Journal of orthopaedics最新文献

{"title":"Association of inflammatory markers and surgical intervention with postoperative pneumonia in patients with femoral intertrochanteric fracture: A propensity score-matched cohort study","authors":"Fang Li ,&nbsp;Xiaojun Fu ,&nbsp;Yingding Ruan ,&nbsp;Juncheng Yu ,&nbsp;Junhua Chen ,&nbsp;Liming Xu ,&nbsp;Jie Xiao","doi":"10.1016/j.jor.2025.06.025","DOIUrl":"10.1016/j.jor.2025.06.025","url":null,"abstract":"<div><h3>Background</h3><div>This study was conducted to determine the value of inflammatory markers and surgical intervention for predicting the occurrence of postoperative pneumonia (POP) in patients undergoing proximal femoral nail antirotation (PFNA) surgery for femoral intertrochanteric fracture (FIF).</div></div><div><h3>Methods</h3><div>A retrospective cohort analysis was conducted on patients with FIF who underwent PFNA surgery at The First People's Hospital of Jiande from January 2021 to December 2024. Systematically documented variables included preoperative and postoperative inflammatory biomarker levels, demographic characteristics, surgical approach and duration, and postoperative outcomes. The prognostic capacity of inflammatory markers for predicting POP was evaluated through a propensity score-matched comparative analysis framework.</div></div><div><h3>Results</h3><div>Among 335 patients, 53 (15.8 %) had POP. After matching, 193 patients (POP group: n = 49; non-POP group: n = 144) were included in the analysis. The median (25th percentile, 75th percentile) postoperative systemic immune–inflammation index and neutrophil-to-lymphocyte ratio (NLR) were significantly higher in the POP group than in the non-POP group (1832.00 [1388.00, 3369.67] vs. 1261.76 [936.44, 1893.94], respectively P &lt; 0.001, and 13.43 [10.85, 16.67] vs. 7.89 [5.32, 11.00], respectively, P &lt; 0.001). Multivariate analysis showed that postoperative NLR was an independent predictor of POP (area under the receiver operating characteristic curve 0.8396, P &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Postoperative NLR may predict POP among patients undergoing PFNA surgery for FIF. However, the clinical utility and optimal thresholds require validation in future prospective studies.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 326-334"},"PeriodicalIF":1.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144680617","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-assisted “physiological alignment” TKA with a 3-degree varus inclination does not affect gait ability, regardless of pre-arthritic CPAK classification matching","authors":"Kazuki Amemiya ,&nbsp;Takao Kaneko ,&nbsp;Kosuke Shiga ,&nbsp;Shogo Horiuchi ,&nbsp;Masaru Omata","doi":"10.1016/j.jor.2025.06.019","DOIUrl":"10.1016/j.jor.2025.06.019","url":null,"abstract":"<div><h3>Background</h3><div>Traditionally, the hip-knee-ankle (HKA) angle has been used as an indicator of lower limb mechanical alignment to predict postoperative outcomes in total knee arthroplasty (TKA). However, patients with knee osteoarthritis exhibit considerable individual variation in coronal plane alignment of the lower limb. The Coronal Plane Alignment of the Knee (CPAK) classification was introduced as a novel method to reflect these individual alignment characteristics. Nevertheless, it remains inconclusive whether aligning the lower limb to the patient's native CPAK phenotype before and after TKA leads to improved outcomes.</div></div><div><h3>Objective</h3><div>The purpose of this study is to investigate the impact of postoperative CPAK phenotypes and the changes from pre-to postoperative states on gait in robotic-assisted (RA) bi-cruciate stabilized (BCS) TKA using an asymmetric prosthesis aimed at achieving functional alignment (FA).</div></div><div><h3>Participants</h3><div>and Setting: This retrospective, single-surgeon, consecutive cohort study included 46 patients who underwent RA-BCS TKA.</div></div><div><h3>Methods</h3><div>Pre- and postoperative CPAK classifications were compared, and changes in the arithmetic hip-knee-ankle angle (aHKA), joint line obliquity (JLO), and gait analysis scores were evaluated both preoperatively and one year postoperatively.</div></div><div><h3>Results</h3><div>No significant differences were observed between the two groups in preoperative or postoperative walking ability, or in the postoperative changes in gait parameters.</div></div><div><h3>Conclusions</h3><div>RA-BCS TKA using physiological alignment and an asymmetric prosthesis with a built-in 3° varus inclination demonstrated no significant differences in walking ability, regardless of the prearthritic CPAK classification.</div></div><div><h3>Level of evidence</h3><div>Level Ⅲ</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 287-292"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556663","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":"Preservation of preoperative CPAK is not associated with improved clinical outcomes one-year after functionally aligned robot-assisted TKA","authors":"Oriol Pujol ,&nbsp;Joan Minguell ,&nbsp;Joan Pijoan ,&nbsp;Miguel Nuño ,&nbsp;Irene Portas-Torres ,&nbsp;Marc Aguilar ,&nbsp;Mercè Reverté ,&nbsp;Martí Plomer ,&nbsp;Enrique García-Albó ,&nbsp;Nayana Joshi","doi":"10.1016/j.jor.2025.06.030","DOIUrl":"10.1016/j.jor.2025.06.030","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine if maintaining the preoperative CPAK class influences on clinical outcomes when performing a functional aligned robotic assisted TKA (RATKA).</div></div><div><h3>Methods</h3><div>This prospective cohort study compared patients who maintained their preoperative CPAK classification following functionally aligned RATKA with those who did not. Clinical outcomes were assed at 6 and 12 months postoperatively. Collected data included demographics variables, pain (VAS), range of motion (ROM), KOOS scores and radiographic parameters (HKA, MPTA, LDFA). JLO and aHKA values were calculated to determine CPAK classification.</div></div><div><h3>Results</h3><div>Fifty-five patients were included. The preoperative CPAK phenotype was preserved in 34.6 % of cases, the aHKA group in 55.6 % and the JLO group in 52.7 %. JLO preservation was significantly more frequent in distal-apex knees (90 %). Preservation of the preoperative CPAK phenotype, aHKA group or JLO group had no significant effect on knee ROM, pain or functional outcomes at 6 or 12 months postoperatively.</div></div><div><h3>Conclusions</h3><div>Changes in CPAK classification, aHKA or JLO during RATKA with functional alignment do not impact clinical outcomes at 6 or 12 months. Implant positioning should aim for a stable, well-balanced knee within safe positioning boundaries, rather than exact CPAK restoration.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 282-286"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556849","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 influence of CPAK classification on the pivot motion between kinematic and mechanical alignment total knee arthroplasty","authors":"Eiichi Shiigi ,&nbsp;Tsuneari Takahashi ,&nbsp;Koji Yoshida ,&nbsp;Masahiro Numa ,&nbsp;Keiko Kamata ,&nbsp;Katsushi Takeshita ,&nbsp;Takashi Sakai","doi":"10.1016/j.jor.2025.06.022","DOIUrl":"10.1016/j.jor.2025.06.022","url":null,"abstract":"<div><h3>Purpose</h3><div>This study investigated whether the preoperative coronal plane alignment of the knee (CPAK), categorized as type I or II, has an effect on postoperative tibial internal rotation (TIR) relative to the femur in patients who received a medial pivot-cruciate retaining (MP-CR) total knee arthroplasty (TKA).</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 62 patients who underwent MP-CR TKA with the GMK Sphere implant (Medacta International, Switzerland) from January 2024 to May 2025. Based on their CPAK classification, patients were divided into two groups (type I or II). Intraoperative kinematic assessments were performed using augmented reality (AR) CT-guided navigation (NextAR, Medacta), evaluating the dynamic elongation of medial and lateral collateral ligaments during either kinematic (KA) or mechanical alignment (MA) procedures. The primary measure was TIR at 30°, 60°, 90°, and 120° of knee flexion.</div><div>Univariate analyses identified significant differences, which were further assessed using multi-way ANOVA to determine interactions with CPAK classification.</div></div><div><h3>Results</h3><div>Notable differences in TIR were found between CPAK types I and II at 60° (2.1° ± 4.8° vs. −2.0° ± 4.2°, p = 0.009), 90° (7.0° ± 4.3° vs. 2.1° ± 5.6°, p = 0.002), and 120° (13.1° ± 5.2° vs. 7.5° ± 4.9°, p = 0.002). Additionally, at 90°, sex and alignment method (KA vs. MA) showed significant interaction with CPAK classification (F = 6.4; p = 0.015), while the alignment method alone had no significant effect on TIR.</div></div><div><h3>Conclusion</h3><div>The CPAK classification prior to surgery affected TIR outcomes regardless of the alignment method used, as measured via AR-CT navigation.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 310-315"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522269","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":"Stress-guided determination of screw trajectory for C1 lateral mass fixation: A finite element approach","authors":"Mehmet Selim Demirtas ,&nbsp;Densel Arac ,&nbsp;Fatih Keskin","doi":"10.1016/j.jor.2025.06.024","DOIUrl":"10.1016/j.jor.2025.06.024","url":null,"abstract":"<div><h3>Aim</h3><div>This study aimed to determine the proper positioning for a C1 (atlas) lateral mass screw by a stress analysis on a 3D model of the C1 vertebra based on computerized tomography scans.</div></div><div><h3>Material and methods</h3><div>A 3D model of the C1 vertebra was constructed using computed tomography images from 80 patients who presented to our hospital with neck pain but no cervical pathology. Using a geometrical approach for screw placement in the C1 lateral mass, the screw trajectory was traced, and a suitable entry point, screw angulations, and screw length were calculated. These values were determined through finite element analysis based on stress distribution resulting from screw pull-out forces.</div></div><div><h3>Results</h3><div>The developed geometrical method can be utilized to determine the screw path by using radiologic images for patient specific surgical planning. Additionally, the average distance from the midline to the screw entry site was 20.27 ± 1.48 mm, an acceptable medial angle of 20.75 ± 3.84°. There is only minor effect of mean superior angle on the stress distribution. Based on these entry point and angulation values, the favorable screw length was determined as 21.16 ± 2.37 mm.</div></div><div><h3>Conclusion</h3><div>There is no consensus on the most optimum screw entry and angle values for C1 screw stabilization in terms of structural integrity. This study offers strong evidence supporting the applicability of the C1 lateral mass screw technique for cervical instability by providing favorable entry site and angulation values.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 316-323"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522686","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":"Discrepancy between predicted and actual soft tissue balance in robot-assisted total knee arthroplasty","authors":"Hiroshi Inui,&nbsp;Haruhiko Nakamura,&nbsp;Ryota Takei,&nbsp;Masaki Uchida,&nbsp;Kei Satou,&nbsp;Tetsu Yamashita,&nbsp;Risa Matsumoto","doi":"10.1016/j.jor.2025.06.032","DOIUrl":"10.1016/j.jor.2025.06.032","url":null,"abstract":"<div><h3>Background</h3><div>Achieving optimal soft tissue balance in total knee arthroplasty (TKA) is vital for successful clinical outcomes. Robotic-assisted TKA predicts postoperative soft tissue balance based on preoperative varus–valgus stress. Nevertheless, these predictions may not always be accurate due to changes in soft tissue balance after osteotomy and variability in manual stress application. Therefore, this study was conducted to investigate the differences between predicted and final soft tissue balance and determine the factors affecting these differences.</div></div><div><h3>Methods</h3><div>In 112 robotic-assisted TKA cases, the predicted joint gaps at extension (10°) and flexion (90°) were evaluated intraoperatively before osteotomy, and the final joint gaps were evaluated after final implantation under manual varus–valgus stress. Differences between the predicted and final gaps (DPFG) e calculated, and correlations between DPFG and preoperative parameters were analyzed.</div></div><div><h3>Results</h3><div>The final joint gaps were significantly larger than the predicted gaps in both extension and flexion (P &lt; 0.001). A greater preoperative hip–knee–ankle angle and increased flexion angle were associated with smaller DPFG in the medial compartment. Conversely, severe preoperative flexion contracture correlated with larger DPFG in extension in the lateral compartment.</div></div><div><h3>Conclusion</h3><div>Soft tissue balance predictions in robotic-assisted TKA are not always accurate, with the final joint gaps tending to be larger than predicted. Preoperative limb alignment and knee range of motion influence these differences, emphasizing the need for surgeons to interpret robotic predictions cautiously. Adjustments during surgery may be required to optimize soft tissue balance.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 257-262"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144548640","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":"8–11 year results of LARS augmented hamstring in anterior cruciate ligament reconstruction surgery: Incidence of synovitis and failures","authors":"Sol Qurashi ,&nbsp;Wagdy Ashaia ,&nbsp;Janna Maier ,&nbsp;William Ridley ,&nbsp;Tat Chao ,&nbsp;Muhaimen Jassim ,&nbsp;Sam Aktas ,&nbsp;Femi E. Ayeni ,&nbsp;Raj Narulla","doi":"10.1016/j.jor.2025.06.033","DOIUrl":"10.1016/j.jor.2025.06.033","url":null,"abstract":"<div><h3>Background</h3><div>Anterior cruciate ligament (ACL) injury account for the majority of sport related knee ligament injuries and ACL reconstruction surgery is one of the most performed operations in the young adult population. Various graft types have been used to reconstruct the ACL, however there is no consensus on the best option. Concerns about quality and size of the graft and its effects on success of the reconstruction remain. Synthetic grafts have also been used for a long time as a substitute or to augment biological grafts however, concerns about early failure and particle related synovitis have limited their intra-articular use. The most common synthetic graft option still in use is the Ligament Augmentation and Reconstruction System (LARS).</div></div><div><h3>Method</h3><div>The study is a case controlled retrospective comparison of 102 consecutive cases reporting 8–11 year results in relation to clinical outcomes revision rates and synovitis of ACL reconstruction surgery using LARS synthetic grafts as an augment when compared with hamstring graft alone.</div></div><div><h3>Result</h3><div>The study found a mean follow up was 9 years and one month (8–11 years) and revision rate was 5.7 % for the LARS augmented group and 12.5 % for the Hamstring group, but not significantly different, odds ratio 0.4 (C.I: 0.1179–1.555, p = 0.255). LARS augmented autograft ACL reconstruction had similar results at 8–11 years when compared to autograft only reconstructions. No synovitis was noted in either group.</div></div><div><h3>Conclusion</h3><div>LARS ensures an appropriately sized graft, is safe and not associated with synovitis in our cohort at 8–11 year follow up.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 252-256"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144534805","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 50 most cited articles on patellofemoral instability: A bibliometric and network analysis of research trends and impact","authors":"Alexander Price ,&nbsp;Nicolaas Kotze ,&nbsp;Xander van Heerden ,&nbsp;Gerard A. Sheridan","doi":"10.1016/j.jor.2025.06.026","DOIUrl":"10.1016/j.jor.2025.06.026","url":null,"abstract":"<div><h3>Background</h3><div>Patellofemoral instability remains a complex clinical challenge, especially among adolescents and young adults. While research in this area has expanded considerably, few studies have comprehensively examined the most influential literature shaping current knowledge and guiding clinical practice.</div></div><div><h3>Methods</h3><div>The top 50 most cited articles related to patellofemoral instability were identified using Publish or Perish software (Version 8, Harzing.com) to access data from Google Scholar. Citation metrics, study characteristics (e.g. design, level of evidence, origin, journal), and thematic foci were extracted. Keyword network mapping was conducted using Gephi to identify dominant research themes.</div></div><div><h3>Results</h3><div>Citation counts ranged from 179 to 2,295, with a median of 276. Most studies were published after 2005 and were predominantly Level IV and V evidence. Surgical reconstruction, especially medial patellofemoral ligament (MPFL) procedures, was the prevailing research focus. Geographically, 40 % of studies originated from the United States of America (USA), followed by France and the United Kingdom (UK). Thematic clustering revealed three main domains: surgical reconstruction, anatomical diagnostics, and clinical outcomes. Non-operative treatment modalities and rehabilitation were notably under investigated.</div></div><div><h3>Conclusion</h3><div>This study provides an up-to-date and comprehensive analysis of the most influential literature regarding patellofemoral instability. It highlights persistent gaps in high-level evidence, conservative treatment approaches, and global representation. These findings offer a strategic direction for future research, emphasizing the need for high-level evidence that is both inclusive and patient-focused to better guide clinical practice.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 245-251"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144534816","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":"Tibial shaft fractures: A bibliometric analysis of the top 50 most cited publications","authors":"Ethan Gilkinson,&nbsp;Ben Murphy,&nbsp;Niall McGoldrick,&nbsp;John Quinlan","doi":"10.1016/j.jor.2025.06.020","DOIUrl":"10.1016/j.jor.2025.06.020","url":null,"abstract":"<div><h3>Background</h3><div>Tibial shaft fractures (TSFs) are a frequent presentation within orthopaedics, most often occurring in young males following a high energy trauma. The appropriate management of these fractures is crucial, ensuring patients have the best chance at achieving a functional recovery. In spite of the vast number of studies conducted on TSFs, the quality of scientific evidence and various trends related to this injury remains poor. The aim of our analysis is to identify these trends within the 50 most cited publications pertaining to TSFs.</div></div><div><h3>Methods</h3><div>A bibliometric analysis was carried out using the Web of Science platform to report the 50 most cited publications associated with TSFs. The publications were screened using definite inclusion and exclusion criteria. Features such as institution, authorship, level of evidence and patient demographics were reported.</div></div><div><h3>Results</h3><div>The 50 most cited publications in total listed 10, 407 citations, with the most cited study receiving 1075 citations. Treatment outcomes (66 %) and surgical technique (32 %) were the primary focus of the majority of the publications. Retrospective cohort and case control studies made up almost half of the studies (48 %), many being of level III evidence. The McMaster University Hospital was the institution that produced the greatest number of studies, with the Journal of Bone and Joint Surgery having published most of the articles.</div></div><div><h3>Conclusion</h3><div>Many publications exist related to TSFs, primarily focusing on treatment outcomes and how to minimize the incidence of non-union following surgical fixation. However, a significant number of the publications were of low evidence and were identified as being retrospective in nature. Following this analysis, future research should aim to produce studies of a higher quality and focus on areas that carry the most promise or influence, such as the use of recombinant human bone morphogenetic protein-2 in intramedullary nailing of TSFs.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 324-328"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522279","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":"Arthroscopic fixation versus open reduction and internal fixation for displaced tibial side posterior cruciate ligament avulsion fractures: A systematic review and meta-analysis","authors":"Rajesh Kumar Rajnish ,&nbsp;Sandeep Kumar Yadav ,&nbsp;Amit Srivastava ,&nbsp;Arvind Prasad Gupta ,&nbsp;Saurabh Gupta ,&nbsp;Abhay Elhence","doi":"10.1016/j.jor.2025.06.021","DOIUrl":"10.1016/j.jor.2025.06.021","url":null,"abstract":"<div><h3>Background</h3><div>The reported incidence of the posterior cruciate ligament (PCL) injury ranges from 3 to 23 % of all knee injuries. Several injury patterns of the PCL have been described, including intra-substance, femoral detachment, and tibial avulsion, of which the last two are more common. Displaced PCL avulsion injury from the tibial side requires surgical fixation; however, there is no consensus in the literature regarding the optimal surgical approach for the fixation of these injuries.</div></div><div><h3>Purpose</h3><div>To perform a systematic review and meta-analysis of the outcomes and complications of arthroscopic and open fixation of displaced tibial side PCL avulsion fractures.</div></div><div><h3>Methods</h3><div>We performed a primary electronic search across PubMed, Embase, Scopus, and Cochrane Library databases and looked for comparative studies that evaluated and compared the outcomes of arthroscopic versus open reduction and fixation of displaced tibial side PCL avulsion fractures. Statistical analyses were executed with the software RevMan-5.4.1.</div></div><div><h3>Results</h3><div>This meta-analysis included two RCTs, one prospective and seven retrospective comparative studies. Evaluation across all ten studies suggested no statistically significant difference for arthroscopic versus open fixation in terms of postoperative International Knee Documentation Committee (IKDC) score (MD 4.43 [-0.73, 9.42; p = 0.09]), Lysholm score (MD 2.69 [-1.07,6.45; p = 0.16], knee range of motion (ROM) (MD -1.08 [-2.80,0.63; p = 0.21]), complications (OR1.75 [0.86, 3.54; P = 0.12]), Tegner activity (MD 0.14 [-0.46,0.74; p = 0.64]), posterior tibial translation (PTT) (MD -0.60 [-1.51,0.31; p = 0.20, posterior drawer test (PDT), operating time (MD 12.03 [-0.47, 24.53; p = 0.06]), and length of hospital stay. The fracture union rate was 98.77 % in the arthroscopic group and 100 % in the open fixation group, with comparable union time. There is a significantly lesser amount of blood loss in the arthroscopic group compared to the open group.</div></div><div><h3>Conclusion</h3><div>Current evidence shows comparable outcomes and complications for tibial side PCL avulsion fracture fixation through arthroscopic or open methods.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 271-281"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144548639","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}