Journal of orthopaedics最新文献

{"title":"Middle trapezius tendon transfer for isolated irreparable supraspinatus tears shows favorable outcomes despite subscapularis tear","authors":"Chang Hee Baek,&nbsp;Bo Taek Kim,&nbsp;Jung Gon Kim,&nbsp;Chaemoon Lim,&nbsp;Seung Jin Kim","doi":"10.1016/j.jor.2025.12.031","DOIUrl":"10.1016/j.jor.2025.12.031","url":null,"abstract":"<div><h3>Introduction</h3><div>Middle trapezius tendon (MTT) transfer has emerged as a viable treatment option for isolated irreparable supraspinatus tears (IIST). This study aimed to compare the clinical outcomes of MTT transfer between patients with intact subscapularis and those with concomitant subscapularis tears.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted on patients who underwent arthroscopically assisted MTT transfer for IISTs between January 2018 and December 2023, with a minimum follow-up of 24 months. Patients were stratified into two groups: subscapularis intact and subscapularis tear (Lafosse type I–III, treated with debridement or repair). Patients with incomplete follow-up or missing data were excluded. Clinical outcomes—including pain (VAS), functional scores (Constant and ASES), active range of motion (ROM), and strength—were evaluated pre- and postoperatively. Radiologic assessments included acromiohumeral distance (AHD) and Hamada grade for glenohumeral arthritis. Minimal clinically important differences (MCID) and complications were also recorded.</div></div><div><h3>Results</h3><div>After excluding five patients, 61 patients were included (48 Subscapularis-intact, 13 Subscapularis-tear). Both groups demonstrated significant postoperative improvements in VAS, Constant, ASES scores, ROM and strength in forward elevation and abduction. Preoperative internal rotation ROM and strength were lower in the subscapularis-tear group, but postoperative values were comparable between the groups. MCID achievement rates exceeded 90 % in both groups. Complications included one retear and one minor progression of arthritis in the subscapularis-tear group, one infection in the subscapularis-tear group, and one retear in the subscapularis-intact group.</div></div><div><h3>Conclusion</h3><div>MTT transfer provides significant improvements in pain, function, forward elevation, and abduction in patients with IISTs, regardless of preoperative subscapularis integrity. Although preoperative internal rotation ROM and strength were lower in the subscapularis-tear group, postoperative recovery restored these measures to levels comparable with the subscapularis-intact group, supporting the efficacy of MTT transfer even in the presence of concomitant subscapularis pathology.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"75 ","pages":"Pages 113-119"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative complication rates of titanium vs carbon fiber intramedullary nails in pathologic long bone fractures: A systematic review and meta-analysis","authors":"Joseph D. Giacalone ,&nbsp;Kunal Shah ,&nbsp;Taylor Davis ,&nbsp;Sanjana Subramanyam ,&nbsp;James C. Wittig","doi":"10.1016/j.jor.2026.02.005","DOIUrl":"10.1016/j.jor.2026.02.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Carbon fiber (CF) intramedullary (IM) nails have emerged as a promising alternative to titanium (TI) implants for managing pathologic long bone fractures, offering advantages such as radiolucency for improved imaging, reduced artifact during surveillance, and minimal attenuation of therapeutic radiation. Although early studies suggest comparable complication rates between CF and TI constructs, existing evidence remains limited by small sample sizes and a lack of direct, high-quality comparisons of complication profiles. This study aimed to systematically compare complication rates between CF and TI IM nails for the treatment of pathologic long-bone disease secondary to malignancy.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis were conducted in accordance with the PRISMA 2020 guidelines to evaluate the complication profiles of CF versus TI IM nails in patients with impending or completed pathologic long-bone fractures secondary to malignancy. Eligible studies reported on postoperative outcomes, including revision surgery, nonunion, periprosthetic fracture, implant failure, and overall complication rates. Data were analyzed using single-proportion meta-analysis and subgroup analysis in RStudio v4.5.1.</div></div><div><h3>Results</h3><div>Five retrospective cohort studies comprising 361 patients (194 treated with TI nails and 167 with CF nails) met the inclusion criteria. There were no statistically significant differences between cohorts in rates of nonunion (p = 0.876), periprosthetic fracture (p = 0.834), revision surgery (p = 0.757), or total complication rates (p = 0.617). However, implant failure occurred at a higher rate in the CF group (p = 0.016), based on a limited number of events.</div></div><div><h3>Conclusion</h3><div>CF IM nails appear to demonstrate complication rates comparable to traditional TI implants in the fixation of pathologic long bone fractures secondary to bone tumors, although they may be associated with a higher observed risk of implant failure. Given the low to very low quality of available evidence and the relatively small pooled sample size of this review, these findings should be considered exploratory. Future large-scale, prospective randomized studies are warranted to confirm these findings and enhance their generalizability across diverse oncologic populations.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"75 ","pages":"Pages 46-56"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teriparatide enhances vertebral bone quality: Quantitative analysis using the VBQ score in lumbar fusion patients","authors":"Tetsutaro Abe,&nbsp;Masashi Miyazaki,&nbsp;Noriaki Sako,&nbsp;Nobuhiro Kaku","doi":"10.1016/j.jor.2026.02.033","DOIUrl":"10.1016/j.jor.2026.02.033","url":null,"abstract":"<div><h3>Background</h3><div>Vertebral bone quality is a critical factor influencing spinal stability and surgical planning. The vertebral bone quality (VBQ) score, derived from routine MRI, has emerged as a noninvasive imaging biomarker of bone quality; however, its clinical implications in the perioperative spinal fusion setting remain incompletely understood.</div></div><div><h3>Methods</h3><div>This retrospective study included patients who underwent single-level lumbar fusion at L4–5. VBQ was measured at T12–L2 to avoid instrumentation-related artifacts. Associations between VBQ and radiographic parameters were evaluated using correlation and multivariable regression analyses. Inter- and intra-rater reliability were assessed using kappa statistics.</div></div><div><h3>Results</h3><div>VBQ scores significantly decreased in the PTH group (ΔVBQ −0.31 ± 0.56), indicating improved bone quality, whereas no improvement was observed in controls (ΔVBQ 0.08 ± 0.61; p = 0.03). HU changes did not differ between groups. ΔVBQ correlated with postoperative BMD (r = −0.28, p = 0.04) and PTH duration (r = −0.39, p = 0.01). Regression analysis identified PTH use (β = −0.39, 95%CI: −0.72 to −0.06, p = 0.02) and treatment duration (β = −0.27, 95%CI: −0.52 to −0.02, p = 0.03) as independent predictors of VBQ improvement with R² of 0.32.</div></div><div><h3>Conclusion</h3><div>Perioperative teriparatide significantly enhances vertebral bone quality, demonstrated by reduced VBQ scores over 12 months. VBQ appears more sensitive than HU or BMD to anabolic therapy–induced qualitative changes and may serve as a practical imaging biomarker for optimizing perioperative bone management in osteoporotic spinal fusion patients.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"75 ","pages":"Pages 67-72"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age and chronic ACL injury are associated with reduced ramp-region vascularity during ACL reconstruction","authors":"Tsuneari Takahashi ,&nbsp;Katsushi Takeshita","doi":"10.1016/j.jor.2026.02.049","DOIUrl":"10.1016/j.jor.2026.02.049","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate arthroscopic vascularity of the medial meniscus ramp region during anterior cruciate ligament (ACL) reconstruction and to identify factors associated with reduced ramp-region vascularity.</div></div><div><h3>Methods</h3><div>This retrospective cohort study reviewed consecutive patients who underwent primary ACL reconstruction between January 2020 and January 2026. Ramp-region vascularity was assessed arthroscopically using a transcondylar view from the anterolateral portal and dichotomized as adequate versus not adequate based on visible synovial vessels and hyperemia, without inducing iatrogenic bleeding. Chronic ACL injury was defined as surgery performed ≥12 months after injury. Univariate comparisons were performed, followed by Bayesian information criterion (BIC)-based multivariable logistic regression analysis to identify independent factors associated with reduced ramp-region vascularity.</div></div><div><h3>Results</h3><div>A total of 192 patients were screened, and 126 patients were included for analysis. Ramp-region vascularity was adequate in 74 patients and not adequate in 52 patients. Patients with reduced vascularity were significantly older than those with adequate vascularity (47.0 ± 17.5 vs 30.6 ± 17.0 years, P &lt; 0.001), and chronic injury was more common in the reduced vascularity group (29/52 vs 12/74, P &lt; 0.001). In multivariable analysis, older age was independently associated with reduced vascularity (odds ratio [OR], 1.04 per year; 95% confidence interval [CI], 1.01–1.07; P = 0.004). Chronic injury (not chronic vs chronic: OR, 0.273; 95% CI, 0.094–0.790; P = 0.017), arthroscopically visible ramp lesions (OR, 0.170; 95% CI, 0.058–0.494; P = 0.001), and preoperative Lysholm score (OR, 1.03; 95% CI, 1.01–1.06; P = 0.010) were also retained in the final model.</div></div><div><h3>Conclusion</h3><div>Reduced ramp-region vascularity during ACL reconstruction was independently associated with older age and chronic ACL injury. Patient age and injury chronicity may help identify knees with a biologically unfavorable ramp environment.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"75 ","pages":"Pages 101-105"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimized data augmentation for osteosarcoma detection in deep and lightweight networks","authors":"Waala Gouda ,&nbsp;Sidra Tahir ,&nbsp;Tariq Ali ,&nbsp;Abdul Shahid","doi":"10.1016/j.jor.2025.12.013","DOIUrl":"10.1016/j.jor.2025.12.013","url":null,"abstract":"<div><div>Osteosarcoma (Ost) is an extremely aggressive primary bone malignancy that mostly occurs among children and young adults. Precise histopathological classification is challenging due to strong intra- and inter-tumoral heterogeneity, combined with the scarcity of annotated datasets. The current study demonstrates a systematic deep learning (DL) methodology crafted to investigate the effects of preprocessing and data augmentation approaches to osteosarcoma image classification. Hematoxylin and Eosin (H&amp;E)-stained histopathological images were obtained from the publicly accessible UT Southwestern/UT Dallas Osteosarcoma dataset and standardized to standard noise reduction, contrast enhancement, and artifact suppression procedures to facilitate tissue prominence. Controlled augmentation settings were built (no augmentation, and 650, 1000, and 1500 synthetic images per class) to investigate how sequential dataset enlargement impacts generalization performance. Four transfer learning models similar to VGG19, InceptionV3, InceptionResNetV2, and NasMobileNet were fine-tuned and assessed through accuracy, sensitivity, specificity, and ROC-AUC metrics. The results confirm that moderate augmentation provided the best results, with NasMobileNet reporting 95.07 % accuracy, 95 % sensitivity, and 95 % specificity (AUC = 0.96), whereas deeper models like InceptionResNetV2 took advantage of increased augmentation (up to 94.37 % accuracy). Statistical analysis further confirmed that the found differences were not significant (p &gt; 0.05), indicating support for consistency among models. The results overall highlight that the efficacy of augmentation depends on the model and that integration of systematic analysis with interpretability enhances the reliability of osteosarcoma classification through the power of deep learning.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 296-313"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orthopedic implant surface modification with nanoengineered [YSZ/HAp-Ag]n multilayer coatings to promote osteoblast adhesion and early differentiation","authors":"E Lorena Medina ,&nbsp;J.J. Vaca-González ,&nbsp;Diego Quexada-Rodríguez ,&nbsp;Salah Ramtani ,&nbsp;Celine Falentin- Daudre ,&nbsp;Diego Garzón-Alvarado","doi":"10.1016/j.jor.2025.12.045","DOIUrl":"10.1016/j.jor.2025.12.045","url":null,"abstract":"<div><h3>Background</h3><div>Metallic implants frequently face three critical challenges that compromise long-term clinical performance: (i) limited biofunctionality that delays osteointegration, (ii) corrosion processes that deteriorate the implant surface and release harmful ions, and (iii) bacterial biofilm formation, which increases the risk of persistent infection. This study explores multilayer [YSZ/HAp-Ag]n coatings engineered to overcome these issues by enhancing osteoblastic response, improving surface stability, and providing antimicrobial potential.</div></div><div><h3>Materials and methods</h3><div>Multilayer coatings with different bilayer numbers (n = 1, 10, 30, 50, 70) were deposited on titanium substrates using magnetron sputtering. Structural and surface characterization included morphology, roughness, wettability, and stiffness. MC3T3-E1 osteoblastic cells were cultured on the coatings to evaluate adhesion, viability (MTT), and differentiation through alkaline phosphatase (ALP) activity at 7 and 14 days.</div></div><div><h3>Results</h3><div>Crater-like surface textures, roughness above 220 nm, and higher hydrophilicity promoted enhanced cell spreading, greater confluence, and decreased circularity, indicative of strong anchorage. All coatings exhibited &gt;70 % cell viability, confirming non-cytotoxic behavior. Rougher and more hydrophilic surfaces outperformed uncoated titanium. Stiffer coatings produced a significant increase in ALP activity at day 7, suggesting accelerated early osteogenic differentiation, followed by a decrease at day 14 consistent with cellular maturation. Among all configurations, the 30-bilayer coating (n30) offered the most balanced structural and mechanical properties, resulting in the highest biological performance.</div></div><div><h3>Conclusions</h3><div>Multilayer [YSZ/HAp-Ag]n coatings effectively stimulate osteoblastic adhesion, viability, and early differentiation while addressing key limitations of metallic implants. Their tunable architecture—especially the n30 configuration—represents a promising strategy to enhance implant integration and long-term functional performance.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 79-90"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Established acetabular radiological reference values can be reliably transferred to reconstructed parallel-beam 2D images from ultra-low-dose pelvic CT","authors":"Arnaud Klopfenstein ,&nbsp;Thomas Marth ,&nbsp;Stefan Sommer ,&nbsp;Reto Sutter ,&nbsp;Patrick O. Zingg ,&nbsp;Dominik Kaiser","doi":"10.1016/j.jor.2025.12.063","DOIUrl":"10.1016/j.jor.2025.12.063","url":null,"abstract":"<div><h3>Background</h3><div>The anteroposterior radiograph of the pelvis is essential for diagnosing hip pathologies. Radiograph-like projections reconstructed as cone-beam images from CT data correlate strongly with conventional radiographs. However, CT inherently uses parallel x-rays rather than a cone-beam geometry. This study aims to determine whether parallel-beam radiograph-like projections from CT provide comparable reference values to cone-beam reconstructions.</div></div><div><h3>Methods</h3><div>63 patients (126 hips) undergoing CT for symptomatic hip pathologies without prior hip surgery were included. From the same CT data, cone-beam and parallel-beam radiograph-like images were reconstructed using a standardized algorithm. Reference values, including lateral center-edge angle (LCEA), medial center-edge angle (MCEA), acetabular index (AI), acetabular arc (AA), extrusion index (EI), crossover sign, and posterior wall sign, were measured on both projection types, eliminating technical bias. Two observers performed all measurements twice to assess inter- and intra-observer reliability, and intraclass correlation coefficients (ICCs) were calculated.</div></div><div><h3>Results</h3><div>126 hips were analyzed: 52 with LCEA &lt;22° (“acetabular undercoverage”), 49 with LCEA 22°–33° (“normal coverage”), and 25 with LCEA &gt;33° (“acetabular overcoverage”). ICCs between observers and between projection types demonstrated good to excellent reliability for all reference values (0.89–0.99).</div></div><div><h3>Conclusion</h3><div>Parallel-beam radiograph-like projections demonstrate good to excellent reliability (ICCs: 0.89–0.99) for key reference values of hip pathologies compared to cone-beam radiograph-like projections from the same CT data. These findings suggest parallel beam projections can be reliably used with established reference values for conventional radiographs.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 73-78"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic S2Alar iliac screw placement: Comparing conventional and robot assisted minimally invasive techniques","authors":"Balamurugan Thirugnanam ,&nbsp;Vidyadhara Srinivasa ,&nbsp;Abhishek Soni ,&nbsp;R. Dinesh Iyer ,&nbsp;Madhava Pai Kanhangad","doi":"10.1016/j.jor.2026.01.009","DOIUrl":"10.1016/j.jor.2026.01.009","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the clinical, imaging, and peri-operative results of robotic-guided conventional versus robot assisted minimally invasive techniques for S2 Alar-Iliac (S2AI) screw placement during spinopelvic fixation.</div></div><div><h3>Methods</h3><div>A prospective comparative study comparing the clinicoradiological parameters of patients undergoing conventional robotic assisted S2AI screw insertion and those who underwent Robotic minimally invasive percutaneous screw insertion between November 2023 and June 2025 was done. Data collected included demographics, operative time, intraoperative blood loss, postoperative pain, hospital stay, radiographic angles, radiation dose, screw accuracy, and complications.</div></div><div><h3>Results</h3><div>A total of 102 patients underwent spinopelvic fixation during the study period - 56 patients (116 screws) underwent conventional robotic assisted S2AI screw insertion and 46 patients (92 screws) underwent robot assisted percutaneous S2AI screw insertion. Both groups showed accurate screw placement without any intraoperative adverse events. The robot assisted percutaneous group had markedly reduced postoperative VAS scores (3.2 ± 1.1 vs. 5.8 ± 1.5, p &lt; 0.0001) and reduced length of stay (3.1 ± 0.9 vs. 5.0 ± 1.3 days, p &lt; 0.0001). Intraoperative blood loss,wound complications and operative time were also lesser in the robot assisted group but was not statistically significant. All other radiographic parameters and radiation dose were comparable across groups.</div></div><div><h3>Conclusion</h3><div>Robot assisted minimally invasive S2AI screw placement is a safe and efficient alternative to the conventional open technique. It offers comparable radiographic accuracy and biomechanical stability, with the added benefits of reduced postoperative pain and shorter hospital stay.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 214-219"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spring ligament repair with and without augmentation demonstrates favorable outcomes in progressive collapsing flatfoot disorder: A systematic review","authors":"Jared Rubin ,&nbsp;Alexander Tham ,&nbsp;Reed Macey ,&nbsp;Nathaniel Mattera ,&nbsp;Michael Allen ,&nbsp;Samuel R. Montgomery Jr. ,&nbsp;Megan Donnelly ,&nbsp;Jay Zaifman ,&nbsp;John G. Kennedy","doi":"10.1016/j.jor.2026.01.014","DOIUrl":"10.1016/j.jor.2026.01.014","url":null,"abstract":"<div><h3>Background</h3><div>Spring ligament disruption is a primary contributor to the development of progressive collapsing flatfoot deformity (PCFD). The purpose of this systematic review is to evaluate the radiographic findings, clinical outcomes, complications, and failures following spring ligament repair with and without augmentation.</div></div><div><h3>Methods</h3><div>During December 2025, the PubMed, Cochrane, and EMBASE library databases were systematically searched to identify studies examining radiographic findings, clinical outcomes, complications, and failures in patients who underwent spring ligament repair with and without augmentation.</div></div><div><h3>Results</h3><div>Nine studies including 209 patients (212 feet) with spring ligament injuries were analyzed. Patients who underwent spring ligament repair with and without augmentation were evaluated. Both treatment approaches were associated with clinically meaningful improvements in radiographic alignment, with mean talo-first metatarsal angle (TFMA) correction of 12.9° following isolated repair and 11.0° following repair with augmentation. Clinical outcomes also improved, with mean increases in American Orthopaedic Foot and Ankle Society (AOFAS) scores of 24.1 and 29.8 points for isolated repair and repair with augmentation, respectively. Complication rates were low for both isolated repair (4.5 %) and repair with augmentation (6.7 %), with corresponding failure rates of 1.3 % and 3.3 %, respectively.</div></div><div><h3>Conclusion</h3><div>Spring ligament repair with and without augmentation is associated with meaningful improvements in radiographic alignment and clinical outcomes in patients with PCFD. Across the included studies, both treatment approaches also demonstrated low complication and failure rates. While suture augmentation may provide additional mechanical support in select patients, the available evidence precludes direct comparative conclusions regarding the superiority of the technique over isolated spring ligament repair. Further high-quality, comparative studies are warranted to definitively establish the optimal surgical method for managing spring ligament injuries.</div></div><div><h3>Level of evidence</h3><div>IV</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 226-233"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Legal blindness as a risk factor for complications and prolonged hospitalization after spinal fusion","authors":"Donald MacElroy ,&nbsp;Jay B. Ayar ,&nbsp;Samir Rao ,&nbsp;Merritt D. Kinon","doi":"10.1016/j.jor.2026.01.001","DOIUrl":"10.1016/j.jor.2026.01.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Legally blind patients represent a vulnerable group who may face barriers to safe mobility, postoperative rehabilitation, and discharge planning. There is limited evidence describing perioperative course during spinal fusion surgery in this population. This study aimed to evaluate the association between legal blindness, operative complications and discharge disposition in patients undergoing cervical or lumbar spinal fusion.</div></div><div><h3>Methods</h3><div>The National Inpatient Sample was queried from 2016 to 2021, identifying adult hospitalizations for cervical or lumbar spinal fusion using ICD-10 procedure codes. The primary exposure was legal blindness (ICD-10-CM: H54.8). Outcomes included: major medical complications, non-home discharge and extended length of stay (&gt;3 days). Survey-weighted logistic regression was used to evaluate associations between legal blindness and complications.</div></div><div><h3>Results</h3><div>Among 338,578 hospitalizations for cervical or lumbar spinal fusion that met our inclusion criteria, 315 involved legally blind patients. In multivariate analysis adjusting for demographics, comorbidities and hospital level covariates, legal blindness was independently associated with higher odds of major medical complications (aOR 1.58, 95 % CI 1.08–2.32), non-home discharge (aOR 2.57, 95 % CI 1.98–3.32), and extended length of stay (aOR 1.67, 95 % CI 1.31–2.12).</div></div><div><h3>Conclusions</h3><div>Legal blindness is independently associated with increased major medical complications, extended hospital stays and higher rates of non-home discharge following spinal fusion procedures. These findings highlight the importance of recognizing visual impairment as a marker of perioperative vulnerability in the context of spinal fusion surgery and highlight the need for targeted perioperative strategies to support this underrepresented population.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 152-156"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}