue complications. Minimally invasive percutaneous methods and subtalar arthroscopy have emerged to mitigate soft tissue injury, but their limited exposure often hinders reliable reduction of the medial wall. To address these limitations, we developed a novel MAP strategy (Medial wall/Arthroscopy/Posterior facet) that prioritizes a medial-to-lateral sequence to achieve effective and stable reduction.</p><p><strong>Methods: </strong>This retrospective analysis included 180 cases of unilateral DIACFs treated between 2022 and 2024. Patients were classified into three groups based on the surgical treatment as follows: arthroscopy-assisted percutaneous screw fixation (MAP, 40 cases), percutaneous screw fixation (PF, 49 cases), and open reduction and internal fixation (ORIF, 91 cases). Outcomes were assessed at 12 months postoperatively, including complications, radiographs, and functional scores using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot score, visual analog scale (VAS) and Maryland Foot Score.</p><p><strong>Results: </strong>The MAP group exhibited the longest surgical duration (80.0 [70.0, 90.0] min) but had the shortest hospital stay (5.0 [4.0, 6.0] days). The ORIF group experienced a longer preoperative delay (6.0 [6.0, 7.0] days) and had a significantly higher overall complication rate compared to the MAP and PF groups (31.9% vs. 15.0% and 14.3%, p = 0.027). At the 12-month postoperative follow-up, the MAP group demonstrated significantly greater AOFAS scores (84.50 [78.25, 86.00]) compared to the PF group (80.00 [75.00, 84.00], p = 0.029) and the ORIF group (81.00 [74.00, 86.00], p = 0.021). The VAS pain score in the MAP group (2.00 [1.25, 3.00]) was significantly lower than that in the ORIF group (3.00 [2.00, 3.00], p = 0.009). Regarding radiographic assessments, all three groups demonstrated satisfactory postoperative restoration in Böhler's angle, calcaneal height, and calcaneal width compared to preoperative baselines, with no significant intergroup differences observed.</p><p><strong>Conclusion: </strong>In this retrospective cohort study, the MAP strategy was associated with favourable short-term functional outcomes and a low rate of soft-tissue complications in DIACFs.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382282","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":"Calcaneonavicular ligament in early and flexible progressive foot deformity: a case-control study.","authors":"Beatriz Martínez-Sañudo, Eva Lopezosa-Reca, Francisco-Javier Martínez-Barrios, Salvador Fornell, Marcos González-Alonso, Sergio Tejero","doi":"10.1186/s13018-026-06912-2","DOIUrl":"10.1186/s13018-026-06912-2","url":null,"abstract":"<p><strong>Background and objectives: </strong>Progressive Collapsing Foot Deformity (PCFD), a multifactorial disorder, involves the synergistic failure of dynamic restraints, primarily the posterior tibial tendon (PTT), and static restraints, chiefly the calcaneonavicular ligament (SL). The necessity of routinely reconstructing the SL complex in the early, flexible stages of the disease is a significant clinical debate.To clarify this, this study aimed to assess whether measurable macro-structural changes, specifically alterations in the ultrasonographic thickness of the supramedial fasciculus of the calcaneonavicular ligament, are already established in patients presenting with symptomatic, flexible PCFD compared with healthy controls.</p><p><strong>Methods: </strong>An observational cross-sectional study (level of evidence: III, prognostic study) included 108 adult subjects: a symptomatic flexible PCFD group (n = 55) and a control group (n = 53). Exclusion criteria were strictly implemented to prevent the inclusion of advanced, rigid deformities, specifically excluding patients presenting with talar uncoverage greater than 50% on weight-bearing anteroposterior radiographs or a plantar sag indicative of severe collapse on lateral radiographs. The thickness of the calcaneonavicular ligament (SL) was the primary outcome measure measured using high-frequency ultrasound. Secondary measures included PTT thickness to confirm the pathological status of the experimental cohort.</p><p><strong>Results: </strong>The mean thickness of the calcaneonavicular ligament showed no statistically significant difference between the control group (5.07 mm, SD = 0.116) and the PCFD group (4.81 mm, SD = 0.119) (p = 0.368). This demonstrates the structural integrity of the SL complex in the early, flexible stage of the deformity. In contrast, all measurements of the PTT demonstrated significant thickening in the experimental group, confirming established tendinosis (p < 0.001).</p><p><strong>Conclusions: </strong>In symptomatic, flexible Progressive Collapsing Foot Deformity dynamic tissue pathology (PTT tendinosis) is established, yet the structural thickness of the superomedial calcaneonavicular ligament remains stable. This supports a temporal pathomechanical sequence in which the dynamic restraint failure precedes the gross dimensional collapse of the primary static stabilizer. The preservation of SL structural stability in early disease stages argues against the routine, mandatory exploration and reconstruction of the medial soft tissues unless functional dynamic imaging reveals severe laxity.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368834","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":"Tumor survivors' musculoskeletal health assessment: advances in imaging biomarkers for cancer treatment-related sequelae.","authors":"Jingxin He, Huichun Xiang, Shufen Xiao, Xingshun Zhou","doi":"10.1186/s13018-026-07090-x","DOIUrl":"10.1186/s13018-026-07090-x","url":null,"abstract":"<p><p>With significant advancements in cancer treatment, the population of cancer survivors has grown substantially, bringing long-term health challenges to the forefront of clinical concern. Among these, cancer treatment-related musculoskeletal sequelae critically impact survivors' quality of life, functional independence, and overall survival. Musculoskeletal health deterioration-including bone density loss, sarcopenia, myosteatosis, osteonecrosis, and muscle damage-represents a complex clinical issue that requires precise evaluation and monitoring. Imaging technologies have emerged as essential non-invasive tools for identifying, quantifying, and tracking these late effects. This review systematically examines the current landscape of imaging biomarkers used to assess musculoskeletal health in cancer survivors, emphasizing their associations with common cancer therapies such as radiotherapy, chemotherapy, endocrine therapy, and targeted and immunotherapies. We explore the application and recent advances of various imaging modalities-including dual-energy X-ray absorptiometry (DXA), quantitative computed tomography (QCT), magnetic resonance imaging (MRI), positron emission tomography/computed tomography (PET/CT), and ultrasound imaging-in detecting and characterizing treatment-induced musculoskeletal alterations. Moreover, the review highlights the translational potential of these imaging biomarkers in clinical practice, aiming to enhance early detection, guide personalized interventions, and improve long-term outcomes for cancer survivors. By consolidating current evidence and identifying existing gaps, this article provides a comprehensive overview of the role of imaging biomarkers in addressing the critical issue of musculoskeletal health in the growing population of cancer survivors.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148376109","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":"Sagittal alignment and patellofemoral consequences of open wedge high tibial osteotomy: a comparative radiological and gait analysis of supratubercle and distal tibial tuberosity techniques.","authors":"Jian Cai, Shaohua Liu","doi":"10.1186/s13018-026-07065-y","DOIUrl":"10.1186/s13018-026-07065-y","url":null,"abstract":"<p><strong>Background: </strong>The optimal osteotomy configuration in medial open-wedge high tibial osteotomy (OWHTO) remains debated. Descending biplanar and ascending biplanar techniques differ regarding biomechanical stability, risk of patellar height alteration, and hinge-related complications, yet high-quality comparative evidence integrating clinical, radiological, and gait-level functional outcomes is lacking.</p><p><strong>Methods: </strong>In this retrospective comparative cohort study, we reviewed 96 patients with medial compartment knee osteoarthritis who underwent supratubercle biplanar OWHTO (STB-OWHTO, n = 45) or distal tibial tuberosity osteotomy OWHTO (DTT-OWHTO). Clinical outcomes (Hospital for Special Surgery score), radiological parameters (weight-bearing line ratio, posterior tibial slope, and Caton-Deschamps index [CDI]), and gait biomechanics (spatiotemporal, kinematic, and kinetic variables, including the knee adduction moment) were retrospectively extracted from medical records and an institutional gait-analysis database preoperatively and at an early postoperative follow-up (mean duration, ~ 60 days).</p><p><strong>Results: </strong>Baseline characteristics were comparable between the two groups. Both techniques yielded significant improvements in the HSS score and gait performance alongside a marked reduction in KAM (all P < 0.001). STB-OWHTO exerted a greater coronal realignment effect on WBLR (group-by-time interaction P = 0.016), while it was associated with an increase in the posterior tibial slope (+ 5.26°, P < 0.001) and a reduction in patellar height (CDI = - 0.17, P < 0.001). Conversely, DTT-OWHTO preserved patellar height (insignificant CDI change, P = 0.169) and reduced the posterior tibial slope (P = 0.003). Spatiotemporal gait improvements were similar between the two groups. Small between-group differences in stance-phase knee flexion were identified.</p><p><strong>Conclusion: </strong>Both STB-OWHTO and DTT-OWHTO provide early clinical improvement and effective medial compartment unloading during gait in varus knee osteoarthritis, while they produce distinct sagittal-plane and patellofemoral consequences. The osteotomy configuration should be individualized according to the patellofemoral status, ligament considerations, and the desired slope modification.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368814","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":"Efficacy of polymethyl methacrylate combined with calcium phosphate cement in percutaneous vertebroplasty for postmenopausal women with osteoporotic thoracolumbar compression fractures.","authors":"Ming Chen, Jianchao Cui, Zhuoyan Cai, Youtao Liu, Yuan Chen, Zhensong Yao, Yuerong Xu","doi":"10.1186/s13018-026-07038-1","DOIUrl":"10.1186/s13018-026-07038-1","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To evaluate the safety and efficacy of polymethyl methacrylate bone cement combined with calcium phosphate bone cement in percutaneous vertebroplasty for postmenopausal women, compared with polymethyl methacrylate bone cement alone.</p><p><strong>Methods: </strong>We analyzed the clinical data of 114 postmenopausal female patients who underwent single-level thoracolumbar PVP surgery at the Orthopedics Department of Baiyun Hospital, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, from January 2023 to June 2024.A total of 55 patients were included in the conventional group and 59 patients were assigned to the combined group, based on the type of filler used during the procedure.Comparative assessments included general demographic characteristics, low back pain Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) scores, perioperative parameters (e.g., operative duration, intraoperative blood loss, time to ambulation), imaging findings, postoperative complications, and adverse events.</p><p><strong>Results: </strong>All patients successfully underwent the procedure and were followed up for at least one year. No significant differences were observed in baseline data between the two groups.At postoperative follow-up, both groups showed significantly lower low-back pain Visual Analog Scale (VAS) scores and Oswestry Disability Index (ODI) scores compared with preoperative values (P < 0.05). At 1 day and 1 month after surgery, the combined group had significantly lower VAS and ODI scores than the conventional group (P < 0.05). However, by 1 year postoperatively, there were no significant differences in VAS or ODI scores between the two groups (P > 0.05).Compared with preoperative measurements, both groups exhibited significant improvement in lumbar lordosis angle, sagittal Cobb angle, thoracic kyphosis angle, thoracolumbar kyphosis angle, coronal Cobb angle, and vertebral body height at postoperative follow-up (P < 0.05).Furthermore, compared with the conventional group, the combined group demonstrated a lower incidence of cement leakage and adjacent vertebral refracture after PVP, as well as less residual postoperative back pain.</p><p><strong>Conclusions: </strong>In percutaneous vertebroplasty (PVP) for thoracolumbar vertebral compression fractures in postmenopausal women, the application of methyl methacrylate (PMMA) combined with calcium phosphate cement (CPC) is safe and effective. It significantly alleviates pain, improves surgical outcomes, and enhances patient satisfaction. The efficacy and safety of this combined approach are comparable to PMMA cement alone, with advantages in reducing back pain, improving quality of life, lowering the risk of cement leakage, and decreasing the incidence of adjacent vertebral fractures.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361047","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}