Journal of Orthopaedic Surgery and Research最新文献

{"title":"Barbed versus traditional sutures in primary total knee arthroplasty: systematic review and meta-analysis of clinical outcomes and wound-related complications.","authors":"Hamed W Babtain, Abdalmalik T Malki, Awwab A Shahhatalsayed, Basmah S Alweal, Retal E Faidah, Anas M Alqarni, Loai A Alsulimani, Abdulrahman H Albadri, Muath S Alqahtani, Dhafer S Almuffarh","doi":"10.1186/s13018-026-07036-3","DOIUrl":"https://doi.org/10.1186/s13018-026-07036-3","url":null,"abstract":"<p><strong>Background: </strong>Despite the widespread use of total knee arthroplasty (TKA), the optimal wound closure technique remains clinically unresolved. Barbed sutures have been proposed as a knotless alternative to traditional sutures, with potential advantages in operative efficiency and wound closure; however, concerns remain regarding postoperative complications. This systematic review and meta-analysis aimed to compare the clinical outcomes and postoperative complications associated with barbed versus traditional sutures in patients undergoing primary TKA.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted using MEDLINE/PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), ScienceDirect, Scopus, and Embase from database inception through November 2025. Eligible studies were restricted to randomized controlled trials (RCTs) involving adults undergoing primary TKA that directly compared barbed with traditional (knotted) sutures and reported at least one predefined clinical or wound-related outcome. Primary outcomes included wound closure time, superficial wound infection, postoperative Knee Society Score (KSS), knee range of motion (ROM), and wound-related adverse events. Meta-analysis was performed using RevMan version 5.3. The study was registered in PROSPERO (CRD420251128395) and received Institutional Review Board (IRB) approval from King Abdullah International Medical Research Center (Protocol No. NRJ25/044/8).</p><p><strong>Results: </strong>Five randomized controlled trials involving 1035 patients mettheeligibilitycriteria. Barbed sutures appeared to be associated with shorter wound closure times (MD = - 5.39 min, 95% CI: - 9.89 to - 0.88; P = 0.02). However, substantial heterogeneity was observed across studies. Superficial wound infection was significantly more frequent with barbed sutures (OR = 2.33, 95% CI: 1.07-5.05; P = 0.03). No significant differences were observed in postoperative KSS at 6 weeks and 3 months (MD = 0.42, 95% CI: - 0.88 to 1.72; P = 0.53).</p><p><strong>Conclusion: </strong>Barbed sutures may reduce wound closure time during TKA but are associated with a higher risk of superficial wound infection. No significant differences were observed in early functional outcomes, and further high-quality studies are needed to clarify long-term safety and efficacy.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338958","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":"Calcaneal locking intramedullary nailing versus extensile lateral plating for displaced intra‑articular calcaneal fractures: a propensity‑weighted cohort study focusing on perioperative soft‑tissue burden and early recovery trajectories.","authors":"Liang Liu, Dong Wang, Qidong Guo","doi":"10.1186/s13018-026-07073-y","DOIUrl":"10.1186/s13018-026-07073-y","url":null,"abstract":"<p><strong>Background: </strong>Displaced intra-articular calcaneal fractures (DIACFs) are among the most challenging hindfoot injuries and are often associated with persistent disability, reduced quality of life, and treatment-related complications [1, 2]. Although extensile lateral open reduction and plate fixation can restore calcaneal anatomy, it is accompanied by substantial soft-tissue morbidity [3-6]. Locking intramedullary nailing (IMN) is less invasive, yet comparative studies often emphasize overall complication rates and long-term functional scores, with limited quantification of perioperative soft-tissue management burden and early recovery trajectories [9, 10].</p><p><strong>Methods: </strong>We performed a retrospective cohort study comparing locking IMN with extensile lateral plating (ORIF) in adults with DIACFs. The primary outcomes were (1) a Soft‑Tissue Burden Index (STBI) incorporating drain utilization, postoperative drainage volume, wound leakage duration, dressing changes, aspiration for hematoma/seroma, and soft‑tissue reintervention; and (2) early recovery trajectories using repeated pain scores (VAS) and patient‑reported outcomes (Foot Function Index, FFI) at prespecified time points (2, 6, and 12 weeks; 6 and 12 months). Confounding was addressed using inverse probability of treatment weighting (IPTW) [13-15, 17].</p><p><strong>Results: </strong>Ninety patients were included (IMN n = 28; ORIF n = 62). After IPTW, baseline covariates were balanced. IMN demonstrated a lower STBI than ORIF (weighted mean 1.3 ± 1.1 vs. 3.5 ± 1.4; p < 0.001), driven by reduced drain utilization (3/28 [11%] vs. 59/62 [95%]; p < 0.001) and fewer dressing changes within 14 days (2.2 ± 1.5 vs. 6.4 ± 3.1; p < 0.001). Early recovery favored IMN, with lower VAS at 6 weeks (2.5 ± 1.2 vs. 3.7 ± 1.4; p < 0.001) and 12 weeks (1.7 ± 1.0 vs. 2.4 ± 1.2; p = 0.020), and better FFI at 6 weeks (52.3 ± 14.7 vs. 63.1 ± 15.4; p < 0.001) and 12 weeks (34.4 ± 12.3 vs. 43.2 ± 13.1; p = 0.003). Time to full weight bearing was shorter in IMN (10.7 ± 2.3 vs. 12.9 ± 2.6 weeks; p = 0.004). Twelve‑month functional outcomes were similar (FFI 16.8 ± 8.6 vs. 18.2 ± 9.4; p = 0.520). Wound‑related complications were lower in IMN (1/28 [4%] vs. 12/62 [19%]; p = 0.048).</p><p><strong>Conclusions: </strong>Locking IMN showed lower perioperative soft‑tissue burden and faster early recovery compared with extensile lateral plating, while maintaining similar mid‑term outcomes.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345357","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":"Epigenetic dysregulation in osteonecrosis of the femoral head: a critical review of DNA methylation, histone modifications, and clinical translation.","authors":"Guoqi Ji, Weiying Ge, Bowen Shi, Jian Chen, Yabin Liu, Zhiming Zhao","doi":"10.1186/s13018-026-07032-7","DOIUrl":"10.1186/s13018-026-07032-7","url":null,"abstract":"<p><p>Osteonecrosis of the Femoral Head (ONFH) is a progressive osteoarticular disease caused by local ischemia, ultimately leading to femoral head collapse and loss of joint function. Epigenetics has emerged as a pivotal tool for unraveling the complex pathogenesis of ONFH, with DNA methylation and histone modifications playing central roles. These key epigenetic mechanisms critically regulate osteocyte function, bone remodeling, and angiogenesis. Aberrant DNA methylation silences osteogenic genes, e.g., runt-related transcription factor 2(RUNX2), bone morphogenetic protein 2(BMP2) and angiogenic factors (e.g., VEGF), thereby impairing bone repair and revascularization. Concurrently, histone modifications (e.g., H3K27ac, H3K27me3) dynamically modulate chromatin accessibility, influencing osteocyte fate and bone remodeling homeostasis. These epigenetic alterations interact with signaling pathways such as Wnt/β-catenin, PI3K/Akt, and HIF-1α, forming a regulatory network that drives disease progression. However, the precise molecular mechanisms and interactive networks remain incompletely elucidated. This review systematically summarizes recent advances regarding the roles of DNA methylation and histone modifications in ONFH, discusses their impact on disease pathology, and aims to provide a theoretical foundation and identify potential targets for early diagnosis and precision therapy of ONFH.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13573461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338920","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":"The impact of two-dimensional and three-dimensional computed tomography on the decision to operate in distal radius fractures: a multicenter survey-based study.","authors":"Osman Görkem Muratoğlu, Cem Yıldırım, Hasan Ceylan, Gökhan Güzel, Volkan Karaduman, Necati Doğan","doi":"10.1186/s13018-026-07049-y","DOIUrl":"10.1186/s13018-026-07049-y","url":null,"abstract":"<p><strong>Objective: </strong>Imaging modalities play a critical role in determining surgical versus conservative management for distal radius fractures. This study aimed to evaluate the impact of two-dimensional (2D) and three-dimensional (3D) computed tomography (CT) on the decision to operate in distal radius fractures and to compare their influence between AO Type B and Type C fractures.</p><p><strong>Methods: </strong>This cross-sectional, survey-based study included 97 orthopedic and traumatology specialists. Twelve distal radius fracture cases classified according to the AO system (six Type B and six Type C) were selected. Participants were sequentially presented with plain radiographs, post-reduction radiographs in cast, 2D CT images, and 3D CT reconstructions for each case. After each imaging stage, participants were asked to indicate their decision to operate (surgical or conservative). Changes in the decision to operate were statistically analyzed.</p><p><strong>Results: </strong>Among AO Type B fractures, the addition of CT imaging to plain and post-reduction radiographs did not significantly change the decision to operate in most cases (p > 0.05). In contrast, among AO Type C fractures, the addition of 2D CT imaging significantly changed the decision to operate in favor of surgical management (p < 0.05), whereas the subsequent addition of 3D CT did not produce a further significant change (p > 0.05).</p><p><strong>Conclusion: </strong>For AO Type B distal radius fractures, the addition of CT imaging to plain and post-reduction radiographs had limited impact on the decision to operate. In AO Type C fractures, 2D CT imaging significantly influenced the decision to operate, whereas the subsequent addition of 3D CT did not provide an additional impact on the decision to operate.</p><p><strong>Level of evidence iii: </strong>Descriptive survey study.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of convex-side spinal canal elongation with distraction spinal cord injury during severe adolescent scoliosis correction: a retrospective cohort study.","authors":"Chaofan Han, Honghao Yang, Zihao Ding, Guoan Li, Yong Hai","doi":"10.1186/s13018-026-07058-x","DOIUrl":"10.1186/s13018-026-07058-x","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between spinal canal elongation during deformity correction and distraction spinal cord injury (DSCI) in severe adolescent idiopathic scoliosis.</p><p><strong>Methods: </strong>We retrospectively analyzed 79 patients with severe AIS (Major Cobb angle > 80°) who underwent posterior correction and had both preoperative and postoperative computed tomography scans available for three-dimensional reconstruction. Spinal canal length (SCL) was measured preoperatively and postoperatively at the concave, central, and convex aspects of the canal. The cross-sectional area of the spinal canal (CSA) was also recorded. Logistic regression was used to assess associations between spinal canal parameters and postoperative neurological injury. Receiver operating characteristic (ROC) analysis was performed to evaluate discriminative performance and to derive cohort-specific candidate cut points using the maximum Youden index.</p><p><strong>Results: </strong>Among 79 included patients, 13 (16.5%) developed DSCI. The DSCI group showed a smaller CSA (151.3 ± 19.8 vs. 181.1 ± 40.7 mm², p = 0.010) and greater SCL elongation at the concave side (10.1 ± 5.6 vs. 7.5 ± 3.6 mm, p = 0.008), central line (8.8 ± 3.9 vs. 5.0 ± 3.0 mm, p < 0.001), and convex side (7.6 ± 3.3 vs. 3.4 ± 2.7 mm, p < 0.001). Multivariate analysis identified convex SCL elongation (OR = 2.230, 95% CI 1.329-3.739, p = 0.002) and CSA (OR = 0.950, 95% CI 0.916-0.985, p = 0.006) as independent factors associated with DSCI. Convex SCL showed the highest discriminative ability on ROC analysis (AUC = 0.86).</p><p><strong>Conclusion: </strong>Excessive convex-side SCL elongation combined with reduced CSA represents a high-risk morphological pattern for DSCI in severe AIS correction. Postoperative neurological risk is multifactorial-driven by complex three-dimensional corrective forces, osteotomies, and baseline anatomical reserve, rather than simple longitudinal distraction. Preoperative evaluation of canal reserve and anticipated elongation may provide a morphological framework for risk stratification in complex deformity surgery.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13355340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338987","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":"Biomechanical advances in oblique lateral lumbar interbody fusion using different interbody cages.","authors":"Yermike Bieshanbieke, Fei Xie, Baofeng Yan","doi":"10.1186/s13018-026-07051-4","DOIUrl":"10.1186/s13018-026-07051-4","url":null,"abstract":"<p><p>Oblique lateral lumbar interbody fusion (OLIF) is a minimally invasive spinal fusion technique that has gained increasing popularity in the treatment of lumbar degenerative diseases. The interbody cage is a critical implant in OLIF procedures, and its material properties, structural design, dimensions, placement location, and combination with supplemental fixation strategies play a decisive role in determining immediate postoperative stability, fusion rate, restoration of disc height and lumbar lordosis, stress distribution, and the risk of adjacent segment degeneration (ASD). This review aims to summarize recent biomechanical research advances on OLIF combined with different interbody cages, to critically evaluate the advantages and limitations of various cage designs, and to analyze the effects of different fixation strategies on postoperative biomechanical performance. By comparing the biomechanical characteristics of polyetheretherketone, titanium alloy, novel biodegradable, and composite cages, and integrating evidence from finite element analyses, in vitro biomechanical experiments, and clinical studies, this review elucidates their differences in providing spinal stability, promoting osseous fusion, and reducing postoperative complications. In addition, this article highlights the biomechanical impact of cage placement, size, and geometry, and explores how topological optimization and patient-specific design may further enhance cage performance. Drawing on successful experiences with interbody cage designs in cervical fusion surgery, future directions for lumbar interbody cages are discussed, including integrated structural design, material innovation, and personalized customization, with the goal of providing optimized surgical strategies and implant selection for clinical practice.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13556087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317555","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":"Orthogeriatric care after hip fracture: the role of process reliability in improving outcomes.","authors":"Tyreke J O Holness, Sharmi Haque, Benjamin H L Harris, Michael B Fertleman, Louis J Koizia","doi":"10.1186/s13018-026-07055-0","DOIUrl":"10.1186/s13018-026-07055-0","url":null,"abstract":"<p><p>Older adults who sustain a hip fracture frequently experience loss of independence and identifying care pathways that improve recovery remains a major clinical priority. In their recent study, Netzer et al. report that patients managed within an orthogeriatric model of care (OMC) were more frequently discharged to rehabilitation facilities and subsequently home. They further observed improved adherence to key clinical care standards.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"21 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13295484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317628","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":"Comparative efficacy of platelet-rich plasma monotherapy versus combination therapies for knee osteoarthritis: a systematic review and network meta-analysis.","authors":"Dehao Luan, Xiaonan Zhang, Ziyi Zhang, Xi Man, Hai Bo","doi":"10.1186/s13018-026-07042-5","DOIUrl":"10.1186/s13018-026-07042-5","url":null,"abstract":"<p><strong>Background: </strong>Platelet-rich plasma (PRP) is widely used as an intra-articular treatment for knee osteoarthritis (KOA), but whether combining PRP with hyaluronic acid (HA), mesenchymal stem cells (MSCs), or ozone (O₃) provides additional clinical benefit remains unclear. We conducted a systematic review and network meta-analysis (NMA) to compare the efficacy of PRP monotherapy with these three PRP-based combination strategies.</p><p><strong>Methods: </strong>Twelve electronic databases were searched from inception to April 2026 for randomized controlled trials (RCTs) that compared intra-articular PRP alone with PRP combined with HA, MSCs, or O₃ in adults with KOA. Two reviewers independently performed study selection, data extraction, and risk of bias assessment using the Cochrane RoB 2 tool. The primary outcomes were changes in WOMAC total score and VAS pain score. A random-effects NMA was conducted within a frequentist framework in Stata 17.0. Treatment rankings were calculated using surface under the cumulative ranking curve (SUCRA) values.</p><p><strong>Results: </strong>Eighteen RCTs involving 1,376 participants met the inclusion criteria. The evidence network was star-shaped, with PRP alone serving as the sole common comparator. For WOMAC function, PRP + HA was the only combination that demonstrated a statistically significant improvement over PRP alone (MD =  - 6.16, 95% CI - 9.71 to - 2.61, P < 0.001). Differences were not significant for PRP + O₃ (MD =  - 9.65, 95% CI - 20.33 to 1.03) or PRP + MSC (MD =  - 0.80, 95% CI - 12.85 to 11.25). For VAS pain, PRP + HA again showed superior pain relief (MD =  - 1.01, 95% CI - 1.57 to - 0.44, P < 0.001). PRP + MSC (MD =  - 0.77, 95% CI - 1.92 to 0.38) and PRP + O₃ (MD =  - 0.15, 95% CI - 1.87 to 1.57) did not differ significantly from PRP alone. SUCRA values ranked PRP + HA highest for VAS pain and second for WOMAC function. No significant publication bias was detected.</p><p><strong>Conclusions: </strong>Among PRP-based combination therapies for KOA, the addition of HA to PRP is supported by the most consistent evidence for improving pain and function. Current data are insufficient to conclude that adding MSCs or O₃ provides any additional benefit. Standardized, large-scale RCTs with longer follow-up are needed to clarify the role of these emerging combinations.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13397688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317568","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":"Rethinking Morton's neuroma: a sonographic study of bilateral prevalence and symmetry.","authors":"Florian J Jaklin, Ulrich Renner, Oskar Aszmann, Wolfgang J Weninger, Stefan Meng","doi":"10.1186/s13018-026-07045-2","DOIUrl":"10.1186/s13018-026-07045-2","url":null,"abstract":"<p><strong>Background: </strong>Morton neuroma (MN) is commonly regarded as a focal, unilateral condition. Whether sonographically detectable lesions also occur contralaterally to the symptomatic side has not been defined systematically. We aimed to determine the bilateral sonographic prevalence, anatomic distribution, symmetry, and size characteristics of lesions consistent with MN in patients referred with clinical suspicion of MN.</p><p><strong>Methods: </strong>In this cross-sectional study, we included all consecutive patients referred between January 2023 and December 2024 for suspected MN. All underwent standardized bilateral high-resolution forefoot ultrasound irrespective of symptom laterality, with lesions defined as hypoechoic nodular enlargements measuring ≥ 3 mm. Prevalence was estimated using exact binomial 95% confidence intervals (CI), and size associations were assessed with linear mixed-effects models including random patient intercepts and fixed effects for intermetatarsal space, side, sex, age, morphology, and symptom status.</p><p><strong>Results: </strong>A total of 226 patients (167 women; mean age, 55 ± 12 years) were included, and 568 lesions consistent with interdigital nerve enlargements were confirmed (mean, 2.5 ± 1.0 per patient). Lesions were most common in the third intermetatarsal space (62.3%) and second space (36.4%). Bilateral involvement was present in 183/226 patients (81.0%; 95% CI, 75.2-85.9%). Among those with strictly unilateral symptoms, contralateral lesions were found in 123/161 (76.4%; 95% CI, 69.1-82.7%). Bilateral disease was mirror-symmetric in 133/183 (72.7%). Intermetatarsal space and morphology were associated with size, whereas size was not independently associated with symptomatic status.</p><p><strong>Conclusion: </strong>Sonographically detected interdigital nerve enlargements are frequently bilateral and often symmetric, including in patients with unilateral symptoms. The high prevalence of subclinical contralateral enlargements challenges the traditional view of MN as a focal, unilateral entity. Routine bilateral ultrasound may be useful at baseline to characterize overall lesion burden and support counseling. However, management must remain strictly symptom-based, as incidentally detected, asymptomatic enlargements do not justify intervention.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148308399","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":"MiR-21 promotes osteogenic transformation in ankylosing spondylitis fibroblasts and modulates bone metabolism in a murine arthritis model potentially involving the MAPK NF-κB pathway.","authors":"Weiwei Pan, Wenbiao Zheng, Weiqian Wu, Fanghu Chen","doi":"10.1186/s13018-026-06983-1","DOIUrl":"10.1186/s13018-026-06983-1","url":null,"abstract":"<p><strong>Background: </strong>Ankylosing spondylitis (AS) is a chronic inflammatory disease characterized by pathological bone formation. Synovial fibroblasts are key effector cells in this process, and their dysregulated osteogenic transformation is a critical event. The role of microRNA‑21 (miR‑21) and the mitogen-activated protein kinase (MAPK)/nuclear factor kappa-B‌ (NF‑κB) pathway in inflammation and bone metabolism is established; however, whether miR‑21 promotes AS fibroblast osteogenesis specifically via this pathway is unclear. This study aimed to determine whether miR-21 promotes osteogenic transformation and bone metabolism in AS synovial fibroblasts via the MAPK/NF‑κB pathway.</p><p><strong>Methods: </strong>Gain‑ and loss‑of‑function of miR‑21 was achieved in AS synovial fibroblasts by transfection with miR‑21 mimic or inhibitor, followed by evaluation of proliferation, osteogenic differentiation (alkaline phosphatase/alizarin red staining), and MAPK/NF‑κB pathway activity. In a proteoglycan‑induced arthritis (PGIA) mouse model, miR‑21 was inhibited by Antagomir to assess spinal pathology, serum inflammatory cytokines, bone metabolism markers, and MAPK/NF‑κB signaling.</p><p><strong>Results: </strong>In vitro, miR-21 overexpression significantly promoted fibroblast proliferation, osteogenic differentiation, and activated the MAPK/NF-κB pathway, while its inhibition had opposite effects. In vivo, AntagomiR-21 treatment ameliorated spinal cartilage damage, reduced serum levels of inflammatory cytokines (IL-6, IL-1β, TNF-α) and bone metabolism markers (RANKL/OPG), and suppressed the MAPK/NF-κB pathway in PGIA mice.</p><p><strong>Conclusions: </strong>Our findings suggest that miR-21 is associated with synovial fibroblast proliferation and osteogenesis, potentially via the MAPK/NF‑κB pathway, and that its inhibition alleviates inflammatory arthritis phenotypes in mice. These observations indicate that miR‑21 may warrant further investigation as a candidate target in AS-related inflammation and cartilage pathology.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148308415","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}