Journal of Orthopaedic Surgery and Research最新文献

{"title":"Performance and safety of the PYTHEAS Your Guided Trajectory^® for intra-pedicular screw placement in spine surgery.","authors":"Vincent Haignère, Aymeric Faure, Hadrien Giorgi, David Afonso, Guillaume Luquiens, Sarah Kabani, Thierry Chevallier, Pascal Kouyoumdjian","doi":"10.1186/s13018-026-06749-9","DOIUrl":"https://doi.org/10.1186/s13018-026-06749-9","url":null,"abstract":"<p><strong>Purpose: </strong>Safe and accurate pedicular screw placement in spine posterior approach may be a challenging procedure. Navigation systems help reduce pedicular screw mal-positioning. This study aimed to assess the safety and usability of the PYTHEAS Your Guided Trajectory^® angular assistance navigation device for pedicular screw placement.</p><p><strong>Methods: </strong>This prospective, two-centre, single-arm, open-label, first-in-human study recruited 13 adult patients with indication for posterior arthrodesis of at least two lumbar or thoracic vertebrae with placement of pedicle screws at vertebral level. The primary outcome was the performance of the PYTHEAS medical device on the correct direction of pedicle aiming, allowing intrapedicular perforation, without false path. Calibration mode and surgery time were recorded. Surgeon satisfaction of the device was measured using custom questionnaires and usability was assessed according to the System Usability Scale (SUS) questionnaire. The operator defines levels of vertebrae, then per level, entry point and direction of screw, and calibration landmarks using a pre-operative standard CT scan. During surgery, the system is calibrated via specific or global mode according to surgeon preference. Pedicle is canulated using angular guided probe with a real-time display of its current versus planned orientation. Then screw is inserted using angular guided screwdriver.</p><p><strong>Results: </strong>All 83 cannulations were classed as having \"good\" placement according to the palpation technique and confirmed on screenshots of the trajectory taken versus that indicated by the device, and by CT scan. All screw placements were satisfactory on post-operative CT scan. No adverse events were recorded. Surgery time ranged from 50 min to 259 min, corresponding to 23.1 ± 14.7 min per pedicle operated in global calibration mode. Usability score was 74.2 ± 10.9, exceeding the threshold for satisfactory usability. Surgeons were very satisfied with the transfer time and ease of data transfer between the tablet and computer (84.6% and 76.9%, respectively).</p><p><strong>Conclusions: </strong>The PYTHEAS device allowed accurate pedicular screws in thoracic, lumbar and sacral levels, with an excellent safety profile and user satisfaction. Trial registration NCT05565131, registered 30 September 2022.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654208","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":"Polydeoxyribonucleotide improves scar healing following limited scar resection for chronic Achilles tendon rupture in a rat model.","authors":"Haochun Zhang, Wenguang Wu, Yun Su, Chi Xiao, Hongxun Wang, Fengcheng Cui, Weixuan Duan, Xiangjun Meng","doi":"10.1186/s13018-026-06780-w","DOIUrl":"https://doi.org/10.1186/s13018-026-06780-w","url":null,"abstract":"<p><strong>Background: </strong>Chronic Achilles tendon rupture (CATR) results from delayed diagnosis or treatment, leading to retracted tendon ends filled with biomechanically inferior scar tissue. Limited scar resection (LSR) offers a less invasive surgical option by preserving and repairing scar tissue between tendon stumps, but the quality of healing remains suboptimal. Polydeoxyribonucleotide (PDRN) has demonstrated pro-healing properties in tendon disorders, yet its effects on scar remodeling after LSR are unknown.</p><p><strong>Methods: </strong>Chronic Achilles tendon rupture was induced in male Sprague-Dawley rats by full-thickness transection without repair and 4 weeks of unrestricted activity. Animals were randomized into four groups: normal, control (conservative treatment), LSR, and LSR+PDRN. Outcomes were assessed at 3 and 6 weeks post-intervention via macroscopical scoring, biomechanical testing (maximum load, stiffness, stress), histology (modified Movin score), and immunohistochemistry (COL I/III expression).</p><p><strong>Results: </strong>Compared to conservative treatment, LSR technique demonstrated a faster recovery of maximum load to baseline levels, regardless of whether it was combined with PDRN adjuvant therapy. With PDRN supplementation, stiffness was also restored to baseline. Biomechanical outcomes improved throughout the healing process in all experimental groups, with the LSR+PDRN group exhibiting higher maximum load, stiffness, and stress than both the control and LSR groups. At week 3, the LSR+PDRN group showed enhanced fibroblast proliferation and COL III secretion. By week 6, COL I expression was significantly better in the LSR+PDRN group compared to the control and LSR groups, although it still differed from that of normal Achilles tendon.</p><p><strong>Conclusion: </strong>PDRN treatment enhances the biomechanical strength, histological structure, and COL I composition of the scar tissue following LSR in a rat model of CATR.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147645667","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":"Ultrasound-guided hydrorelease/hydrodissection reduces gliding resistance in a rat sciatic nerve adhesion model : a preclinical experimental study.","authors":"Kazuma Miyatake, Shinya Tsujiku, Hyounmin Choe, Yohei Kusaba, Takuma Naka, Reina Nakamura, Hirokazu Arakawa, Shota Fujimori, Yutaka Inaba","doi":"10.1186/s13018-026-06816-1","DOIUrl":"https://doi.org/10.1186/s13018-026-06816-1","url":null,"abstract":"<p><strong>Background: </strong>Ultrasound-guided nerve hydrodissection (HD), often referred to as hydrorelease (HR) in Asia, is increasingly used for peripheral nerve entrapment. Although HD/HR is clinically applied to separate nerves from surrounding tissues and potentially improve symptoms, its mechanical effects on nerve mobility under perineural adhesions remain incompletely understood. This study aimed to establish a mild rat sciatic nerve adhesion model and to evaluate whether ultrasound-guided HR/HD improves nerve gliding without impairing nerve function.</p><p><strong>Methods: </strong>A rat sciatic nerve adhesion model was created in the right thigh by exposing the sciatic nerve, coagulating the nerve bed, and fixing both ends of the nerve to the bed with 8 - 0 nylon sutures; the contralateral side served as control. Adhesion severity was assessed macroscopically at 1, 3, and 6 weeks (stage 0-2) by two examiners, and tensile strength required to detach the nerve from the bed was measured using a digital force gauge. Nerve function at 6 weeks was evaluated by nerve conduction studies (CMAP and motor nerve conduction velocity). Based on model characterization, ultrasound-guided HR/HD was performed at 6 weeks using 2 mL saline to circumferentially dissect the paraneural sheath, and gross adhesion and tensile strength were reassessed one day after injection. Statistical analyses included one-way ANOVA, Tukey's test, and Kendall's coefficient of concordance.</p><p><strong>Results: </strong>Adhesions progressed over time, with most nerves showing stage 2 adhesions at 6 weeks; inter-observer agreement was high (Kendall's coefficient 0.92). Tensile strength increased with time (0.91 ± 0.11 N in controls; 1.12 ± 0.29 N at 1 week; 1.72 ± 0.58 N at 3 weeks; 3.10 ± 0.18 N at 6 weeks), with significantly higher values at 3 and 6 weeks compared with earlier time points (P < 0.05). Motor nerve conduction parameters at 6 weeks did not differ significantly between adhesion and control sides. Ultrasound-guided HR/HD significantly reduced tensile strength in the adhesion model (2.05 ± 0.16 N; P < 0.05 vs. untreated adhesions), although values remained higher than controls.</p><p><strong>Conclusions: </strong>In a rat sciatic nerve adhesion model with preserved nerve conduction, ultrasound-guided HR/HD reduced tensile strength required to detach the nerve from the bed, indicating improved mechanical mobility/gliding under adhesions. These findings support HR/HD as a minimally invasive approach to enhance nerve gliding in mild perineural adhesion conditions and warrant further studies on long-term outcomes and imaging-pathology correlations.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147633785","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":"Artificial intelligence in ACL injury prediction and prevention: a systematic review.","authors":"Mohammad Reza Molavi, Mohamad Mottaghitalab, Parsa Samaei, Hamed Zarei","doi":"10.1186/s13018-026-06825-0","DOIUrl":"https://doi.org/10.1186/s13018-026-06825-0","url":null,"abstract":"<p><strong>Background: </strong>Anterior cruciate ligament (ACL) injuries are prevalent in sports, with significant physical, economic, and long-term health impacts. Artificial intelligence (AI) offers promising solutions for predicting and preventing ACL injuries through advanced data analysis. This systematic review evaluates AI applications in ACL injury prediction and prevention, focusing on techniques, performance metrics, sports contexts, and intervention effectiveness.</p><p><strong>Methods: </strong>Following PRISMA 2020 guidelines, we searched PubMed, Scopus, Google Scholar, and Web of Science from inception to November 1, 2025 for peer-reviewed studies in English using AI for ACL injury prediction or prevention. Studies were excluded if they focused on other injuries or were non-original research. Two reviewers independently screened articles, extracted data (e.g., AI techniques, sample size, outcomes), and assessed methodological quality using the PROBAST + AI. Narrative synthesis was conducted due to methodological heterogeneity.</p><p><strong>Results: </strong>Seven studies, published between 2019 and 2024, were included, involving 5-880 participants (age range 13-22.8 years) across sports like basketball, handball, and soccer. AI techniques included machine learning (e.g., support vector machines, random forest) and deep learning (e.g., convolutional neural networks), with applications in risk prediction and biomechanical assessment. Predictive models achieved accuracies of 79.5-96% and AUCs of 0.63-0.85, while prevention-focused studies reported high validity (e.g., R²: 0.9947-0.9992). Input data ranged from biomechanical parameters to video-based knee angles. PROBAST + AI demonstrated low ROB, indicating robust methodological quality for development.</p><p><strong>Conclusion: </strong>AI demonstrates significant potential in predicting ACL injury risk and informing prevention strategies through biomechanical and kinematic analyses. However, small sample sizes, heterogeneous methodologies, and practical barriers (e.g., equipment costs) limit clinical adoption. Future research should focus on larger, diverse cohorts and standardized protocols to enhance generalizability and implementation.</p><p><strong>Registry number: </strong>CRD420251230914.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147633772","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":"Learning curve for robotic-assisted total knee arthroplasty.","authors":"Filippo Migliorini, Luise Schäfer, Ludovico Lucenti, Jens Schneider, Andrea Maria Nobili, Daniel Kämmer, Nicola Maffulli, Andreas Bell","doi":"10.1186/s13018-026-06835-y","DOIUrl":"10.1186/s13018-026-06835-y","url":null,"abstract":"<p><strong>Introduction: </strong>The learning curve refers to the relationship between a learner's execution of a task and the number of attempts or time necessary to perform it in a predictable, reliable, and optimal fashion. The learner's competence in a task should improve over time as they execute the job more frequently. The present investigation aims to clarify the learning curve associated with robotic-assisted total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>Consecutive patients undergoing total knee arthroplasty at the Department of Orthopaedic Surgery, Eifelklinik St. Brigida, Simmerath, Germany, between 2021 and 2025 were prospectively screened for participation in this clinical study. All procedures were performed through a medial parapatellar approach, following a functional alignment strategy. Implantation was performed in accordance with the manufacturer's recommendations using the Smith & Nephew Legion Genesis II system with a posterior-stabilised polyethylene insert. Both femoral and tibial components were cemented with Palacos cement (Heraeus Medical GmbH, Wehrheim, Germany). Postoperative physiotherapy followed the standard institutional protocol. At hospital admission, demographic variables including age, body mass index (BMI), and sex were recorded. Operative time was documented for each procedure and defined as the interval from skin incision to completion of wound closure.</p><p><strong>Results: </strong>The first 200 robotic-assisted TKAs were monitored. 66% (112 of 200 patients) were women, and 47.5% (95 of 200 TKAs) were performed on the right side. The mean age of the patients was 68.6 ± 8.1 years, and their BMI was 28.6 kg/m². The exponential decay model revealed a characteristic learning curve, characterised by initial rapid gains followed by a plateau. The estimated asymptotic operative time was approximately 89.2 minutes, with a learning rate coefficient of 0.035. This implies that the majority of efficiency improvements occur early, but meaningful reductions persist beyond the 20th case. Block-wise comparisons supported the existence of an earlier functional learning threshold. Statistically significant reductions in operative time, compared with the first 10 cases, were observed from the 41st to 50th procedure block (p = 0.02), with stabilisation in the 90-minute range thereafter.</p><p><strong>Conclusion: </strong>The most efficient gains occur early, and operative times stabilise at around 90 minutes after approximately 40 procedures.</p><p><strong>Registration: </strong>German Registry of Clinical Trials (ID DRKS00030614).</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13130575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627986","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":"Effect of reduced orbital rotation on image quality and intra-articular screw detection in intraoperative 3D imaging of proximal humerus plate fixation: a cadaveric study.","authors":"Benno Bullert, Livia Morlock, Fenna Brunken, Paul A Gruetzner, Sven Y Vetter, Nils Beisemann","doi":"10.1186/s13018-026-06800-9","DOIUrl":"10.1186/s13018-026-06800-9","url":null,"abstract":"<p><strong>Background: </strong>Proximal humerus fractures are common injuries in the elderly, frequently treated with plate osteosynthesis. Intraoperative 2D fluoroscopy provides only limited visualization of the humeral head's complex anatomy, often leading to undetected intra-articular screw perforations. Intraoperative 3D imaging provides enhanced assessment but is technically limited by the confined operating field and the risk of collisions between the C-arm, patient, and operating table. This cadaveric study systematically investigated how progressive reduction of orbital rotation during intraoperative 3D imaging of the proximal humerus affects image quality and intra-articular screw detection accuracy in plate osteosynthesis.</p><p><strong>Methods: </strong>Five fresh-frozen cadaveric shoulders were scanned using an isocentric C-arm. Full 200° scans served as the gold standard. From these datasets, reconstructions with reduced orbital rotations (100°-200°, in 20° increments) were generated under three imaging conditions: (1) without a metal implant, (2) with plate osteosynthesis and extra-articular screw configuration, and (3) with plate osteosynthesis and intra-articular screw configuration. Both configurations were reconstructed with and without metal artifact reduction (MAR), resulting in 30 datasets per specimen. Three blinded raters independently assessed subjective image quality, visualization of the articular surface, intra-articular screw detection, and diagnostic certainty.</p><p><strong>Results: </strong>A reduction of orbital rotation had a significant overall effect on subjective image quality and assessability of articular surfaces (p < 0.001). Post-hoc analysis showed no further significant improvement in image quality beyond 160° of orbital rotation. MAR significantly enhanced image quality and surface visualization (p < 0.001). Sensitivity in detecting intra-articular screws was preserved down to an orbital rotation of 160°, while specificity was unaffected by rotation reduction (p = 0.519). MAR did not significantly influence screw detection accuracy.</p><p><strong>Conclusions: </strong>Intraoperative 3D imaging with a 160° orbital rotation yields sufficient image quality, enabling the reliable identification of intra-articular screws during plate osteosynthesis of the proximal humerus. The additional use of MAR enhances visualization in the presence of metal without increasing the detection rate of misplaced screws. 3D imaging with reduced orbital rotation minimizes spatial demands and collision risks, supporting its practical application as an effective intraoperative imaging technique for the shoulder.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13130734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623336","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 mechanical outcomes of robotic-assisted versus conventional total knee arthroplasty: a retrospective propensity-matched analysis of 163,516 patients.","authors":"Amir Ghafarian, Muaaz Wajahath, Noah Hodson, Jawad Saad, Ali Mehaidli","doi":"10.1186/s13018-026-06770-y","DOIUrl":"https://doi.org/10.1186/s13018-026-06770-y","url":null,"abstract":"<p><strong>Background: </strong>Total knee arthroplasty (TKA) achieves good overall outcomes, yet 15-30% of patients remain dissatisfied, often attributed in part to variability in implant positioning and soft-tissue balance. Robotic-assisted TKA (RA-TKA) aims to improve intraoperative accuracy, but its real-world association with postoperative healthcare utilization and mid-term mechanical outcomes remains uncertain at scale. This study compared 90-day utilization and complication outcomes and 2-year mechanical outcomes of RA-TKA versus conventional TKA (C-TKA) in a large, national propensity-matched cohort.</p><p><strong>Methods: </strong>This retrospective cohort study used the TriNetX US Collaborative Network to evaluate outcomes following primary TKA among adults undergoing TKA between January 2018 and January 2023. Patients receiving RA-TKA were identified and 1:1 propensity-matched to C-TKA patients based on demographics and comorbidities. Primary outcomes were 90-day inpatient hospitalization encounter and 90-day opioid prescription fill. Secondary outcomes included 2-year mechanical outcomes (revision TKA and mechanical loosening diagnoses). Analyses were performed within TriNetX using built-in propensity matching and risk ratio calculations with 95% confidence intervals. After propensity score matching, covariate balance was assessed using standardized mean differences, with values < 0.10 indicating acceptable balance.</p><p><strong>Results: </strong>PSM analysis yielded 6,176 pairs of RA-TKA and C-TKA patients (mean age 65.3 ± 8.6 years; 37.5% female; BMI 32.1 ± 8.7). RA-TKA was associated with lower 90-day inpatient hospitalization encounters (4.0% vs. 5.7%, RR 0.69; p < 0.001) and fewer opioid prescription fills (78.4% vs. 85.8%, RR 0.91; p < 0.001). Early medical and surgical complication rates were similar between groups (all p > 0.05). At 2 years, RA-TKA demonstrated lower rates of revision (1.3% vs. 2.2%, RR 0.58; p < 0.001) and mechanical loosening diagnoses (0.28% vs. 0.78%, RR 0.35; p < 0.001), with no difference in manipulation under anesthesia (3.26% vs. 3.22%, p = 0.919).</p><p><strong>Conclusion: </strong>In this large propensity-matched national cohort, RA-TKA was associated with lower 90-day inpatient hospitalization encounters and opioid prescription fills, and lower coded revision and loosening outcomes at 2 years, while early complication rates were similar. These findings should be interpreted as associations given the use of administrative coding and unmeasured confounding.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623323","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":"Effect of Q-angle symmetry on knee joint kinematics in level walking, upslope walking and landing task.","authors":"Zibo Gao, Qingyang Kang, Yang Liu, Zhihong Qiu, Fangzheng Lin, Ji Qi, Yongjin Li, Dingkun Lin, Xiaolong Zeng","doi":"10.1186/s13018-026-06791-7","DOIUrl":"10.1186/s13018-026-06791-7","url":null,"abstract":"<p><strong>Background: </strong>The quadriceps angle (Q-angle) is a key biomechanical measure of lower limb alignment. While its asymmetry is linked to knee disorders like patellofemoral pain, its dynamic impact on full six-degree-of-freedom (6DOF) knee kinematics across different tasks remains unclear.</p><p><strong>Methods: </strong>Forty healthy university students were categorized into Q-angle symmetric (QS, bilateral difference ≤ 3°) or asymmetric (QA, > 3°) groups. Knee 6DOF kinematics were captured during level walking, 10% upslope walking, and landing task using a 3D motion capture system. The International Physical Activity Questionnaire (IPAQ), Visual Analogue Scale (VAS) for pain, and Kujala score were assessed at baseline and 18-month follow-up. Statistical parametric mapping (SPM1D) was used for kinematic analysis.</p><p><strong>Results: </strong>During level walking, the QA group showed greater internal rotation at 69-74% gait cycle (GC) (p = 0.042) and altered flexion/extension at 75-90% GC (p = 0.012). During upslope walking, the QA group exhibited different flexion/extension at 74-87% GC (p = 0.018). No kinematic differences were found in any 6DOF parameter during landing task. At 18 months, there were no significant intergroup differences in IPAQ, VAS, or Kujala scores (all p > 0.05).</p><p><strong>Conclusion: </strong>Q-angle asymmetry induces task- and phase-specific alterations in knee angular kinematics during walking tasks but does not affect translational kinematics or short-term functional outcomes in healthy young adults. Its biomechanical effect is limited and context-dependent, suggesting caution in using it as a standalone risk marker for knee injury.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"21 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13063520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147645662","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":"MEX3B aggravates osteoarthritis progression by post-transcriptionally activating TLR4-NF-κB signaling axis.","authors":"Zeze Fu, Yanfeng Huang, Siqi Zhang, Jian Chen","doi":"10.1186/s13018-026-06798-0","DOIUrl":"https://doi.org/10.1186/s13018-026-06798-0","url":null,"abstract":"<p><strong>Background: </strong>Osteoarthritis (OA) is a chronic degenerative joint disease characterized by cartilage degradation, synovial inflammation, and subchondral bone remodeling. Toll-like receptors (TLRs), particularly TLR4, are pivotal in driving the inflammatory responses central to OA pathogenesis. The RNA-binding protein MEX3B is implicated in post-transcriptional regulation, but its role in OA remains unexplored.</p><p><strong>Methods: </strong>Bioinformatic analysis of the GSE114007 dataset identified differentially expressed RNA-binding proteins in OA cartilage. MEX3B expression was validated in human OA tissues. In vitro, an inflammatory model was established in primary murine chondrocytes using lipopolysaccharide (LPS). The functional role of MEX3B was assessed through knockdown experiments, evaluating its impact on TLR4 expression, NF-κB pathway activation (measured by p-p65 and p-IκBα levels), and the expression of inflammatory cytokines (IL-1α, TNF-α) and cartilage-degrading enzymes (ADAMTS5, MMP13). Mechanistically, RNA immunoprecipitation and domain-deletion assays were employed to confirm the direct binding of MEX3B to TLR4 mRNA via its KH domain. In vivo, the protective effect of MEX3B knockout was evaluated in a murine ACLT model, with or without intra-articular administration of the TLR4 agonist monophosphoryl lipid A (MPLA).</p><p><strong>Results: </strong>MEX3B was significantly upregulated in OA cartilage. Its knockdown in chondrocytes suppressed TLR4 expression at both mRNA and protein levels, impaired TLR4 membrane localization, and inhibited the NF-κB pathway. This led to a marked reduction in inflammatory mediators and catabolic factors. Mechanistically, MEX3B directly binds to TLR4 mRNA through its KH domain, leading to increased TLR4 protein levels and pathway activation. In vivo, MEX3B deficiency mitigated OA progression, which was effectively reversed by the TLR4 agonist MPLA.</p><p><strong>Conclusion: </strong>Our study unveils a novel mechanism whereby MEX3B, by post-transcriptionally regulating TLR4 expression, activates the NF-κB signaling cascade, thereby promoting inflammation and cartilage breakdown in OA. These findings position MEX3B as a promising therapeutic target for intervening in the inflammatory process of OA.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147618870","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":"Comparative analysis of postoperative outcomes in men and women following total hip replacement surgery.","authors":"Sandra Ruta, Til Leander Riedl, Patrick Orth, Christian Götze, Filippo Migliorini, Julian Koettnitz","doi":"10.1186/s13018-026-06811-6","DOIUrl":"10.1186/s13018-026-06811-6","url":null,"abstract":"<p><strong>Background: </strong>Total hip arthroplasty (THA) is a widely performed procedure to alleviate pain and restore function in patients with advanced hip osteoarthritis. Despite extensive research, the question of sex disparities remains inconclusive, with studies showing comparable or different clinical outcomes.</p><p><strong>Methods: </strong>A prospective analysis was conducted on 167 patients who underwent total hip arthroplasty (THA) between 06/2022 and 06/2023 at a university hospital to analyses sex-specific outcomes. Demographic data, the mobility, the use of walking aids, pre- and postoperative range of motion, pain and the HHS (Harris Hip Score) after six months were collected and analysed. Data analyses were conducted with SPSS Version 29.0.</p><p><strong>Results: </strong>The mean age of the patients was 66.9 ± 10.5 with a percentage of women (w) of 60.5%. After six months the range of motion between the sexes was significantly different with more motion deficits for men (m). For example, women revealed a significantly greater total range of motion (ranks: 70.8 vs. 92.6; p = 0.001) with a higher degree (°) of hip flexion ((w) 103.0° ± 7.5° vs. (m) 98.2° ± 7.4°; p = 0.001) and internal rotation ((w)13.3° ± 6.8° vs. (m) 8.9° ± 6.6°, p = 0.001). The pain in both sides was significantly reduced six months after surgery (rest: 2.2 ± 0.9 vs. 0.6 ± 1.5; movement: 7.3 ± 1.1 vs. 1.6 ± 2.4; for both p = 0.001) but no sex difference could be found. The gait pattern and stair climbing ability were better in men (p = 0.008; p = 0.037), but no significant differences in postoperative satisfaction or quality of life could be detected (p = 0.671; p = 0.409). The combination of a stem with a low offset and cups larger than 55 mm showed better results in the Harris Hip Score (HHS) (mean: 86.9 ± 10.7 vs. 95.3 ± 4.0; p = 0.001), what can be considered an advantage for men.</p><p><strong>Conclusions: </strong>This study shows sex differences in the range of motion and mobility in everyday life. Although the female sex showed better mobility, no differences in satisfaction or quality of life were found six months after surgery. However, the combination of stem and cup size seems to have a relevant influence on postoperative outcome, especially in men.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13064225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147615769","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}