Journal of Orthopaedic Science最新文献

{"title":"\"Does advanced imaging improve the reliability of 2018 AO/OTA classification for trochanteric femoral fractures?\"","authors":"Prajwal Gupta, Sumit Arora, Shahrukh Khan, Swati Gupta, Vineet Bajaj, Abhishek Kashyap","doi":"10.1016/j.jos.2024.12.009","DOIUrl":"https://doi.org/10.1016/j.jos.2024.12.009","url":null,"abstract":"<p><strong>Background: </strong>The influence of advanced imaging modalities on the reliability of 2018 AO/OTA classification and detection of features contributing to fracture instability have not been adequately studied in the literature.</p><p><strong>Methods: </strong>This prospective study was conducted to assess the reliability of 2018 AO/OTA classification for trochanteric femoral fractures, and features of instability in 50 patients using radiographs, multiplanar reformats (MPR), and 3D-reconstruction with fracture segmentation (3DR-FS) by 3 observers on 2 occasions at an interval of 4 weeks.</p><p><strong>Results: </strong>Mean inter-observer reliabilities on radiographs, MPR, 3DR-FS were 0.36, 0.39, 0.46 after first reading, and 0.35, 0.35, 0.44 after second reading respectively. The mean intra-observer reliabilities for radiographs, MPR, 3DR-FS were 0.36, 0.43, and 0.50 respectively. Inter-observer reliabilities on subgroup analysis were 0.35, 0.27, 0.40 for subgroup A1 and 0.19, 0.22, and 0.30 for subgroup A2 on radiographs, MPR and 3DR-FS respectively. All results were statistically significant (p-value <0.05). Posterior comminution was detected in 125(41 %), 247(82 %), and 255 (85 %) out of total 300 instances on radiographs, MPR and 3DR-FS respectively. Coronal split was detected in 113(37 %), 189(63 %), and 242 (80 %) out of total 300 instances on radiographs, MPR, and 3DR-FS respectively. Flexion of the proximal fragment was detected in 106(35 %), 163(54 %), and 180 (60 %) out of total 300 instances on radiographs, MPR, and 3DR-FS respectively. Lateral wall fracture was detected in 45(15 %), 80(26 %), and 138 (46 %) out of total 300 instances on radiographs, MPR, and 3DR-FS respectively. The banana fragment was detected in 5(1 %), 16(5 %), and 83 (27 %) out of a total of 300 instances on radiographs, MPR, and 3DR-FS respectively.</p><p><strong>Conclusions: </strong>2018 AO/OTA classification for trochanteric femoral fractures has 'fair' reliabilities on radiographs and MPR that improve to 'moderate' on adding 3DR-FS. We attribute it mostly to the difficulty in localizing innominate tubercle. Adding advanced imaging helps better detect fracture instabilities.</p><p><strong>Level of evidence: </strong>Level I, Diagnostic.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An alternative choice for overweight pediatric patient with femoral shaft fracture when rigid nail is contraindicated due to narrow intramedullary canal: Elastic stable intramedullary nail plus temporary external fixator.","authors":"Xin Tang, Jiaxin Liang, Baowen Zhang, Saroj Rai, Qingyi Hu, Yan Zou, Pan Hong","doi":"10.1016/j.jos.2025.01.002","DOIUrl":"https://doi.org/10.1016/j.jos.2025.01.002","url":null,"abstract":"<p><strong>Background: </strong>Length unstable femoral shaft fractures in school-aged children usually demand surgical treatment, but the optimal choice remains controversial, especially in overweight adolescents. This study aimed to compare the clinical results of locking compression plates (LCP) and elastic stable intramedullary nails (ESIN) combined with temporary external fixator (TEF) in school-aged children weighing over 50 kg.</p><p><strong>Methods: </strong>Between January 2010 and January 2018, children over 50 kg with length unstable femoral shaft fracture treated with ESIN & EF in the authors' institute were included in this study. Adolescent patients with matched age, sex, body weight and fracture type receiving LCP were retrieved from hospital database. The Flynn Score System was used to evaluate the clinical outcomes of treatments at the last follow-up.</p><p><strong>Results: </strong>A total of 30 young children aged 10-14 years were included. Fifteen patients (9 male and 6 female) received ESIN & EF treatment, while the other fifteen (9 male and 6 female) received LCP treatment. All patients were followed up for more than 12 months post-surgery (14-26 months). In all, less operation time, less estimated blood loss and shortened hospital stay (P < 0.001), faster union time (P = 0.031) were observed in ESIN & EF group, compared with the Plating group. All surgeries in the ESIN & EF group were performed without exposing the fracture site. In contrast, 60 % (9/15) of the surgeries in the Plating group were performed with the fracture site exposed. Every patient scored satisfactory or excellent on the Flynn Score System without major complications demanding revision surgeries.</p><p><strong>Conclusions: </strong>ESIN plus EF produces satisfactory clinical outcome for overweight pediatric patients with femoral shaft fracture when rigid nail is contraindicated due to narrow medullary canal.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation between medial meniscus degenerative tears and medial meniscus extrusion and dynamics using ultrasonography.","authors":"Kazuki Asai, Junsuke Nakase, Yosuke Shima, Kenichi Goshima, Kazunari Kuroda, Takeshi Oshima, Mitsuhiro Kimura, Kengo Shimozaki, Tomoyuki Kanayama, Naoki Takemoto, Manase Nishimura, Satoru Demura","doi":"10.1016/j.jos.2024.12.008","DOIUrl":"https://doi.org/10.1016/j.jos.2024.12.008","url":null,"abstract":"<p><strong>Background: </strong>Evaluating the correlation between degenerative meniscus tears and medial meniscus extrusion is necessary to determine the appropriate treatment plan for early-stage knee osteoarthritis. This study evaluated the relationship between degenerative meniscal tears and medial meniscus extrusion in early-stage knee osteoarthritis by using ultrasonography.</p><p><strong>Methods: </strong>A total of 132 knees from 123 patients with early-stage knee osteoarthritis were evaluated retrospectively. Medial meniscus extrusion at knee flexion angles of 0° and 90°, and meniscal degenerative tears, were evaluated using ultrasonography and magnetic resonance imaging. Medial meniscus extrusion was classified into four grades, while degenerative meniscal tears were categorized into five types as follows: type 0, no tear or only degenerative changes; type 1, horizontal tear only in the posterior segment of the medial meniscus; type 2, horizontal tear shown in both the posterior and middle segments of the medial meniscus; type 3, flap tear or maceration of the medial meniscus; type 4, medial meniscus posterior root tear or radial tear. Correlations between the type of meniscal tear and the medial meniscus extrusion grade in each meniscal tear group were evaluated.</p><p><strong>Results: </strong>The meniscal tear type was significantly correlated with the medial meniscus extrusion grade (r = 0.518, p = 0.001). The percentages of cases with medial meniscus extrusion grade 2 or 3 (i.e., medial meniscus extrusion >3 mm at knee flexion angle of 0°) were 23.8 %, 50.0 %, 86.8 %, 94.1 %, and 92.3 % for types 0-4, respectively. The percentages of cases with medial meniscus extrusion >3 mm at knee flexion angles of 0° and 90° were 0 %, 20.0 %, 52.6 %, 70.6 %, and 50.0 % for types 0-4, respectively.</p><p><strong>Conclusion: </strong>The more severe the meniscal degenerative tear, the greater the medial meniscus extrusion and the more abnormal the dynamics in early-stage knee osteoarthritis.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of combined focused shock wave and ultrasound-guided percutaneous irrigation of rotator cuff calcific tendinopathy therapy.","authors":"Yu Hiraoka, Nobuyasu Ochiai, Eiko Hashimoto, Kenta Inagaki, Fumiya Hattori, Taro Akiyama, Fumihide Terakawa, Seiji Ohtori","doi":"10.1016/j.jos.2024.12.005","DOIUrl":"https://doi.org/10.1016/j.jos.2024.12.005","url":null,"abstract":"<p><strong>Background: </strong>Various conservative treatments have been reported for refractory calcific tendinitis of the shoulder. This study aimed to evaluate the clinical outcomes of a combined therapy of focused shock wave (FSW) and ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT).</p><p><strong>Methods: </strong>A total of 229 patients (246 shoulders) who experienced shoulder pain for over six months due to calcific tendinitis were included. The mean age of the patients was 55.0 years, and the mean disease duration was 30.0 months. FSW was performed monthly with ultrasonography. US-PICT was performed before FSW until the symptoms or calcium deposits disappeared. The resorption rate, number of treatments, and clinical scores (the University of California at Los Angeles [UCLA] and Constant scores) were evaluated at the final follow-up. Radiological characteristics of the calcium deposits before treatment were evaluated using the Molé classification. Clinical outcomes were compared between the complete resorption and residual groups.</p><p><strong>Results: </strong>Complete resorption occurred in 82.9 % of the 204 shoulders. Partial resorption was observed in 38 shoulders, and no change was noted in 4 shoulders. The mean number of FSW and US-PICT treatments was 4.0 and 2.4, respectively. The UCLA and Constant scores considerably improved from 18.7 to 33.0 and from 68.9 to 95.0, respectively. The number of treatments was markedly higher in Molé classification type B. The complete resorption group exhibited better UCLA and Constant scores and required fewer treatments. Additionally, Molé classification type B had a higher proportion of patients in the residual group.</p><p><strong>Conclusions: </strong>The combined FSW and US-PICT therapy showed good clinical outcomes with a high resorption rate for refractory calcific tendinitis of the shoulder. Patients in the complete resorption group had better clinical outcomes and required fewer treatment sessions. Furthermore, attention should be paid to the refractory radiological characteristics of patients with Molé classification type B.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing gait mechanics: The effectiveness of a novel walking aid.","authors":"Yuyu Ishimoto, Satoshi Arita, Hiroshi Yamada","doi":"10.1016/j.jos.2024.12.006","DOIUrl":"10.1016/j.jos.2024.12.006","url":null,"abstract":"<p><strong>Background: </strong>A walking support orthosis known as the e-foot®, a rubber orthotic worn from the hip to the forefoot to enhance joint flexibility and movement, has been developed to assist elderly people and individuals with walking impairments. Despite its widespread acceptance and positive reception in some care settings, the precise impact of this device on gait dynamics remains unexplored. This study aims to bridge this gap by comparing the walking speeds of healthy volunteers using the e-foot® against their normal walking speeds. Furthermore, it seeks to elucidate the biomechanical alterations induced by the e-foot® on their gait patterns.</p><p><strong>Methods: </strong>In this intervention study, 78 healthy volunteers underwent a 10-m walk test, both with and without the e-foot®, to measure its effect on walking speed. Gait changes were biomechanically compared by analyzing marker positions and accelerations of the lower extremities during the walk tests.</p><p><strong>Results: </strong>The e-foot® orthotic device significantly improved walking times for both men and women in the 10-m walk test. Biomechanical testing showed a consistent trend of higher marker positions of the knees, heels, and toes when participants were using the e-foot®. Additionally, marker acceleration during the first half of the swing phase was greater with the e-foot®, indicating a faster gait initiation.</p><p><strong>Conclusions: </strong>The e-foot® increased the walking speed of healthy volunteers. Also, there were changes to knee, heel and toe positions during gait, and comparative increase in acceleration was recorded in these three parts during swinging gait.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two types of cannulated screw fixation based on Letenneur classification for the treatment of Hoffa fracture: A finite element analysis.","authors":"Peng Jia, Xiaohu Chang, Xin Tang","doi":"10.1016/j.jos.2024.11.012","DOIUrl":"https://doi.org/10.1016/j.jos.2024.11.012","url":null,"abstract":"<p><strong>Purpose: </strong>A finite element analysis was performed to simulate the biomechanical differences between anterior-posterior (AP) direction and posterior-anterior (PA) direction placement of two cannulated screws in Hoffa fractures.</p><p><strong>Methods: </strong>Computed tomography images of an healthy male volunteer were used to simulate Letenneur Ⅰ, Ⅱa, Ⅱb, Ⅱc, Ⅲ Hoffa fractures, and two groups of screw internal fixation models were constructed. Two 6.5 mm cannulated screws were implanted parallel in the AP direction or the PA direction. The biomechanical test was performed to determine the displacement, stress distribution, and peaks in the distal femur and cannulated screws in 10 models.</p><p><strong>Results: </strong>The displacement distribution and peak values of the distal femur and cannulated screws in both groups were similar, and displacement increasing as the load increased. The stress distribution in the distal femur was similar between the two groups, with stress mainly concentrated on both sides of the fracture line, the posterolateral and anterior aspects of the femoral shaft. The peak stress in the PA group of the Letenneur type Ⅱb was significantly higher than that in the AP group, and the stress in the distal femur increased with increasing load. The stress distribution in the cannulated screws of Letenneur Ⅰ, Ⅱa, Ⅱb, and Ⅲ, was similar, but differences are observed between the two groups in type Ⅱc. The stress in the cannulated screws increased with increasing load, and the peak values in the PA group are significantly higher than those in the AP group.</p><p><strong>Conclusion: </strong>The mechanical stability of the two screw insertion methods is similar. Inserting screws from anterior to posterior can reduce the stress on the distal femur and cannulated screws, and also minimize the dissection of the posterior soft tissues. Therefore, inserting screws from anterior to posterior is a more recommended surgical approach for Hoffa fractures.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Midterm comparative result of absorbable screws and metal screws in pediatric medial humeral epicondyle fracture.","authors":"Ming Zeng, Keyu Xie, Shu Cao, Jie Wen, Sisi Wang, Sheng Xiao","doi":"10.1016/j.jos.2024.12.004","DOIUrl":"https://doi.org/10.1016/j.jos.2024.12.004","url":null,"abstract":"<p><strong>Backgroud: </strong>Medial humeral epicondyle fracture is a prevalent type of upper limb fractures in pediatric patients. This study aims to compare the follow-up clinical results and complications in 30 children with medial epicondyle fractures who were treated with either metal screws or absorbable screws at our hospital.</p><p><strong>Methods: </strong>A retrospective review was conducted on 30 children with medial humeral epicondyle fractures, who were divided into two groups: Metal group (18 children) underwent fixation using metal screws, while Absorbable group (12 children) received absorbable screws between January 2016 and June 2024. We collected the operation time and the length of incision of each patient. All the patients were followed up for over 20 months. Clinical outcomes were assessed and compared using elbow range of motion (ROM), mayo elbow performance score (MEPS) and range of rotation (ROR) during the last follow-up visit. Additionally, pain levels measured by a 10-point visual analog scale (VAS) and complications were duly documented.</p><p><strong>Results: </strong>In terms of operative time, length of incision, and VAS scores, no significant differences were observed (p > 0.05). The patients were followed up at an average of 33.1 months (range, 22-49 months). The mean MEPS were 89.44 ± 3.79 and 89.58 ± 3.34 (p = 0.89), the mean ROM were 122.28 ± 5.87 and 125.1 ± 5.83 (p = 0.27), and the mean ROR were 153.33 ± 5.94 and 155.83 ± 5.15 (p = 0.26) in groups A and B, respectively. In addition, two children in Metal group experienced symptoms of screw stimulation, while Absorbable group did not.</p><p><strong>Conclusion: </strong>The use of absorbable screws in treating pediatric medial epicondyle fractures can yield equivalent therapeutic outcomes to traditional metal screws, obviating the need for subsequent surgical interventions and mitigating complications associated with screw irritation resulting from non-degradable metallic implants.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of changes in pelvic anteversion during gait on walking ability and physical function in patients with adult spinal deformity: A cross-sectional study","authors":"Keita Sato ,&nbsp;Toshikazu Ito ,&nbsp;Tatsuya Endo ,&nbsp;Takuya Miura ,&nbsp;Masumi Iwabuchi ,&nbsp;Osamu Shirado","doi":"10.1016/j.jos.2023.12.005","DOIUrl":"10.1016/j.jos.2023.12.005","url":null,"abstract":"<div><h3>Backgrounds</h3><div>Evaluation of gait posture using a three-dimensional motion analysis system (3DMAS) revealed that elderly patients with adult spinal deformity (ASD) experience pelvic anteversion while walking. The purpose of this study was to investigate the influence of changes in pelvic anteversion during gait on walking ability and physical function in patients with ASD.</div></div><div><h3>Methods</h3><div>Fifty-four patients with ASD aged 50 years or older who were admitted to our hospital between March 2016 and December 2021 were included in the study. The 6-min walking distance (6MWD) was used to evaluate walking ability, and trunk and hip extensor strength were measured to evaluate physical function in the subjects. The 3DMAS was used to measure the subject's changes in pelvic anteversion during gait. After measuring the changes in pelvic anteversion, the median value of the study subjects was calculated, according to which the subjects were divided into two groups (small anteversion [S] group, large anteversion [L] group). Walking ability and physical function were compared between the two groups.</div></div><div><h3>Results</h3><div>The number of subjects in each group was 27. Comparisons of walking ability and physical function between the groups revealed significant differences in 6MWD (S group, 333.6 ± 111.2 m; L group, 238.0 ± 106.3 m) and hip extensor strength (S group, 15.8 ± 3.8 kgf; L group, 13.4 ± 4.4 kgf). No significant differences regarding trunk extensor strength were observed between the groups (S group, 15.2 ± 4.0 kgf; L group, 12.9 ± 4.8 kgf).</div></div><div><h3>Conclusion</h3><div>The results of the present study revealed that ASD patients with greater pelvic anteversion associated with walking have lower walking ability and physical function. These results suggest the importance of evaluating the posture of ASD patients not only by using radiographic findings but also by assessing movement, such as gait posture.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 1","pages":"Pages 25-31"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139048949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A nationwide multicenter study of the cost effectiveness of five leading drugs for pharmacological management of cervicobrachial symptoms","authors":"Norimitsu Wakao ,&nbsp;Takeo Furuya ,&nbsp;Toshitaka Yoshii ,&nbsp;Hideyuki Arima ,&nbsp;Yu Yamato ,&nbsp;Hiroaki Nakashima ,&nbsp;Shiro Imagama ,&nbsp;Yasuaki Imajo ,&nbsp;Hiroshi Miyamoto ,&nbsp;Gen Inoue ,&nbsp;Masayuki Miyagi ,&nbsp;Shunsuke Kanbara ,&nbsp;Yoichi Iizuka ,&nbsp;Hirotaka Chikuda ,&nbsp;Kei Watanabe ,&nbsp;Kazuyoshi Kobayashi ,&nbsp;Mikito Tsushima ,&nbsp;Masashi Miyazaki ,&nbsp;Mitsuru Yagi ,&nbsp;Satoshi Suzuki ,&nbsp;Hirotaka Haro","doi":"10.1016/j.jos.2023.12.004","DOIUrl":"10.1016/j.jos.2023.12.004","url":null,"abstract":"<div><h3>Background</h3><div>Cervicobrachial pain frequently affects the quality of life (QOL) of the general public and has a significant economic impact on the health care systems of various countries. There are a number of treatment options for this disease, including widely-used drug therapy, but the effectiveness of each option is indeterminate, and there have been no published cost-effectiveness analysis studies so far. This prospective observational study aimed to examine the cost-effectiveness of drug treatment for cervicobrachial symptoms.</div></div><div><h3>Methods</h3><div>A 6-month medication regimen for each of five frequently-prescribed drugs for cervicobrachial symptoms was administered to 322 patients at 24 centers in Japan. Outcome measures, including of the EuroQol Group 5D, Short Form-8, and Visual Analog Scale (VAS), were investigated at baseline and every month thereafter. Incremental cost-effectiveness ratios (ICERs) of the drug cost to quality-adjusted life years (QALYs) were calculated. A stratified analysis of patient characteristics was also performed to identify baseline factors potentially affecting cost-effectiveness.</div></div><div><h3>Results</h3><div>The ICER of entire drug treatment for cervicobrachial symptoms was 7,491,640 yen. Compared with the reference willingness-to-pay, the ICER was assumed to not be cost-effective. A certain number of QALYs were gained during the first 3 months after the treatment intervention, but almost no QALYs were gained during the following 3 months. Stratified analysis showed that cost-effectiveness was extremely low for patients with high baseline VAS and high QOL.</div></div><div><h3>Conclusions</h3><div>The available medications for cervicobrachial symptoms did not have excellent cost-effectiveness. Although a certain number of QALYs were gained during the first 3 months after medication, no QALYs were gained in the latter half of the study period, suggesting that it is not advisable to continue the medication needlessly.</div></div><div><h3>Level of evidence</h3><div>II, prospective cohort study.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 1","pages":"Pages 18-24"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139048948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative glycemic control reduces the risk of retear in diabetic patients following arthroscopic rotator cuff repair: A meta-analysis","authors":"Junwen Liang ,&nbsp;Qianrun Liang ,&nbsp;Xihao Wang ,&nbsp;Xiangdong Yun","doi":"10.1016/j.jos.2024.01.003","DOIUrl":"10.1016/j.jos.2024.01.003","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies have associated diabetes with reduced shoulder motion, increased pain, and higher postoperative retear risk after arthroscopic rotator cuff repair (ARCR). However, the impact of glycemic control, measured by hemoglobin A1c (HbA1c) levels, on retear and revision rates after ARCR in diabetic patients remains unclear.</div></div><div><h3>Methods</h3><div>This systematic review was conducted using the PubMed, Cochrane Library, Web of Science, and Embase databases according to the preferred reporting conventions for systematic reviews and meta-analyses. Only studies that compared retears and revisions in ARCR patients with documented HbA1c levels between controlled and uncontrolled diabetes groups were included. Relevant data were extracted and analyzed using STATA software. The methodological index for nonrandomized studies was employed to assess the risk of bias in the selected studies. Additionally, heterogeneity tests and sensitivity analyses were conducted to evaluate potential heterogeneity within the samples, and publication bias was also detected.</div></div><div><h3>Results</h3><div>Six studies (4395 patients), including five retrospective cohort studies and one case‒control study, were included. Four of these studies assessed retears involving 253 patients. Lower HbA1c levels, indicating better glycemic control, were significantly associated with reduced retear rates after ARCR in diabetic patients (<em>P</em> = 0.000; odds ratio = 0.242, 95 % confidence interval: 0.128–0.454; <em>I</em>² = 25 %). For revision evaluations, two studies, with a total of 4142 patients, found no significant difference in rates between controlled and uncontrolled diabetes groups, and no publication bias was detected.</div></div><div><h3>Conclusion</h3><div>Following ARCR in diabetic patients, effective glycemic control significantly reduces retear rates without affecting revisions, and maintaining glycemic control in the postoperative period may contribute to rotator cuff healing.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 1","pages":"Pages 78-84"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139672075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}