Journal of orthopaedics最新文献

{"title":"Manual vs robotic patellofemoral arthroplasty outcomes: A Michigan arthroplasty registry collaborative quality initiative-based study","authors":"Alexander Ziedas,&nbsp;Adam Miller,&nbsp;Elliot Biddle,&nbsp;Michael Laker,&nbsp;Jefferey Michaelson,&nbsp;Todd Frush,&nbsp;David C. Markel","doi":"10.1016/j.jor.2025.05.002","DOIUrl":"10.1016/j.jor.2025.05.002","url":null,"abstract":"<div><h3>Background</h3><div>Historically, all patellofemoral arthroplasty (PFA) was performed manually. Recently, robotic-assisted PFA has gained popularity. The purpose of this study was to determine whether a robotic-assisted technique influenced outcomes and revision rates. We hypothesized that robotic-assisted PFA would have improved 90-day complication and revision rates.</div></div><div><h3>Methods</h3><div>A single center's data from the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) was queried for all primary PFAs from January 2014 to December 2022. Manual and robotic cohorts were compared for revisions and 90-day complications, including emergency visits, readmissions, and returns to the operating room (OR). Chi-square and Fisher's exact tests were used for categorical data and t-tests for continuous data.</div></div><div><h3>Results</h3><div>Among 75 PFAs (mean age 53.0 ± 12.9 years, 78% women), 19 were manual and 56 robotic. Manual PFA experienced more 90-day complications (31% vs 10%, p = 0.0321) and a longer mean length of stay (30.9 ± 14.4 vs 20.6 ± 17.7 h, p = 0.03). No significant differences existed in age, BMI, gender, race, surgical time, 30-day complications, or revision rate. Manual PFA had no revisions, while 5% of robotic PFAs were revised for osteoarthritis progression, with a mean conversion time of 4.5 ± 2.7 years. Five-year cumulative percent revision (CPR) for all PFAs was 7.37%. Logistical regression showed manual PFA patients were more likely to experience 90-day complications (OR 3.84, p = 0.04).</div></div><div><h3>Conclusions</h3><div>Manual PFA were prone to more 90-day complications and longer hospital stays compared to robotic PFA, which may minimize complications without affecting revision rates. Importantly, the PFA revision rate herein exceeded MARCQI-reported rates for unicompartmental and total knee arthroplasty.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"64 ","pages":"Pages 217-221"},"PeriodicalIF":1.5,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143923797","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":"Impact of spinopelvic parameters on acetabular cup positioning and patient-reported outcomes following total hip arthroplasty","authors":"Jonathan Liu ,&nbsp;Sarah Criddle ,&nbsp;Noah Gilreath ,&nbsp;Jeremy Heard ,&nbsp;Mohammad Daher ,&nbsp;Tucker Callanan ,&nbsp;Edward Testa ,&nbsp;Alan H. Daniels ,&nbsp;Valentin Antoci Jr.","doi":"10.1016/j.jor.2025.05.005","DOIUrl":"10.1016/j.jor.2025.05.005","url":null,"abstract":"<div><h3>Background</h3><div>Hip instability is one of the most common complications after total hip arthroplasty (THA). While prior research has explored patient factors, surgical technique, soft tissue dynamics, implant design, and spinopelvic parameters. In particular, the relationship between spinopelvic alignment and acetabular cup positioning is not yet fully understood. Therefore, we aim to evaluate the association between spinopelvic parameters, acetabular cup positioning, and 12-month postoperative PROMs.</div></div><div><h3>Methods</h3><div>This study included 90 patients undergoing primary THA at a single institution from March 2019 to May 2023. Pelvic parameters (acetabular inclination, acetabular version, pelvic incidence, pelvic tilt, sacral slope, flexion, and obliquity) were assessed using EOS imaging and radiographs. Additional data were obtained from the Veterans RAND-12 survey and the FORCE-TJR database. PROMs were collected preoperatively, at 3 months, and at 12 months postoperatively, along with postoperative hospital metrics. Statistical analysis included Pearson's correlation to evaluate associations between pelvic parameters and PROMs.</div></div><div><h3>Results</h3><div>Postoperatively, 1.1 % of patients required reoperation, 2.2 % experienced dislocation, 5.5 % were readmitted within 90 days, and 12.1 % had complications, though none were associated with spinopelvic parameters or cup positioning. Acetabular cup inclination was significantly correlated with pelvic tilt (R = 0.30, p = 0.003), while acetabular version showed negative correlations with pelvic incidence (R = −0.23, p = 0.02) and sacral slope (R = −0.31, p = 0.002). At 12 months, acetabular inclination predicted improvement in MCS (R = 0.28, p = 0.02), and obliquity predicted improvements in activities of daily living (R = 0.29, p = 0.02), pain (R = 0.28, p = 0.03), and quality of life (R = 0.30, p = 0.002).</div></div><div><h3>Conclusion</h3><div>In the first year after THA, acetabular inclination was linked to improved patient-reported outcomes, while greater pelvic obliquity was associated with better scores in activities of daily living, pain, and quality of life. Post-operative acetabular cup version had weak correlations with pelvic incidence, sacral slope, and pelvic tilt. No other associations were found between spinopelvic parameters, cup positioning, and instability or complications.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"69 ","pages":"Pages 186-190"},"PeriodicalIF":1.5,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144230416","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":"The effect of blood flow restriction combined with neuromuscular electrical stimulation on knee joint function: A systematic review and meta-analysis","authors":"Fahed Herbawi ,&nbsp;Asmaa Daami ,&nbsp;Haneen Ishtayah ,&nbsp;Hiba Fakher Al Deen ,&nbsp;Maha Nofal ,&nbsp;Shaimaa Zaid ,&nbsp;Mario Lozano-Lozano ,&nbsp;Carolina Fernandez-Lao","doi":"10.1016/j.jor.2025.05.012","DOIUrl":"10.1016/j.jor.2025.05.012","url":null,"abstract":"<div><h3>Objective</h3><div>To determine whether the combined application of blood flow restriction and neuromuscular electrical stimulation significantly affects quadriceps strength, hypertrophy, pain, and fatigue.</div></div><div><h3>Design</h3><div>Systematic review with meta-analysis.</div></div><div><h3>Literature search</h3><div>PubMed, Scopus, and Web of Science from inception to November 2023.</div></div><div><h3>Study selection criteria</h3><div>Randomized and non-randomized full-text human clinical trials published in English investigating the combination between blood flow restriction and neuromuscular electrical stimulation on knee joint.</div></div><div><h3>Data synthesis</h3><div>The correlation data was pooled across studies using a random effects model. Cohen's D was calculated for each original study and an overall estimator, and a two-sided p value &lt; 0.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>Out of 294 records, nine studies with 257 participants were included in the systematic review. A meta-analysis revealed no significant differences in quadriceps strength at two, 3, and 6 weeks. Similarly, it was also shown in hypertrophy at 7–15 min, 2, and 6 weeks.</div></div><div><h3>Conclusion</h3><div>The blood flow restriction combined with neuromuscular electrical stimulation had no additional effect to the original isolated techniques on quadriceps strength and hypertrophy. Moreover, causes higher pain and fatigue levels after its use.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 155-166"},"PeriodicalIF":1.5,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143931796","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":"Global research hotspots of stem cell therapy for rotator cuff injuries: A bibliometric and visualized analysis","authors":"Xiong Wang ,&nbsp;Zhi Zhang ,&nbsp;Biao Cheng ,&nbsp;Yonghu Xu ,&nbsp;Shuming Zi","doi":"10.1016/j.jor.2025.05.010","DOIUrl":"10.1016/j.jor.2025.05.010","url":null,"abstract":"<div><h3>Objective</h3><div>Rotator cuff injuries represent a prevalent cause of shoulder pain and dysfunction, significantly impacting the quality of life. Surgical repair has the potential to restore tendon integrity, alleviate symptoms, and enhance overall function. However, the limited self-healing capacity of tendons, the propensity for fragile scar tissue formation, and the risk of tendons retear necessitate the exploration of alternative approaches. Stem cell therapy has emerged as a promising and effective strategy for the regenerative repair of rotator cuff injuries. This study aims to conduct a comprehensive bibliometric analysis of this field to explore the current state of research and identify emerging focus areas.</div></div><div><h3>Methods</h3><div>Publications related to stem cell therapy for rotator cuff injuries, published from 2003 to 2024, were retrieved from the Web of Science Core Collection (WoSCC). Using VOSviewer, CiteSpace, and Microsoft Excel, we analyzed and visualized publication trends, research hotspots, and emerging frontiers.</div></div><div><h3>Results</h3><div>A total of 927 publications were analyzed, revealing a steady increase in the number of publications within this field, thereby indicating a growing interest. The United States and China are the leading contributors regarding research output and funding. Shanghai Jiao Tong University and the American Journal of Sports Medicine have been identified as the most productive institutions and journals, respectively. The article “Biologics for tendon repair” holds the highest citation count and provides a comprehensive understanding of tendon biology and current treatment strategies. The authors with the highest publication output and citation frequency are Mazzocca, Augustus D., and Rodeo, Scott A., respectively. Keyword analysis indicates a temporal shift, with “mesenchymal stem cells” and “rotator cuff repair” identified as predominant keywords. Recently emerged keywords include “scaffolds,” “tendon stem cells,” and “tenogenic differentiation,” reflecting the current research hotspots, frontiers, and future directions.</div></div><div><h3>Conclusions</h3><div>Stem cell therapy for rotator cuff injuries is a rapidly evolving field. Our analysis provides valuable insights into research trends and future directions, highlighting the potential of regenerative medicine and the necessity for collaborative efforts to advance this promising therapeutic approach.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"64 ","pages":"Pages 199-209"},"PeriodicalIF":1.5,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143916454","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":"Body mass index does not increase risk of complications after reverse total shoulder arthroplasty","authors":"Salvatore Capotosto,&nbsp;Christopher White,&nbsp;Jennifer Yu,&nbsp;John J. Corvi,&nbsp;Hulaimatu Jalloh,&nbsp;Paul J. Cagle","doi":"10.1016/j.jor.2025.05.011","DOIUrl":"10.1016/j.jor.2025.05.011","url":null,"abstract":"<div><h3>Introduction</h3><div>As obesity rates continue to rise in the United States, understanding the long-term impact of body mass index (BMI) on outcomes following reverse total shoulder arthroplasty (rTSA) is increasingly important. While prior studies have yielded conflicting results, limited data exist on functional outcomes beyond five years postoperatively.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of 50 shoulders that underwent primary rTSA by a single surgeon, with a mean follow-up of 6.7 years. Patients were stratified into two groups based on BMI: &lt;30 (n = 37) and ≥30 (n = 13). Demographics, range of motion (ROM), patient-reported outcome measures (PROMs), and implant survival were compared between groups. Statistical analyses included t-tests, χ² tests, Pearson correlations, and Kaplan-Meier survival estimates.</div></div><div><h3>Results</h3><div>Both BMI cohorts experienced significant improvements in ROM and PROMs postoperatively. Forward elevation improved from 81.3° to 133.5° (p &lt; .01), and VAS pain scores decreased from 6.1 to 1.7 (p &lt; .01). There were no statistically significant differences between BMI groups in final ROM, ASES, SST, or VAS scores. Implant survival was similar between groups. No significant correlations were found between BMI and long-term functional outcomes.</div></div><div><h3>Conclusion</h3><div>BMI does not significantly affect long-term clinical or functional outcomes following rTSA. Despite higher BMI posing potential perioperative challenges, obese patients can achieve comparable improvements in pain, ROM, and quality of life. These findings support the efficacy of rTSA across BMI categories when appropriate perioperative care is provided.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 138-143"},"PeriodicalIF":1.5,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143927712","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":"The risk analysis index as a predictor of 30-day mortality for elderly obese patients undergoing elective total joint arthroplasty","authors":"Nithin Gupta ,&nbsp;Jared Sasaki ,&nbsp;Victor Koltenyuk ,&nbsp;Amber Park ,&nbsp;Hikmat R. Chmait ,&nbsp;Anthony Perugini III ,&nbsp;Andrew B. Campbell","doi":"10.1016/j.jor.2025.05.009","DOIUrl":"10.1016/j.jor.2025.05.009","url":null,"abstract":"<div><h3>Introduction</h3><div>The older population of the United States of America is continuing to increase, leading to rising rates of degenerative joint disease. Combined with the high prevalence of obesity in the US, orthopaedic surgeons are performing record numbers of elective total joint arthroplasty (TJA) procedures in higher risk patients. As age and obesity are risk factors for mortality following TJA, preoperative risk stratification tools such as frailty may be used to optimize surgical candidate selection to mitigate adverse outcomes.</div></div><div><h3>Methods</h3><div>The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients ≥65 years of age with a BMI of ≥30 kg/m² who underwent elective primary total knee or total hip arthroplasty for degenerative joint disease. Frailty was measured using the 5-item Modified Frailty Index (mFI-5) and the Risk Analysis Index (RAI). Multivariate regression was performed to evaluate predictive value of frailty and discriminatory accuracy was quantified using receiver operating characteristic (ROC) analysis.</div></div><div><h3>Results</h3><div>There were 169,065 patients who met the inclusion criteria from 2015 to 2019. The median age was 71 years, 60.8 % were women and 72.6 % were White. Increasing frailty predicted greater mortality as measured by the RAI and mFI-5. Further, the RAI had superior discrimination compared to the mFI-5 when quantified using ROC analysis.</div></div><div><h3>Discussion</h3><div>Frailty as measured by the RAI has superior clinical applicability, predictive value and discrimination for identifying patients at risk of mortality following TJA in an older obese population. Given this, orthopaedic surgeons may use the RAI as a tool for optimizing candidate selection and identifying high risk patients preoperatively.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 178-184"},"PeriodicalIF":1.5,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143936623","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":"Finite element analysis for LCP plates","authors":"Monika Bajerska ,&nbsp;Beata Świeczko-Żurek ,&nbsp;Marcin Nowak","doi":"10.1016/j.jor.2025.04.012","DOIUrl":"10.1016/j.jor.2025.04.012","url":null,"abstract":"<div><div>The main assumption of modern orthopedics and trauma surgery is to return to full fitness with a short recovery period. Unfortunately, the emergence of lifestyle diseases such as osteoporosis, which is characterized by a decrease in the biological value of bone tissue, a greater number of road accidents and related injuries to the musculoskeletal system, and the increasing expectations of people with degenerative polyarticular changes to remain mobile, have significantly increased the demand for all types of implants and prostheses.</div><div>Bone fixations pose a serious challenge for doctors, especially when the bone is also osteoporotic. Previous studies on innovative LCP plates (Locking Compression Plate), which are equipped with a special locking mechanism, show their advantage over traditional methods. They are characterized by very good bone stabilization, minimization of movement around the fracture site, faster bone growth, and consequently a shorter reconvalescence period for the patient and a greater chance of returning to full mobility.</div><div>The subject of the work is the FEM analysis for bone fixation - LCP plate. Modern medicine is constantly looking for new possibilities to increase the effectiveness and shorten the treatment time, an excellent example of which are the LCP plates discussed in the work. The main goal of the work is to select the material and parameters for the plate fixing the shin bone and to create a model of the bone-plate system.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 167-177"},"PeriodicalIF":1.5,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143936621","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":"Postoperative footdrop following total hip arthroplasty: Epidemiology, risk factors, and associated complications","authors":"Ashley Knebel ,&nbsp;Manjot Singh ,&nbsp;Michael J. Farias ,&nbsp;Joseph E. Nassar ,&nbsp;Jonathan Liu ,&nbsp;Bassel G. Diebo ,&nbsp;Eric M. Cohen ,&nbsp;Alan H. Daniels","doi":"10.1016/j.jor.2025.05.006","DOIUrl":"10.1016/j.jor.2025.05.006","url":null,"abstract":"<div><h3>Background</h3><div>Footdrop is a relatively uncommon complication following total hip arthroplasty (THA) caused by injury to the sciatic and peroneal nerve. Few studies have evaluated the risk factors or trends for the development of this challenging complication. As such, this study aims to describe the epidemiology, procedural risk factors, and related complications of postoperative footdrop following THA.</div></div><div><h3>Methods</h3><div>Adult primary or revision THA patients were identified using the PearlDiver database. Eligible patients were filtered into cohorts based on the development of footdrop within 90 days of surgery and matched 1:1 by age, sex, and comorbidities. Epidemiological trends in footdrop were evaluated by age and year between 2010 and 2022. Patient demographics, comorbidities, procedural characteristics, hospital outcomes, and occurrence of intra- and post-operative complications were compared.</div></div><div><h3>Results</h3><div>In total, 2282 footdrop (0.3 %) and 893,159 (99.8 %) no footdrop THA patients were included, with a mean age of 64.9 years and 56.2 % were women. The incidence of footdrop decreased from 0.3 % to 0.2 % between 2010 and 2022 and was not associated with age. Preoperatively, footdrop patients more frequently underwent revision THA (Footdrop = 12.3 % vs No footdrop = 5.7 %, <em>P</em> &lt; 0.001) and had more medical comorbidities (<em>P</em> &lt; 0.001). Intraoperatively, they had higher rates of hemorrhage (0.7 % vs 0.2 %, <em>P</em> = 0.034) and nerve injury (0.7 % vs 0.1 %, <em>P</em> &lt; 0.001). Postoperatively, they frequently reported acute kidney injury, urinary tract infection, wound-related complications, hematoma, prosthetic joint infection, aseptic loosening, and revisions (all <em>P</em> &lt; 0.004).</div></div><div><h3>Conclusion</h3><div>Patients developing footdrop following THA were more likely to be women, undergoing revision surgery, and had higher rates of prior lumbar fusion and medical comorbidities. They reported more postoperative complications and subsequent revisions following THA. This study informs us of the risk factors footdrop and may contribute to better patient counseling and surgical planning before undergoing THA.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"64 ","pages":"Pages 189-193"},"PeriodicalIF":1.5,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143916452","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":"Return to play and performance metrics following ulnar collateral ligament reconstruction in major league baseball pitchers","authors":"Oliver C. Sax ,&nbsp;Jeremy Dubin ,&nbsp;Hytham S. Salem ,&nbsp;Joseph Zummo ,&nbsp;Samuel Eaddy ,&nbsp;John V. Ingari ,&nbsp;Craig H. Bennett ,&nbsp;Matthew J. Best","doi":"10.1016/j.jor.2025.05.003","DOIUrl":"10.1016/j.jor.2025.05.003","url":null,"abstract":"<div><h3>Background</h3><div>The introduction of ulnar collateral ligament reconstruction (UCLR) (i.e., Tommy John surgery) has revolutionized the management of UCL injury. Many athletes and coaches may perceive surgery to enhance performance, warranting an investigation of the reliability of reporting of outcomes. Multiple studies suggest improved return to sport metrics, but this may be limited by variables examined and sample sizes.</div></div><div><h3>Hypothesis/purpose</h3><div>We assessed performance metrics in Major League Baseball (MLB) pitchers before and after UCLR in a large publicly available database.</div></div><div><h3>Methods</h3><div>All MLB pitchers who had undergone UCLR between 1983 and 2022 were obtained from a publicly available database: FanGraphs (<span><span>www.fangraphs.com</span><svg><path></path></svg></span>). Inclusion criteria included: (1) pitchers who appeared in ≥10 MLB games during a single season and (2) a minimum of 24 months follow-up. Exclusion criteria included: non-pitcher position players, minor league players, and prior UCL reconstruction. Data collected included: games played, innings pitched, earned run average (ERA), walks and hits per inning pitched (WHIP), walks per 9 innings (BB/9), strikeouts per 9 innings (K/9), wins above replacement (WAR), and runs above replacement (RAR).</div></div><div><h3>Results</h3><div>A total of 357 MLB players who had undergone UCLR were identified between 1983 and 2022. There were 276 of 357 players (77.3 %) who returned to play after UCLR. Average WAR (6.99 vs. 4.81, p = 0.04) and RAR (66.84 vs. 46.41, p = 0.04) were greater in the pre-UCLR cohort than post-UCLR cohort, respectively. The average games played, innings pitched, ERA, WHIP, BB/9, K/9, and pitch selection (fastball, slider, cutter, curveball, and changeup) were similar between the cohorts (all p &gt; 0.05). Fastball velocity (mph) were similar between the cohorts (92.3 ± 2.9 vs. 91.5 ± 7.6; p = 0.20).</div></div><div><h3>Conclusion</h3><div>MLB pitchers returning to playing level after UCLR were found to have decreased WAR and RAR as compared to pre-UCLR, however fastball velocity was similar upon return. Utilizing advanced performance statistics, such as WAR and RAR, provides a more comprehensive view of player performance and works towards improving the reliability of the reporting of outcomes in the literature. These results corroborate the utility of UCLR in return to play and should help guide shared decision making as well as patient/surgeon expectations when considering UCLR.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"64 ","pages":"Pages 194-198"},"PeriodicalIF":1.5,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143916453","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":"Exploring the impact of mechanical stimuli on growth plate morphology and trabecular adaptation: A finite element approach","authors":"Diego Quexada Rodríguez ,&nbsp;Marie-Christine Ho Ba Tho ,&nbsp;Olfa Trabelsi ,&nbsp;Diego Garzón-Alvarado","doi":"10.1016/j.jor.2025.04.014","DOIUrl":"10.1016/j.jor.2025.04.014","url":null,"abstract":"<div><h3>Background</h3><div>This research investigates how trabecular patterns affect growth plate morphology, focusing on shape, trabecular patterns, and ossification bridges. By studying mechanical adaptations, we propose a new methodology to model endochondral growth and bone remodeling, applicable to clinical cases involving growth abnormalities or growth plate diseases.</div></div><div><h3>Methods</h3><div>We developed a finite element model that integrates bone remodeling with an endochondral ossification law. The osteogenic index was used to impose a strain rate tensor, capturing growth from chondrocyte hypertrophy and proliferation in the growth plate. Then an examination was performed of the mechanical influence of trabecular structures on growth plate development and ossification through qualitative topology comparisons and statistical analysis of shape parameters affecting bone formation. Validation was conducted using medical images and μ-CT scans. The model was calibrated with a benchmark case, adjusting growth plate shape and thickness, and then applied to a hip dysplasia case and tibial growth.</div></div><div><h3>Findings</h3><div>Growth plate adapts its shape in response to the local mechanical environment and this has implications for growth plate closure. Unlike previous models treating the environment as a continuum, our model assessed localized load transmission via trabecular groups. Morphological changes in the growth plate and nearby bone adaptation help withstand shear stress, increasing bone density in specific regions, the most significant parameters being growth plate thickness and period of oscillations. A response surface and Pearson coefficient analysis show that the thickness and amplitude of the growth plate have the most significant effect on the bone density in the vicinity of the growth plate.</div></div><div><h3>Conclusions</h3><div>This new model has the potential to advance the management of medical conditions such as slipped capital femoral epiphysis, Sever's disease, and interventions like epiphysiodesis. This research may lead to improved diagnostic tools and therapeutic strategies for treating growth plate-related disorders.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"63 ","pages":"Pages 228-237"},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143917671","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}