Journal of Orthopaedic Case Reports最新文献

{"title":"Combined Endoscopic SpeedBridge™ Reinsertion and Proximal Medial Gastrocnemius Lengthening for Chronic Insertional Achilles Tendinopathy in an Elite Sprinter: A Case Report.","authors":"Ronny Lopes, Antoine Bruneau, Michel Gaillaud, André Santos-Moreira","doi":"10.13107/jocr.2026.v16.i10.8246","DOIUrl":"10.13107/jocr.2026.v16.i10.8246","url":null,"abstract":"<p><strong>Introduction: </strong>Insertional Achilles tendinopathy (IAT) is common in running athletes and, when refractory to conservative treatment, may require surgery. Open debridement and reinsertion are associated with wound-healing complications and prolonged recovery, which are particularly problematic in sprinters, whose performance depends heavily on the gastrocnemius-soleus-Achilles complex. Endoscopic double-row (SpeedBridge™) Achilles reinsertion may reduce soft-tissue morbidity, while concomitant gastrocnemius tightness is increasingly recognized in the pathogenesis of IAT. Return to sport after such surgery is rarely documented, and the need to correct an associated high-arched hindfoot remains debated. We report a single-stage combined procedure in an elite sprinter, with deliberate non-correction of a marked pes cavus.</p><p><strong>Case report: </strong>A 24-year-old elite international-level female sprinter presented with chronic right IAT that had remained symptomatic for approximately 2 years despite structured conservative treatment and three platelet-rich plasma injections. Clinical examination revealed pes cavus and a positive Silfverskiöld test, consistent with gastrocnemius tightness. Weight-bearing lateral radiography showed a calcaneal pitch of 40°. Magnetic resonance imaging (MRI) confirmed insertional tendinopathy with intratendinous calcification, without significant retrocalcaneal bursitis or bone-marrow edema. A single-stage procedure was performed, combining proximal medial gastrocnemius lengthening with endoscopic calcaneal SpeedBridge™, including calcaneoplasty, debridement of calcifications, central tendon detachment, and knotless double-row reinsertion using 4.75-mm anchors. Immediate full weight-bearing, thromboprophylaxis, and early physiotherapy were prescribed. The Victorian institute of sport assessment-Achilles score was 81 at 6 months, and control MRI at that time was normal. Running was resumed in water and on an anti-gravity treadmill at 4 months, jogging at 6 months, high-intensity track running at 9 months, and starting-block sprinting at 13 months, when the patient was pain-free. The patient returned to official competition and pre-injury level at 16 and 20 months of follow-up, respectively.</p><p><strong>Conclusion: </strong>To the best of our knowledge, this is the first report documenting return to sport after combined endoscopic SpeedBridge™ reinsertion and proximal medial gastrocnemius lengthening for IAT in an elite athlete. This case supports a tendon-and-muscle-chain strategy with minimal soft-tissue morbidity and suggests that bony correction of an associated pes cavus is not mandatory to obtain a good functional outcome in this setting.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"227-232"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior Acetabular Reconstruction Can Sometimes Lead To Retroverted Cup Placement In Complex Total Hip Arthroplasty.","authors":"Alok Chandra Agrawal, Shivam Chauhan, Jagprit Singh, Jayakrishnu Thundathil Jayan, Sunit Bhattacharyya, Darshan Madan Temker","doi":"10.13107/jocr.2026.v16.i10.8212","DOIUrl":"10.13107/jocr.2026.v16.i10.8212","url":null,"abstract":"<p><strong>Introduction: </strong>Acetabular fractures with uncontained posterior wall and posterior column bone loss make orientation of the acetabular component difficult during total hip arthroplasty (THA). When the posterior buttress is deficient, the socket tends to settle in retroversion, which alters hip biomechanics, promotes edge loading and accelerated polyethylene wear, and predisposes to anterior impingement and instability. Structural femoral head autograft restores bone stock in such defects, but its influence on final cup version is seldom documented. To our knowledge, this is the first series to specifically highlight persistent cup retroversion despite anatomic autograft reconstruction of the posterior wall.</p><p><strong>Case report: </strong>Three men of Indian ethnicity, aged 47, 35, and 59 years, presented with post-traumatic arthritis 2-8 months after acetabular fractures sustained in road traffic accidents; all had been managed conservatively elsewhere. Imaging showed uncontained posterosuperior defects classified as Paprosky grade 2B, American Academy of Orthopaedic Surgeons segmental posterior and superior, and Gross type 3. Associated injuries included femoral head fracture with posterior dislocation, of Pipkin type 4 in two patients. All were treated by primary THA through the posterior approach. The posterior wall defect was reconstructed with femoral head structural autograft secured with partially threaded cannulated cancellous screws, supplemented by a reconstruction plate in one patient, followed by a porous-coated hemispherical shell with a 10° elevated-rim liner and an uncemented femoral stem. Post-operative radiographs showed stable fixation in all patients. Computed tomography at follow-up demonstrated cup retroversion of 5°, 19°, and 7° from neutral. Pain relief and functional improvement were achieved in all three patients; one sustained a posterior prosthetic dislocation at 2 months, treated by closed reduction, and the other two had mild residual discomfort and a mild gait abnormality.</p><p><strong>Conclusion: </strong>Posterior acetabular bone loss predisposes to retroversion of the acetabular component during THA even after structural autograft reconstruction, with attendant risks of impingement, edge loading, and dislocation. Meticulous pre-operative planning, intraoperative verification of cup version against bony landmarks and fluoroscopy, and readiness to use stability-enhancing bearings are recommended, with cross-sectional imaging to document final component orientation.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"129-136"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occult Femoral Arteriovenous Fistula and Pseudoaneurysm after a Gunshot-Associated Subtrochanteric Fracture: Transfusion-Refractory Anemia as the Sentinel Sign - A Case Report.","authors":"Zeeshan Ahmad Khalil, Krishna Kumar Mangal, Sandip Mahapatra, Aryaman Jaiman","doi":"10.13107/jocr.2026.v16.i10.8218","DOIUrl":"10.13107/jocr.2026.v16.i10.8218","url":null,"abstract":"<p><strong>Introduction: </strong>Traumatic arteriovenous fistulae (AVF) are an uncommon but easily missed consequence of penetrating limb trauma. Affected patients may be asymptomatic or show only subtle systemic signs, and delayed recognition risks serious limb- and life-threatening complications.</p><p><strong>Case report: </strong>A 28-year-old man sustained a gunshot wound to the left thigh with a comminuted subtrochanteric femoral fracture. Distal pulses were palpable and the limb examination was unremarkable, yet he developed persistent tachycardia, tachypnea, and a transfusion-refractory fall in hemoglobin. Color Doppler was reported as normal, but computed tomography (CT) angiography revealed a superficial femoral arteriovenous fistula with an associated pseudoaneurysm and preserved distal run-off. This was treated with a covered stent graft. Definitive fixation of the fracture was deferred due to dual antiplatelet therapy and later performed with a reconstruction nail, cerclage wiring, and bone grafting. At 6 months, the patient was symptom-free, with a united fracture and a full range of hip and knee movement.</p><p><strong>Conclusion: </strong>A traumatic AVF can hide behind palpable pulses and a normal color Doppler. A transfusion-refractory fall in hemoglobin with unexplained tachycardia and tachypnea near a major vessel should prompt CT angiography, which is the definitive investigation in this setting. This triad, derived from a single case, awaits validation in larger series.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"147-153"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osteoblastoma of the Radial Shaft Mimicking Parosteal Osteosarcoma: A Case Report.","authors":"Himadri Dhabal, Saptarshi Barman, Sunny Kumar Mallick, Sanjay Kumar","doi":"10.13107/jocr.2026.v16.i10.8232","DOIUrl":"10.13107/jocr.2026.v16.i10.8232","url":null,"abstract":"<p><strong>Introduction: </strong>Osteoblastoma is a rare benign osteogenic tumor accounting for approximately 1% of primary bone tumors. Involvement of the radial shaft is uncommon and may pose a diagnostic challenge because of overlapping radiological and histopathological features with surface osteosarcomas. We report a rare case of radial shaft osteoblastoma initially suspected to be parosteal osteosarcoma and managed with wide excision and biological reconstruction.</p><p><strong>Case report: </strong>A 17-year-old male presented with progressive pain and swelling over the middle third of the right forearm for the preceding 6 months. Radiographs and magnetic resonance imaging demonstrated a surface-based lesion involving the radial shaft with aggressive radiological features. Core biopsy was suggestive of parosteal osteosarcoma. Due to the clinicoradiological suspicion of malignancy, wide excision of the involved radial segment was performed. Reconstruction was achieved using an ipsilateral non-vascularized fibular autograft stabilized with plate fixation. The pronator quadratus was excised en bloc with the lesion, and pronator teres was reattached to the fibular graft using a 2.8-mm suture anchor. Histopathological examination of the excised specimen demonstrated histomorphological features of a benign osteogenic tumor consistent with osteoblastoma, with no nuclear evidence of malignancy. Follow-up demonstrated satisfactory function and no evidence of recurrence.</p><p><strong>Conclusion: </strong>Radial shaft osteoblastoma may mimic parosteal osteosarcoma clinically, radiologically, and on biopsy. Definitive diagnosis may require examination of the entire excised specimen. Biological reconstruction with ipsilateral fibular autograft can provide satisfactory functional outcomes.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"193-197"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Functional Outcome of Extended Flexor Carpi Radialis Approach for Fracture Fixation of Distal End Radius Fracture.","authors":"Nilesh Gupta, Gautam Chatterji, Ajinkya Vinod Mahajan, Ravi Mehrotra, Gohel Yuvraj Ashwinbhai, Prateek Sahu","doi":"10.13107/jocr.2026.v16.i10.8326","DOIUrl":"10.13107/jocr.2026.v16.i10.8326","url":null,"abstract":"<p><strong>Introduction: </strong>Intra-articular distal radius fractures require accurate anatomical reduction, articular congruity, and stable fixation to restore wrist function and preserve biomechanics. The extended flexor carpi radialis (eFCR) approach provides extensile exposure for complex fracture patterns.</p><p><strong>Material and methods: </strong>This prospective observational study included 30 adults with closed intra-articular fractures treated by open reduction and internal fixation through the eFCR approach with volar locking plate fixation from April 2024 to June 2025. Functional outcome was assessed by disabilities of the arm, shoulder, and hand (DASH) score up to 6 months. Operative time, blood loss, range of motion, union, and complications were recorded.</p><p><strong>Results: </strong>Mean age was 45.83 ± 14.99 years. AO/OTA type C fractures accounted for 22 cases (73.3%) and type B for 8 cases (26.7%). Mean operative time was 89.23 ± 11.01 min and mean blood loss was 96.33 ± 11.89 mL. DASH score improved from 56.92 ± 8.98 at 2 weeks to 9.92 ± 4.20 at 6 months (P < 0.001). At 6 months, mean flexion, extension, supination, and pronation were 71.50 ± 2.70°, 60.10 ± 2.77°, 80.47 ± 4.31°, and 79.03 ± 3.94°. Volar tilt improved from -15.90 ± 3.48° to 9.81 ± 0.59°, radial inclination from 13.12 ± 2.24° to 24.74 ± 1.20°, radial length from 6.18 ± 1.25 mm to 12.06 ± 1.31 mm, and ulnar variance from +4.04 ± 1.07 mm to +0.65 ± 0.58 mm (all P < 0.001). Union occurred in all patients, with two minor complications.</p><p><strong>Conclusion: </strong>The eFCR approach provided reliable anatomical restoration, satisfactory recovery of function, and low morbidity in closed intra-articular distal radius fractures at 6 months.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"500-507"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Unusual Presentation of Right fifth Flexor Digitorum Profundus Tendon Zone 3 Rupture Following Jersey Finger Mechanism Injury.","authors":"Alex Wu, Ibin Varughese, Michelle Caudwell","doi":"10.13107/jocr.2026.v16.i10.8262","DOIUrl":"10.13107/jocr.2026.v16.i10.8262","url":null,"abstract":"<p><strong>Introduction: </strong>Zone 3 mid-substance flexor tendon ruptures not only are exceptionally rare but also can clinically masquerade as zone 1 \"Jersey finger\" during forceful distal interphalangeal joint extension trauma, which can lead to challenges in both conducting diagnosis and surgical intervention planning.</p><p><strong>Case report: </strong>A 58-year-old Caucasian gentleman presented with right little finger pain and deformity. He was referred to the orthopedic department as a \"Jersey finger.. The mechanism was innocuous and incongruent with the pathology. It involved pulling and pushing a standard household doorknob. He described a \"snap and pop\" sensation and pain over his mid-palm A1 pulley level. Clinically, his finger demonstrated flexor digitorum profundus (FDP) function loss and flexor lag deformity. He was also found to have an unusual presentation of diffuse tenderness along the A1 pulley toward zone 3 metacarpal levels. Magnetic resonance imaging (MRI) was performed to fully elucidate the pathology. A complete mid-substance full-thickness tendon rupture was identified in zone 3. It was at the level of the metacarpal base. Primary tendon repair was performed with two minimally invasive surgical incisions (fifth metacarpal Brunner incision and carpal tunnel approach) while using a Lim-Tsai six-strand cruciate core tendon repair technique with circumferential 5' proline reinforcement. After his early active range of motion (ROM) flexor protocol hand therapy, the patient fully regained active ROM and strong grip functional recovery during his 6th-week post-operative review.</p><p><strong>Conclusion: </strong>In this case report, we demonstrated that zone 3 mid-substance full-thickness FDP tendon ruptures can mimic Jersey finger injury as an unusual clinical presentation. Therefore, thorough clinical assessment and radiographic investigations (ultrasound or MRI) are crucial to identify precise ruptured tendon stump locations and guide primary tendon repair with minimal invasive surgical approach. As a result, patients can benefit from having minimal surgical scar tissue while reducing the risk of infection and regaining early functional recovery.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"270-275"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrapelvic Neck Screw Migration after Trochanteric Fixation Nail Advanced Fixation of a Trochanteric Femoral Fracture: A Case Report and Proposed Treatment Algorithm.","authors":"Nabil Slaoui Berezak, Jesús Llorens Fernández, Jorge Crespo Cánovas, Carles Marián Carrasco, Francisco Ferrero-Manzanal","doi":"10.13107/jocr.2026.v16.i10.8222","DOIUrl":"10.13107/jocr.2026.v16.i10.8222","url":null,"abstract":"<p><strong>Introduction: </strong>Although rare, mechanical failure of fixation in trochanteric fractures can lead to significant morbidity, particularly when medial migration of the cephalic screw occurs, posing a serious risk of life-threatening injury to intrapelvic vascular and visceral structures.</p><p><strong>Case report: </strong>We report a case of severe intrapelvic migration of a cephalic screw in a 79-year-old patient following short trochanteric fixation nail advanced fixation for an unstable trochanteric fracture (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association 31-A2). The patient presented with acute mechanical failure, pain, and severe agitation. Urgent surgical intervention was performed, consisting of hardware removal and single-stage conversion to total hip arthroplasty (THA) using a dual-mobility construct. This multidisciplinary strategy successfully resolved the intrapelvic risk, provided stable joint reconstruction, and allowed for immediate full weight-bearing and early mobilization.</p><p><strong>Conclusion: </strong>Intrapelvic screw migration requires prompt recognition and urgent surgical intervention with multidisciplinary preparation. Single-stage conversion to dual-mobility THA may provide a salvage procedure that mitigates visceral/vascular risks and enables early functional recovery in frail elderly patients.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"161-167"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Giant Cell Tumor of the Lateral Malleolus Treated by Tumor Excision and Reconstruction using A 180° Rotated Proximal Fibular Autograft - A Rare Case Report.","authors":"N Ebel Raj, G S Mukharjee, P S Amal","doi":"10.13107/jocr.2026.v16.i10.8264","DOIUrl":"10.13107/jocr.2026.v16.i10.8264","url":null,"abstract":"<p><strong>Introduction: </strong>Giant cell tumor (GCT) of bone was first described by Sir Astley Cooper in 1818. It is one of the most frequently encountered benign bone tumors in orthopedic practice and is characterized by a significant risk of local recurrence following surgical treatment. GCT involving the distal fibula, particularly the lateral malleolus, is extremely rare, accounting for <1% of all cases. Various treatment modalities have been described for lateral malleolus GCT, including tumor excision, ankle arthrodesis, reconstruction with ipsilateral proximal fibular graft, and autograft or allograft reconstruction. This report presents the management of a Campanacci Grade II GCT of the lateral malleolus involving the epiphysis and metaphysis, with compression of the lateral collateral ligament complex, peroneal muscles and tendons, and the talus. The patient was successfully treated with tumor excision, reconstruction using an ipsilateral proximal fibular graft, and ankle joint reconstruction. This technique preserved ankle stability while maintaining joint mobility.</p><p><strong>Case report: </strong>A 26-year-old male presented with a 6-month history of swelling and pain over the lateral aspect of the ankle. Radiological evaluation and histopathological examination were performed to establish the diagnosis and plan treatment. The patient underwent complete surgical excision of the tumor followed by reconstruction using an ipsilateral proximal fibular graft. Histopathological analysis confirmed the diagnosis of a Grade I GCT without evidence of malignant transformation.</p><p><strong>Conclusion: </strong>Due to the rarity of distal fibular GCT, the optimal surgical approach and its impact on ankle stability remain subjects of debate. The reconstruction technique described in this case provides a viable option for managing such uncommon lesions, offering effective tumor control, preservation of ankle stability, and maintenance of functional joint movement. This method may serve as a valuable reference for future reconstruction procedures in similar rare clinical scenarios.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"276-280"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total Hip Arthroplasty for Advanced Femoral Head Osteonecrosis in a 24-Year-Old Competitive Wrestler: A Case Report.","authors":"Sharath Raj, Kartik Sharma, Ajay Jose, Souvik Das, Romil Kumar, Vijay Goni","doi":"10.13107/jocr.2026.v16.i10.8238","DOIUrl":"10.13107/jocr.2026.v16.i10.8238","url":null,"abstract":"<p><strong>Introduction: </strong>Osteonecrosis of the femoral head (ONFH) in young, physically active patients poses a substantial diagnostic and therapeutic challenge. Joint-preserving surgery is generally preferred before femoral head collapse; however, advanced post-collapse disease with secondary degenerative change may make these options less predictable. We report a competitive wrestler with advanced ONFH in whom early total hip arthroplasty (THA) was selected after consideration of joint-preserving alternatives. The case is also notable for potential etiologic contributors, including approximately 7 months of prednisone exposure and heterozygous Factor V Leiden; the remainder of the documented thrombophilia work-up was negative.</p><p><strong>Case report: </strong>A 24-year-old male competitive freestyle wrestler presented with a 6-month history of insidious right groin pain. Imaging demonstrated extensive femoral head osteonecrosis with collapse and early secondary degenerative change. He underwent cementless THA through a posterior approach. At 6 months, the Harris hip score improved from 72 to 94, with substantial improvement in pain and hip range of motion. At 9 months, the clinical scores and range of motion remained approximately unchanged, post-operative radiographs remained normal, and the patient had resumed wrestling matches without reported hip-related problems.</p><p><strong>Conclusion: </strong>This case illustrates that THA may be a reasonable, case-specific option for a young high-demand athlete with advanced post-collapse ONFH when joint preservation is considered unlikely to provide a predictable result. The 9-month outcome demonstrates sustained early-to-intermediate functional recovery in this individual, including return to wrestling matches, but it does not establish long-term implant survivorship, safety of contact sport, or superiority over joint-preserving procedures. Longer follow-up and comparative studies are required before routine early THA can be recommended in young athletes.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"208-214"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence, Arthroscopic Detection, and Clinical Outcomes of Ramp Lesions in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Prospective Observational Study.","authors":"Albin Thomas, Manmatha Nayak, Sujit Kumar Singh, Anuragdeep Syal, Mohammad Abdul Akram, P Neeraj","doi":"10.13107/jocr.2026.v16.i10.8330","DOIUrl":"10.13107/jocr.2026.v16.i10.8330","url":null,"abstract":"<p><strong>Introduction: </strong>Ramp lesions are tears involving the meniscocapsular or meniscotibial attachment of the posterior horn of the medial meniscus and are commonly associated with anterior cruciate ligament (ACL) injuries. These lesions are frequently missed on pre-operative magnetic resonance imaging (MRI) and may contribute to persistent knee instability if left untreated. The present study aimed to determine the incidence of ramp lesions in patients undergoing ACL reconstruction, evaluate the diagnostic yield of systematic arthroscopic assessment compared with MRI, and assess their association with pre-operative instability and post-operative functional outcomes.</p><p><strong>Materials and methods: </strong>This prospective observational study included 50 patients with ACL tears who underwent arthroscopic ACL reconstruction at a tertiary care center. Demographic characteristics, mechanism of injury, MRI findings, arthroscopic findings, associated intra-articular injuries, and clinical outcome measures were recorded. Ramp lesions were identified through systematic arthroscopic evaluation of the posteromedial compartment. Functional outcomes were assessed using the Lysholm Knee Score and International Knee Documentation Committee (IKDC) score. Statistical analysis was performed using the Statistical Package for the Social Sciences version 26.0, with P < 0.05 considered statistically significant.</p><p><strong>Results: </strong>The incidence of ramp lesions was 28.0% (14/50 patients). MRI detected 8 of 14 ramp lesions (57.1%), whereas arthroscopy identified all lesions, with MRI missing 42.9% of cases. Patients with ramp lesions demonstrated significantly greater pre-operative instability, with positive pivot shift tests in 85.7% and Grade III Lachman tests in 78.6% of cases. Mean Lysholm scores improved from 49.3 ± 8.6 to 90.6 ± 5.2, whereas mean IKDC scores improved from 44.7 ± 7.8 to 85.8 ± 6.0 at 6 months postoperatively. Overall, 86.0% of patients experienced no post-operative complications.</p><p><strong>Conclusion: </strong>Ramp lesions are common associated injuries in ACL-deficient knees and are frequently underdiagnosed on MRI. Systematic arthroscopic evaluation significantly improves detection rates and facilitates appropriate management. Early identification and treatment of ramp lesions during ACL reconstruction result in excellent functional recovery and favorable clinical outcomes.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"515-523"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}