Journal of Orthopaedic Science最新文献

{"title":"Disc Level–Specific outcomes of intradiscal condoliase injection for lumbar disc herniation: A multicenter retrospective study","authors":"Kota Watanabe ,&nbsp;Yohei Takahashi ,&nbsp;Takehiro Michikawa ,&nbsp;Takuya Takahashi ,&nbsp;Tomohiro Banno ,&nbsp;Kyohei Sakaki ,&nbsp;Yoshiyasu Arai ,&nbsp;Yuichi Takano ,&nbsp;Yawara Eguchi ,&nbsp;Yuki Taniguchi ,&nbsp;Satoshi Maki ,&nbsp;Yasuchika Aoki ,&nbsp;Shunichi Fujii ,&nbsp;Kentaro Sakaeda ,&nbsp;Yu Matsukura ,&nbsp;Tsutomu Akazawa ,&nbsp;Akihito Minamide ,&nbsp;Hidetoshi Nojiri ,&nbsp;Kenichiro Sakai ,&nbsp;Satoshi Kato ,&nbsp;Takashi Hirai","doi":"10.1016/j.jos.2025.11.007","DOIUrl":"10.1016/j.jos.2025.11.007","url":null,"abstract":"<div><h3>Background</h3><div>The efficacy of intradiscal condoliase injection for lumbar disc herniation (LDH) may vary depending on the affected disc level. This is especially relevant in upper lumbar herniations, where anatomical constraints can complicate surgical treatment. Although condoliase has emerged as a less invasive option, disc-level–specific outcomes remain underexplored.</div></div><div><h3>Methods</h3><div>This multicenter retrospective cohort study included 262 patients with LDH who underwent either intradiscal condoliase injection (CD group, n = 207) or microendoscopic discectomy (MED group, n = 55). Patients were categorized by herniation level: upper lumbar (L1/2, L2/3, L3/4) and lower lumbar (L4/5, L5/S1). The primary objective was to examine whether the effectiveness of condoliase differs by disc level. MED outcomes were included for reference. Primary outcomes included improvement in numerical rating scale (NRS) scores for leg and back pain at 1 year, responder rate (≥50 % improvement in leg pain), and reoperation rate. Intermediate-term (3–6 month) NRS data were also analyzed in a subset.</div></div><div><h3>Results</h3><div>Condoliase demonstrated consistent efficacy across disc levels, with particularly favorable outcomes at upper lumbar levels. At L1/2–L3/4, the CD group achieved a 100 % responder rate and the greatest mean improvement in leg pain (6.9 ± 2.4). At L3/4, outcomes in the CD group were superior to those in the MED group (100 % vs. 57.1 % responder rate). At L4/5, while condoliase was effective, reference data from the MED group showed greater leg pain relief (7.2 ± 2.5 vs. 5.0 ± 2.8) and a higher responder rate (100 % vs. 81.2 %). At L5/S1, both treatments produced similar results. Improvements in low back pain were modest and comparable across levels and groups. In the subset analysis, MED showed faster early symptom relief at L4/5, but condoliase provided steady improvement over time.</div></div><div><h3>Conclusion</h3><div>The effectiveness of condoliase injection therapy differs by disc level and appears particularly favorable at upper lumbar levels. Condoliase represents a safe, minimally invasive alternative for treating upper lumbar LDH. These findings support disc-level–based treatment selection when choosing between condoliase and surgical intervention.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 3","pages":"Pages 521-529"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800601","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":"Epidemiology and safety of spinal instrumentation surgery in Japan: A report from Japanese spinal instrumentation society- database (JSIS-DB)","authors":"Haruki Ueda ,&nbsp;Hideyuki Arima ,&nbsp;Koji Yamada ,&nbsp;Mitsuru Yagi ,&nbsp;Kimiaki Yokosuka ,&nbsp;Junya Katayanagi ,&nbsp;Shunsuke Katsumi ,&nbsp;Atsushi Tagami ,&nbsp;Yusuke Hori ,&nbsp;Yukihiro Matsuyama ,&nbsp;Hiroshi Taneichi ,&nbsp;Tokumi Kanemura ,&nbsp;Akira Matsumura","doi":"10.1016/j.jos.2025.11.008","DOIUrl":"10.1016/j.jos.2025.11.008","url":null,"abstract":"<div><h3>Background</h3><div>Spinal instrumentation surgery has seen improvements in safety and invasiveness thanks to technological innovations such as navigation systems, robotics, and improved implants, and its indications have expanded. This, combined with an increase in patients from aging population, has led to a global rise in surgical cases, particularly in countries with aging societies. However, Japan previously lacked a nationwide registry, making it difficult to fully understand the epidemiological trends of these surgeries. To address this, the Japanese Society of Spinal Instrumentation (JSIS) developed the web-based, multi-institutional case registration database (JSIS-DB) in 2018.</div></div><div><h3>Methods</h3><div>This study analyzed 32,656 confirmed cases registered in the first- and second-generation JSIS-DB between 2018 and 2022. Patient background, implants used, and complications were statistically compared across age groups and surgical procedures. Statistical analysis included Chi-square tests, Wilcoxon rank-sum tests, and logistic regression analysis were used for intergroup comparisons.</div></div><div><h3>Results</h3><div>Regional disparities were observed with a notable concentration of registered cases in metropolitan areas. Patient age showed a bimodal distribution peaking in the teens and seventies. Two-thirds of procedures used posterior approaches. Minimally invasive techniques were significantly more frequent in elderly patients. Revision surgeries showed higher complication rates and more frequent cases without implant use. Systemic and psychiatric complications significantly increased with age. The proportion of patients aged 90 or older undergoing surgery showed a significant annual increase of 0.13 % (p = 0.014).</div></div><div><h3>Conclusions</h3><div>This study presents the first analysis of spinal instrumentation surgery in Japan using a nationwide registry. The results revealed that surgical procedures are being selected based on age and risk factors, ranging from children to the super-elderly. Moving forward, appropriate surgical selection and perioperative management in a super-aged society will become increasingly important. The JSIS-DB is expected to play a significant role as a foundation for future quality improvement and clinical research.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 3","pages":"Pages 530-540"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145846772","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":"Predictive factors for outcomes of chemonucleolysis with condoliase in lumbar disc herniation: A multi-institutional study","authors":"Satoshi Maki ,&nbsp;Takuya Takahashi ,&nbsp;Shunichi Fujii ,&nbsp;Kentaro Sakaeda ,&nbsp;Yohei Takahashi ,&nbsp;Kota Watanabe ,&nbsp;Tomohiro Banno ,&nbsp;Kyohei Sakaki ,&nbsp;Yoshiyasu Arai ,&nbsp;Yuichi Takano ,&nbsp;Yawara Eguchi ,&nbsp;Yuki Taniguchi ,&nbsp;Yasuchika Aoki ,&nbsp;Hiroshi Yamada ,&nbsp;Takashi Kaito ,&nbsp;Yutaka Hiraizumi ,&nbsp;Masatsune Yamagata ,&nbsp;Masaya Nakamura ,&nbsp;Hirotaka Haro ,&nbsp;Seiji Ohtori ,&nbsp;Takashi Hirai","doi":"10.1016/j.jos.2025.11.009","DOIUrl":"10.1016/j.jos.2025.11.009","url":null,"abstract":"<div><h3>Background</h3><div>Chemonucleolysis with condoliase is a minimally invasive treatment for lumbar disc herniation (LDH). However, optimal patient selection criteria remain unclear. This study aimed to identify predictive factors for successful condoliase therapy in LDH, focusing on low back pain (LBP) and leg pain improvement.</div></div><div><h3>Methods</h3><div>This multi-institutional observational study included 238 patients who underwent intradiscal condoliase injection for LDH. Demographic and clinical data were collected, including pain intensity using the Numeric Rating Scale (NRS) for leg and back pain at baseline, 3–6 months, and 12 months. MRI assessments evaluated disc height, Pfirrmann grade, and herniation occupancy ratio. The primary outcome was defined as achieving the minimum clinically important difference (MCID) on the 0–10 NRS, defined as an improvement of ≥2 points at 3–6 months or 12 months, without additional surgery during follow-up. Multivariable logistic regression was used to identify predictors of MCID achievement.</div></div><div><h3>Results</h3><div>Condoliase was effective, with over 70 % of patients achieving MCID for leg pain and over 50 % for LBP. For LBP at 3–6 months, higher baseline back pain intensity (OR 3.09, 95 % CI 2.00–4.78), lower MRI slip (OR 0.59, 95 % CI 0.38–0.92), higher MRI occupancy rate (OR 1.74, 95 % CI 1.19–2.54), and L5/S1 injection level (OR 2.20, 95 % CI 1.06–4.54) predicted MCID achievement. At 12 months, higher baseline back pain intensity (OR 2.26, 95 % CI 1.49–3.44), higher MRI occupancy rate (OR 1.85, 95 % CI 1.24–2.79), shorter disease duration (OR 0.57, 95 % CI 0.38–0.86), and absence of X-ray posterior slip (presence: OR 0.18, 95 % CI 0.04–0.91) were associated with MCID achievement. For leg pain at 3–6 months, lower MRI slip (OR 0.60, 95 % CI 0.41–0.89) and higher baseline leg pain intensity (OR 1.72, 95 % CI 1.23–2.41) were associated with MCID achievement. For leg pain at 12 months, shorter disease duration (OR 0.61, 95 % CI 0.42–0.88), lower X-ray slip (OR 0.54, 95 % CI 0.30–0.97), higher baseline leg pain intensity (OR 1.94, 95 % CI 1.30–2.88), and lower Pfirrmann grade (OR 0.48, 95 % CI 0.23–0.99) were predictive of MCID achievement.</div></div><div><h3>Conclusions</h3><div>This study identified key factors associated with successful outcomes of condoliase in LDH. Baseline pain intensity, MRI findings (herniation occupancy rate, slip), injection level, and disease duration were significant predictors of treatment outcomes. These findings may aid clinicians in patient selection and improve treatment success.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 3","pages":"Pages 541-548"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145794114","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":"Unplanned reoperations due to implant-related complications in older versus non-older patients following adult spinal deformity surgery: A retrospective cohort study using a multi-center database","authors":"Jun Ouchida ,&nbsp;Hiroaki Nakashima ,&nbsp;Hiroyuki Koshimizu ,&nbsp;Sadayuki Ito ,&nbsp;Naoki Segi ,&nbsp;Ippei Yamauchi ,&nbsp;Tetsuya Ohara ,&nbsp;Tokumi Kanemura ,&nbsp;Ryuichi Shinjyo ,&nbsp;Shiro Imagama","doi":"10.1016/j.jos.2025.12.001","DOIUrl":"10.1016/j.jos.2025.12.001","url":null,"abstract":"<div><h3>Background</h3><div>Adult spinal deformity (ASD) surgery involves instrumentation, which can lead to implant-related complications (IRCs) and unplanned returns to the operating room (UPROR). Older patients often have risk factors like osteoporosis and multiple comorbidities, but research on how age-related factors affect IRCs and UPROR across age groups is limited. The aim of this study was to evaluate the characteristics of UPROR due to IRCs between older and non-older patients following ASD surgery.</div></div><div><h3>Methods</h3><div>A retrospective analysis of patients (≥20 years) who underwent spinal fusion with instrumentation from 2010 to 2019 based on a multi-center database. Medical records were reviewed to identify ASD diagnoses and details of IRCs, including UPROR timing. UPROR timing was classified as early (&lt;30 days), intermediate (30–90 days), and late (&gt;90 days) postoperatively. Patients were stratified into older (≥65 years) and non-older (&lt;65 years) groups to compare the characteristics of UPROR between the groups.</div></div><div><h3>Results</h3><div>IRCs occurred in 56 of 565 ASD cases (9.9 %) within 2 years postoperatively. UPROR was required in 38 patients (6.7 %), with implant breakage being the most frequent cause (23 cases), followed by screw malposition (14 cases). Screw-related complications predominated early, whereas implant breakage was most common in the late postoperative period. No significant differences in overall IRC or UPROR prevalence were observed between age groups. However, younger patients exhibited a higher rate of early UPROR (44.4 % vs. 20.0 % within 30 days).</div></div><div><h3>Conclusions</h3><div>These findings highlight the distinct characteristics of IRCs between older and non-older patients, particularly in terms of UPROR timing. Understanding temporal patterns of these complications can inform surgical strategies and enhance patient outcomes by reducing UPROR.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 3","pages":"Pages 555-560"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145794261","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":"Utility of GLFS-25 as a patient-reported outcome measure for older patients with lumbar spinal stenosis: A two-year retrospective cohort study","authors":"Kohei Shibata ,&nbsp;Soya Kawabata ,&nbsp;Yuki Akaike ,&nbsp;Takehiro Michikawa ,&nbsp;Takaya Imai ,&nbsp;Sota Nagai ,&nbsp;Hiroki Takeda ,&nbsp;Shinjiro Kaneko ,&nbsp;Nobuyuki Fujita","doi":"10.1016/j.jos.2025.09.010","DOIUrl":"10.1016/j.jos.2025.09.010","url":null,"abstract":"<div><h3>Background</h3><div>The 25-question Geriatric Locomotive Function Scale (GLFS-25) is a patient-reported outcome measure (PROM) for assessing locomotive syndrome, which reflects mobility limitations due to musculoskeletal decline in older adults. Although lumbar spinal stenosis (LSS) is a major contributor to locomotive syndrome, the utility of GLFS-25 in evaluating the clinical status of older patients with LSS remains unclear. This study aimed to evaluate the GLFS-25 as a disease-specific PROM for older adults with LSS by comparing it with established tools such as the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Zurich Claudication Questionnaire (ZCQ).</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 206 patients aged ≥65 years who underwent surgery for LSS. GLFS-25, JOABPEQ, and ZCQ scores were collected preoperatively and at 6 months, 1 year, and 2 years postoperatively. Correlations between the GLFS-25 and other PROMs were analyzed. Locomotive syndrome stages were determined based on GLFS-25 scores. The predictive accuracy of ZCQ satisfaction scores for postoperative improvement in the locomotive syndrome stage was assessed using receiver operating characteristic analysis.</div></div><div><h3>Results</h3><div>GLFS-25 showed weak to moderate correlations with the five JOABPEQ domains and both ZCQ subscales. Patients with greater improvements in the locomotive syndrome stage also demonstrated higher proportions of treatment efficacy in the JOABPEQ domains. The ZCQ satisfaction score at 2 years postoperatively was a strong predictor of locomotive syndrome stage improvement, with an area under the curve of 0.858. The optimal satisfaction score cutoff for improvement in the locomotive syndrome stage was 1.917 (sensitivity: 80.0 %, specificity: 80.6 %).</div></div><div><h3>Conclusions</h3><div>The GLFS-25 reflects clinical changes in older patients with LSS and correlates well with established PROMs. This tool may enable valid cross-sectional and longitudinal assessment of surgical outcomes for older patients with LSS. A ZCQ satisfaction score of approximately 1.9 indicates a meaningful improvement in the locomotive syndrome stage.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 3","pages":"Pages 507-512"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280653","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":"Evaluating MRI predictors for surgical outcomes in selective laminoplasty for OPLL-Induced cervical myelopathy: A comparative analysis of mKappa-line and mK-line","authors":"Dong-Ho Lee ,&nbsp;Hyung-Rae Lee ,&nbsp;Sang Yun Seok ,&nbsp;In Hee Kim ,&nbsp;Dae Wi Cho ,&nbsp;Jae-Hyuk Yang ,&nbsp;Jae Hwan Cho ,&nbsp;Chang Ju Hwang","doi":"10.1016/j.jos.2025.12.006","DOIUrl":"10.1016/j.jos.2025.12.006","url":null,"abstract":"<div><h3>Background</h3><div>To investigate the effectiveness of the Modified Kappa-line (mKappa-line) and Modified K-line (mK-line) as prognostic tools in managing ossification of the posterior longitudinal ligament (OPLL)-induced cervical myelopathy, especially in selective laminoplasty (LMP) cases.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed 78 patients who underwent LMP for OPLL-induced cervical myelopathy between September 2012 and April 2017. Patients were categorized based on their mKappa-line and mK-line statuses. Radiographic measurements, Japanese Orthopaedic Association (JOA) scores, and Neck Disability Index (NDI) were comprehensively analyzed.</div></div><div><h3>Results</h3><div>Patients in the mKappa-line (-) group exhibited significantly higher OPLL thickness (6.4 ± 1.7 mm; P &lt; 0.01) and canal occupying ratio (64.4 %; P &lt; 0.01) compared to the mKappa-line (+) group. The mKappa-line (-) group also reported lower postoperative JOA scores at 6 months (11.2 ± 4.1 vs. 14.5 ± 2.5; P = 0.01) and at the final follow-up (11.3 ± 4.0 vs. 14.4 ± 2.5; P = 0.01). Multivariate analysis highlighted the interval (INT) of mKappa-line as the sole significant predictor of JOA recovery rate (P = 0.037). Receiver operating characteristic (ROC) curve analysis revealed an area under the curve (AUC) of 0.792 for the mKappa-line (P &lt; 0.01) and 0.675 for the mK-line (P &lt; 0.01), with a critical cut-off value of 1.88 mm for the mKappa-line (INT), below which an inferior outcome (JOA RR &lt; 40 %) is associated.</div></div><div><h3>Conclusions</h3><div>The mKappa-line serves as a superior prognostic tool compared to the mK-line, providing enhanced guidance for surgical planning in selective LMP cases. Further research is warranted to confirm these findings and assess their clinical implications.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 3","pages":"Pages 561-568"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145846829","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":"Evaluation of predisposing factors and comparison of treatment strategies for Su type 2 femur periprosthetic fractures","authors":"Abdurrahman Aydın ,&nbsp;Alper Köksal ,&nbsp;Muhammed Mert ,&nbsp;Murat Önder ,&nbsp;Berkay Doğan ,&nbsp;Deniz Kargın","doi":"10.1016/j.jos.2025.11.006","DOIUrl":"10.1016/j.jos.2025.11.006","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to evaluate the predisposing factors for Su type 2 femur periprosthetic fractures. Moreover, we compared the mid- and short-term outcomes of patients who had undergone single-plate and double-plate fixation for Su type 2 fractures.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted on 3817 patients who had undergone knee replacement surgery at our hospital between January 2009 and December 2022. Of these, 39 patients (Group 1: fracture group) developed periprosthetic femoral Su type 2 fractures. A control group of 40 patients (Group 2: non-fracture group) without fractures was selected using propensity score matching for comparison. To minimize potential confounding, propensity score matching (PSM) was conducted using age, sex, body mass index, and comorbidities. Preoperative Kellgren–Lawrence grading, postoperative hip–knee–ankle (HKA) angles, weight-bearing line (WBL) ratios, femoral component angulation in anteroposterior and lateral views, and femoral notch status were evaluated. Body mass index, vitamin D levels, calcium levels, bone mineral density, and comorbid conditions were recorded and compared.</div></div><div><h3>Results</h3><div>No statistically significant differences in femoral notching, HKA angle, and femoral component angulation in the coronal plane were observed between the fracture (Group 1) and nonfracture (Group 2, control group) groups (<em>p</em> &gt; 0.05). However, statistically significant differences in WBL ratio and femoral component angulation in the sagittal plane were observed between the two groups (<em>p</em> &lt; 0.05). Vitamin D and calcium levels also significantly differed between the two groups (<em>p</em> &lt; 0.05). Five patients who underwent single-plate fixation experienced refractures after a mean of 19 ± 8.1 (12–33) months, whereas no refractures occurred in patients with double-plate fixation.</div></div><div><h3>Conclusion</h3><div>Perioperative and postoperative calcium and vitamin D supplementation and close follow-up of high-risk patients (those with low femoral component sagittal plane angulation and WBL ratio) may help prevent fractures. Double-plate fixation is more advantageous than single-plate fixation for Su type 2 periprosthetic stable fractures.</div></div><div><h3>Level of Evidence</h3><div>Level III, retrospective comparative study</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 3","pages":"Pages 637-643"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145794136","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":"Risk factors for reoperations following guided growth around the knee","authors":"Yu Ting Pan,&nbsp;Ming Chun Lee,&nbsp;Szu Yao Wang,&nbsp;Hsuan Kai Kao,&nbsp;Chia Hsieh Chang","doi":"10.1016/j.jos.2025.10.010","DOIUrl":"10.1016/j.jos.2025.10.010","url":null,"abstract":"<div><h3>Introduction</h3><div>Guided growth using tension band plates is a common treatment for genu varum and valgum deformities in children. Reoperation is a significant adverse event in surgical treatments. This study aims to identify the causes and risk factors for reoperations following guided growth around the knee.</div></div><div><h3>Methods</h3><div>This retrospective study reviewed children who underwent guided growth for genu varum and valgum deformities between 2012 and 2019. Reoperation was defined as revision surgeries for deformities at the same knee, excluding procedures for implant removal. Potential risk factors including age, sex, body mass index, surgical location, underlying etiology, and knee deformities were compared between cases with and without reoperation using the <em>t</em>-test and chi-square test. Risk factors were determined by logistic regression.</div></div><div><h3>Results</h3><div>A total of 91 patients who underwent guided growth on 142 knees were included, with a mean age of 10.9 years at the time of surgery. Reoperations were performed in 36 patients (39.5 %). These included reoperations for recurrence of deformity in 26 knees, slow response in 13 knees, overcorrection in 5 knees, recurvatum of the tibial plateau in 1 knee, and infection in 1 knee. Logistic regression revealed younger age (Odds ratio [OR] 0.6 per older by 1 year, 95 % confidence interval [CI] 0.5–0.8) and non-idiopathic etiologies (OR 3.5, 95 % CI 1.0–11.8) as risk factors. Receiver operating characteristic curve determined age 10.1 years as a cutoff point that had sensitivity 73 % and specificity 91 % in predicting reoperation.</div></div><div><h3>Conclusions</h3><div>The reoperation rate can exceed 50 % in patients with specific etiologies such as rickets, Blount's disease, physeal injuries, and osteochondroma. Timely guided growth is essential for patients with progressive deformities, and retaining the epiphyseal screw and plate for potential recurrence is recommended. In cases of asymptomatic idiopathic knee deformities, delaying guided growth until after age 10 may be considered to reduce the risk of reoperation.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 3","pages":"Pages 658-663"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145513104","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":"Circumferential parallel ligation for debulking of very large neurofibromas in patients with neurofibromatosis type 1","authors":"Takashi Ariizumi ,&nbsp;Hiroyuki Kawashima ,&nbsp;Naoki Oike ,&nbsp;Tomohiro Miyazaki ,&nbsp;Yudai Murayama ,&nbsp;Norio Imai ,&nbsp;Akira Ogose","doi":"10.1016/j.jos.2025.10.007","DOIUrl":"10.1016/j.jos.2025.10.007","url":null,"abstract":"<div><h3>Background</h3><div>Neurofibromatosis Type 1 (NF1) is a genetic disorder characterized by the presence of neurofibromas, including diffuse cutaneous and plexiform variants. In large lesions, debulking surgery is often indicated, but presents challenges due to the hypervascularity of the tumor and the risk of hemorrhage. Circumferential parallel ligation (CPL), originally developed for the management of vascular malformations, may be an effective approach for controlling hemorrhage during debulking surgery.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted of 19 surgeries performed on 12 patients with NF1 and very large neurofibromas, between 2003 and 2024. All patients underwent debulking surgery using CPL. Data on tumor size, operative time, intra-operative blood loss, transfusion requirements, resection rate and post-operative complications were collected and analyzed.</div></div><div><h3>Results</h3><div>The mean tumor size was 26.6 cm, and the mean blood loss was 263.6 ml. Only two of the 19 surgeries required a blood transfusion. CPL was consistently effective in minimizing intra-operative hemorrhage without the use of specialized hemostatic devices. The mean resection rate was 71.9 %, indicating that significant tumor debulking was achieved in the majority of cases. Post-operative complications occurred in four surgeries but resolved with appropriate treatment.</div></div><div><h3>Conclusion</h3><div>CPL is safe and effective for debulking large neurofibromas in patients with NF1, offering reliable hemostasis without requiring costly surgical devices.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 3","pages":"Pages 717-723"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145513141","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":"Optimized step-cut ulnar shortening osteotomy: A less invasive technique with a dedicated guide and plate","authors":"Akira Kodama ,&nbsp;Masaru Munemori ,&nbsp;Yuichi Sumida ,&nbsp;Kentaro Tsuji ,&nbsp;Shigeki Ishibashi ,&nbsp;Nobuo Adachi","doi":"10.1016/j.jos.2025.11.012","DOIUrl":"10.1016/j.jos.2025.11.012","url":null,"abstract":"<div><h3>Purpose</h3><div>Ulnar shortening osteotomy (USO) is a standard treatment for ulnar impaction syndrome and triangular fibrocartilage complex (TFCC) injuries. However, complications such as delayed union, nonunion, and refracture after implant removal remain controversial issues. This study aimed to evaluate the clinical outcomes of modified step-cut USO using an osteotomy guide and a specialized ulnar shortening plate designed to maximize bone contact, enhance fixation stability, and reduce the invasiveness of the procedure.</div></div><div><h3>Methods</h3><div>A retrospective case series involving 23 consecutive patients (23 wrists) who underwent step-cut USO using a dedicated osteotomy guide and plate (Nagoya, Japan) between 2021 and 2024 was conducted. The indications for surgery included ulnar impaction syndrome (n = 14) and TFCC tears (n = 9). The outcomes assessed included wrist range of motion, grip strength, pain using Visual analogue Scale (VAS), Disabilities of the Arm, Shoulder, and Hand score (DASH), radiographic union, and complications.</div></div><div><h3>Results</h3><div>At a mean follow-up of 15.3 months, significant improvements were observed in the VAS and DASH scores, while the range of motion and grip strength were preserved. All patients achieved bone union, with a mean union time of 13 weeks and complete consolidation at 8 months. One patient with osteoporosis showed delayed union but achieved final healing. No cases of nonunion, implant-related complications, or fractures were observed. Mild plate irritation occurred in six cases but did not interfere with the patients’ daily activities.</div></div><div><h3>Conclusion</h3><div>Step-cut USO using a dedicated ulnar shortening device is characterized by high bone union rates and minimal complications, providing a reliable low-profile fixation method and potentially reducing complications associated with conventional techniques.</div></div><div><h3>Level of evidence</h3><div>IV (Therapeutic case series).</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 3","pages":"Pages 576-581"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800522","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}