MUSCULOSKELETAL SURGERY最新文献

{"title":"Getting REAL balance: a simple and reproducible method for imageless robotic TKA.","authors":"Stefano Marco Paolo Rossi, Rudy Sangaletti, Chiara Muci, Paolo Capitani, Francesco Benazzo, Luca Andriollo","doi":"10.1007/s12306-026-00991-4","DOIUrl":"https://doi.org/10.1007/s12306-026-00991-4","url":null,"abstract":"<p><strong>Background: </strong>In imageless robotic-assisted total knee arthroplasty (RA-TKA), intraoperative assessment of ligament balance may be influenced by asymmetric cartilage wear, potentially misrepresenting true soft-tissue behavior. Functional alignment (FA) aims to restore constitutional alignment while respecting the native ligament envelope. Using the unworn compartment as the primary reference for intraoperative balancing may reduce the effect of asymmetric wear and improve mediolateral symmetry.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 180 knees (176 patients) undergoing femur-first imageless RA-TKA with a functional alignment strategy at a single-volume center. All procedures were performed using the ROSA Knee System with a medial congruent implant. Intraoperative balancing prioritized the unworn or less affected compartment, targeting a 19-mm implant space with near-symmetric medial-lateral laxity in extension and flexion. Medial and lateral laxities were recorded robotically before implantation and after final component placement and classified using the Robotic Evaluation of Articular Laxity (REAL).</p><p><strong>Results: </strong>Preoperatively, lateral laxity exceeded medial laxity in both extension and flexion. Following implantation, mediolateral symmetry was restored with a significant reduction in medial-lateral laxity differences (p < 0.001). At final assessment, 178 knees (98.9%) were classified as REAL 1A. Soft-tissue releases were required in 14 knees (7.8%), with no intraoperative instability, additional bone recuts, or device-related complications.</p><p><strong>Conclusions: </strong>In femur-first imageless RA-TKA performed according to functional alignment principles, unworn-compartment-based balancing enables reliable restoration of mediolateral ligament symmetry with balanced REAL phenotypes and a limited need for soft-tissue releases, representing a refinement of robotic ligament assessment in knees with asymmetric osteoarthritis during contemporary robotic surgery.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149287640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Generalized anxiety disorder may lead to increased healthcare utilization following total hip arthroplasty.","authors":"Khaled A Elmenawi, Shlok V Patel, Ezgi Aydin, Shujaa T Khan, Jesus M Villa, Carlos A Higuera, Matthew E Deren, Nicolas S Piuzzi","doi":"10.1007/s12306-026-00988-z","DOIUrl":"https://doi.org/10.1007/s12306-026-00988-z","url":null,"abstract":"<p><strong>Background: </strong>Psychiatric comorbidities are increasingly recognized as modifiers of arthroplasty outcomes. However, the effect of generalized anxiety disorder (GAD) on outcomes following total hip arthroplasty (THA) remains underexplored.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using the PearlDiver national database to identify patients who underwent primary, unilateral THA for osteoarthritis between 2010 and 2022. Patients with <90-day follow-up were excluded. Among 278,655 eligible patients, 17,422 (6.2%) had a preoperative diagnosis of GAD. These patients were propensity score-matched 1:1 (caliper 0.2) to patients without GAD, resulting in 34,844 matched THAs. Primary outcomes included 90-day emergency department (ED) visits, readmissions, reoperations, periprosthetic joint infection (PJI) at 90 days, 1 and 2 years, and revision procedures at 1 and 2 years. Annual trends in GAD prevalence among THA patients were also analyzed.</p><p><strong>Results: </strong>GAD was associated with significantly increased odds of 90-day ED visits (adjusted odds ratio [AOR], 1.21; 95% CI, 1.13-1.29; P<0.001) and 90-day reoperations (AOR, 1.20; 95% CI, 1.05-1.37; P=0.006). No differences were observed in readmissions, PJI, or revision rates at any time point. GAD prevalence among THA patients rose from 0.54% in 2010 to 10.14% in 2022-a 19-fold increase (R²=0.99, P<0.001).</p><p><strong>Conclusion: </strong>Preoperative GAD is associated with higher risk of 90-day ED visits and reoperations following THA. The rising prevalence of GAD suggests that preoperative mental health status may be relevant to perioperative risk stratification and supports further study of targeted optimization strategies in patients undergoing THA.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depression and antidepressant use are associated with prolonged recovery and increased opioid dependence following ulnar nerve transposition.","authors":"T Parmar, S Lingam, M Daher, J A Abboud","doi":"10.1007/s12306-026-00989-y","DOIUrl":"https://doi.org/10.1007/s12306-026-00989-y","url":null,"abstract":"<p><p>Depression is common among patients with cubital tunnel syndrome and may adversely influence surgical recovery. This study evaluates the impact of depression and antidepressant use on postoperative complications following ulnar nerve transposition (UNT). A retrospective cohort study was performed using the TriNetX Research Network. Adults undergoing primary UNT between 2005 and 2025 were identified and stratified by depression status. Three 1:1 propensity-matched analyses were performed to evaluate the impact of (1) depression status, (2) antidepressant use among depressed patients, and (3) specific antidepressant subclasses. Matching controlled for demographics and comorbidities. Outcomes included 90-day medical and postoperative complications and 1 year pain-related outcomes and opioid dependence. After matching, 11,821 patients were included in each cohort. Depression was associated with significantly higher 90-day medical morbidity, including infection (RR 1.39, P = 0.0008), acute postoperative pain (RR 1.28, P < 0.0001), emergency department utilization (RR 1.37, P < 0.0001), and increased need for PT evaluation (RR 1.21, P < 0.0001) and orthopedic aftercare (RR 1.11, P = 0.001). At 1 year, depressed patients demonstrated higher rates of persistent elbow pain (RR 1.16, P < 0.0001) and nearly double the risk of opioid dependence or abuse (RR 1.88, P < 0.0001). Among patients with depression, preoperative antidepressant use was associated with higher 1-year opioid dependence (RR 1.66, P = 0.007) and persistent pain (RR 1.21, P = 0.001). SSRI use specifically was linked to increased long-term pain (RR 1.17, P = 0.001) and opioid dependence (RR 1.31, P = 0.023). TCA use was associated with higher 90 day ED visits (RR 1.20, P = 0.022), while atypical antidepressants were associated with increased acute postoperative pain (RR 1.42, P = 0.004). Depression was associated with adverse postoperative outcomes after UNT. Antidepressant use, particularly SSRIs, was associated with higher long-term pain and opioid-related risk; however, these associations may reflect underlying depression severity rather than a direct pharmacologic effect.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medial joint opening on immediate postoperative supine radiographs predicts inferior midterm functional outcomes in women after total knee arthroplasty.","authors":"Eran Keltz, Eugenie Ng, Libby Spiers, Oren Tirosh, Saud Almaslmani, Sara Vorgin, Phong Tran","doi":"10.1007/s12306-026-00973-6","DOIUrl":"https://doi.org/10.1007/s12306-026-00973-6","url":null,"abstract":"<p><p>Routine postoperative radiographs are common after total knee arthroplasty (TKA), yet their value for assessing early joint balance is unclear. Immediate supine, non-weight-bearing anteroposterior radiographs may show coronal gap asymmetry, but its long-term significance remains uncertain. This study evaluated whether medial-lateral joint space differences on day-one radiographs correlate with midterm patient-reported outcomes. A retrospective cohort of 637 mechanically aligned primary TKAs (556 patients, 2012-2017) was analysed. Medial and lateral gaps were digitally measured on immediate postoperative supine AP and lateral radiographs. Gap asymmetry was expressed as an absolute difference and as a medial-to-lateral ratio. Patient-reported outcome measures (PROMs)-Oxford Knee Score (OKS), pain VAS, and EQ-5D VAS-were assessed at ≥ 3 years. Multivariable linear and logistic regression adjusted for age, sex, and BMI examined associations between radiographic imbalance and outcomes. Median follow-up was 5.4 years. The median lateral-medial gap difference improved from 4.9 mm preoperatively to 0 mm postoperatively. In women < 70 years, each 1-mm medial opening was associated with a 1-point lower OKS and 2.4-point lower EQ-5D VAS. A 100% increase in the medial-lateral ratio predicted an 8.8-point lower OKS in women < 60 years and a 4-point lower OKS in women 60-70 years. Medial opening ≥ 1.5 mm predicted poorer OKS and EQ-5D scores, whereas mild lateral opening showed outcomes comparable to symmetric knees. No significant associations were found in men. Medial joint space widening ≥ 1.5 mm or ≥ 100% ratio increase on day-one radiographs predicts poorer midterm outcomes in women < 70 years, suggesting that early coronal imbalance has lasting clinical relevance in this group.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of hook acetabular cage after intralesional surgery in secondary bone tumors of the acetabulum: indications and results at medium term.","authors":"S Otera, G F Papalia, D Sorrentino, E Checcucci, J Baldi, C Zoccali","doi":"10.1007/s12306-026-00986-1","DOIUrl":"https://doi.org/10.1007/s12306-026-00986-1","url":null,"abstract":"<p><strong>Introduction: </strong>The acetabulum is a common site for metastatic lesions. When lytic lesions involve this region, the surgical approach often consists of intralesional treatment and reconstruction to restore stability and ambulation. Reconstruction using a hook acetabular cage represents a viable reconstructive option. The aim of this study was to evaluate the reliability of the hook acetabular cage for reconstruction after curettage of secondary tumors of the acetabulum.</p><p><strong>Materials and methods: </strong>Patients undergoing intralesional surgery for acetabular roof metastases between 2006 and 2022 at two referral centers were included; surviving patients were required to have at least 1 year of follow-up. Staging involved whole-body CT or FDG-PET; local extension was assessed with radiographs, CT, and MRI. All cases were evaluated by a multidisciplinary tumor board. Statistical analysis included descriptive data, implant survival, and overall survival (OS) using the Kaplan-Meier method.</p><p><strong>Results: </strong>Twenty patients (10 men and 10 women), with a mean age of 61.6 ± 15.5 years, were included. Seventeen patients had acetabular metastases from solid tumors, whereas three had acetabular involvement from multiple myeloma. During a mean follow-up of 34.2 ± 29.1 months, six patients (30%) experienced complications, including three infections and three dislocations. Eleven patients (55%) died during follow-up, including five from causes unrelated to the underlying malignancy. At 36 months, implant survival was 74.4% (95% CI, 48.9-88.5%) and overall survival was 65.1% (95% CI, 37.7-82.8%). Median overall survival was 61 months.</p><p><strong>Conclusions: </strong>Hook acetabular cage reconstruction may provide reliable of the acetabulum after tumor surgery, restoring joint stability and function. The reconstruction system used demonstrated sufficient durability to cover the average survival of the patients. Implant mid-term survival supports their use in selected metastatic cases. Further comparative studies are needed to establish their efficacy relative to alternative devices.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Robotic-assisted total knee arthroplasty does not increase procedure duration or adverse event incidence: a retrospective comparative cohort study in a secondary public hospital\".","authors":"Anas Nasir, Muhammad Saad Bin Arshad Arain, Barbara Pierre Louis, Dania Hussain","doi":"10.1007/s12306-026-00985-2","DOIUrl":"https://doi.org/10.1007/s12306-026-00985-2","url":null,"abstract":"","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proximal humerus fractures treated with a modified palm tree technique.","authors":"Salvatore Mannino, Ludovico Lucenti, Francesco Lumetta, Alfio Brunno, Claudio Domenico Cobisi, Antonio Petillo, Francesca Di Salvo, Antonella Conti, Giuseppe Rovere, Lawrence Camarda","doi":"10.1007/s12306-026-00969-2","DOIUrl":"https://doi.org/10.1007/s12306-026-00969-2","url":null,"abstract":"<p><strong>Purpose: </strong>Several surgical techniques have been used for shoulder fracture treatment. In 1989, Kapandji described the 'Palm Tree technique' for the first time, consisting of inserting three K-bent wires through a bone hole created under deltoid muscle insertion. The purpose of this study was to evaluate clinical and radiographic results of proximal humerus fractures treated by a modified \"palm tree technique.\"</p><p><strong>Methods: </strong>From August 2021 to March 2025, 43 patients with proximal humerus fractures underwent surgical treatment using the modified Palm Tree technique. The mean age was 61.8 years (range, 17-85 years), with a mean follow-up of 17.4 months (range, 6-24 months). According to the Neer classification, two-part, three-part, and four-part fractures were treated by this technique, all performed by the same surgeon. Clinical outcomes were assessed using the Constant Score, UCLA Shoulder Rating Scale, and DASH scores.</p><p><strong>Results: </strong>A total of 43 patients were included in the final analysis. The mean Constant Score was 79.3 ± 25.4, the mean UCLA score was 27.3 ± 10.0, and the mean DASH score was 18.5 ± 25.9. Six cases (14.0%) of K-wire migrations were encountered whereas two cases (4.7%) of avascular necrosis of the head required shoulder arthroplasty. One patient developed non-union (2.3%) and another secondary loss of reduction. No neurovascular injury or fracture at the entry site has been reported.</p><p><strong>Conclusions: </strong>The modified Palm Tree technique appears to represent a feasible, joint-preserving, minimally invasive treatment option for selected proximal humeral fractures, providing favorable functional and radiographic outcomes. Careful patient selection remains essential, particularly in elderly patients with poor bone quality.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"There is a relationship between the acromial index, the critical shoulder angle, and rotator cuff tears.","authors":"Marcos Rassi Fernandes","doi":"10.1007/s12306-026-00976-3","DOIUrl":"https://doi.org/10.1007/s12306-026-00976-3","url":null,"abstract":"<p><p>Understanding anatomical parameters is essential not only for the treatment but also for the prevention of new rotator cuff tears. There are still controversies and conflicting results regarding the association or causal inference between the acromion index, the critical shoulder angle, and this disease. The study aimed to (1) investigate the relationship between the acromial index, the critical shoulder angle, and rotator cuff tears, as well as (2) analyze the intra- and inter-rater reliability of the measurements performed. This was a cross-sectional study conducted at a single diagnostic center using digital radiographs of shoulders with rotator cuff tears, calcific tendinitis, and controls. Three researchers independently and blindly measured the acromial index and the critical shoulder angle twice, with a 7-day interval between measurements. Intra- and inter-rater agreement was calculated using the intraclass correlation coefficient. Tukey's test was used to compare pairs of means to identify differences between the evaluated groups. The significance level for rejecting the null hypothesis was set at 5%. The sample included 56 shoulders with rotator cuff tears, 49 shoulders with calcific tendinitis, and 58 control shoulders. Intra- and inter-rater agreement was excellent in the vast majority of cases. The rotator cuff tear group had the highest mean values for both measurements compared to the other two groups (p < 0.05). There is a relationship between the acromial index, the critical shoulder angle, and rotator cuff tears, with excellent intra- and inter-rater reliability. Level of Evidence III.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopic repair versus open repair for subscapularis tears with or without concomitant supraspinatus tears: a systematic review and meta-analysis of comparative studies.","authors":"Mohamed K A Genedy, Rana Ali Ahmed Elsayed, Ahmed A Khalil, Shoaib Javaid, Toka Muhammed Abusittah, Amr Mahmoud Youssef, Mariam A Shaltout, Ahmed O Sabry","doi":"10.1007/s12306-026-00980-7","DOIUrl":"https://doi.org/10.1007/s12306-026-00980-7","url":null,"abstract":"<p><p>The optimal surgical approach for repairing subscapularis (SSC) tendon tears remains debated. This systematic review and meta-analysis compares outcomes of arthroscopic versus open repair for SSC tears, with and without concomitant supraspinatus (SSP) tears. We systematically searched PubMed, Embase, Scopus, and Web of Science for comparative studies on adults with full-thickness SSC tears. Primary outcomes included functional scores (CMS/ASES), range of motion (ROM), and postoperative SSC integrity (retear, belly press, lift-off tests). Analyses were performed using meta R package. Eight studies comprising 328 patients (166 arthroscopic, 162 open) were included. Overall, no statistically significant difference was found in postoperative functional scores between the two approaches (SMD: 0.20, 95% CI [- 0.36-0.77]). In the subgroup analysis of iSSC tears, the outcomes were comparable across all the measured variables. However, in the subgroup of studies including patients with both iSSC and combined anterosuperior (SSC ± SSP) tears, arthroscopic repair significantly improved forward elevation (MD: 11.29°, 95% CI [5.16-17.42]) and significantly decreased the odds of a positive or intermediate belly press sign (OR: 0.35, 95% CI [0.14-0.85]) and lift-off sign (OR: 0.35, 95% CI [0.15-0.79]). No significant difference in retear rates was observed between the groups (OR: 0.97, 95% CI [0.29-3.21]). The choice of surgical approach should be individualised based on tear complexity and surgeon experience. For iSSC tears, open and arthroscopic repairs offer comparable outcomes. For combined anterosuperior tears, arthroscopic repair might offer better functional recovery. Registration: PROSPERO CRD420251078954.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Torsional deformities and anterior knee pain: a systematic review and clinical approach to miserable malalignment syndrome.","authors":"Filomena Morgillo, Vitantonio Digennaro, Alessandro Panciera, Lorenzo Benvenuti, Nilo Carbone, Riccardo Ferri, Simone Ottavio Zielli, Cesare Faldini","doi":"10.1007/s12306-026-00983-4","DOIUrl":"https://doi.org/10.1007/s12306-026-00983-4","url":null,"abstract":"<p><p>Despite advancements in understanding and treating anterior knee pain linked to lower limb torsional deformities, a definitive consensus on diagnostic criteria, clinical indications, and therapeutic strategies for \"miserable malalignment syndrome\" remains elusive. This systematic review synthesizes current research to unify understanding of this complex condition. Findings highlight varied definitions and surgical approaches, underscoring standardization challenges. This systematic review aimed to synthesize current research to provide a more unified understanding of this complex condition. While studies report favorable anatomical correction and symptomatic relief, inconsistent clinical outcome scores and limited long-term follow-up hinder robust comparisons. Conservative measures are often ineffective due to underlying mechanical imbalance; surgical interventions, primarily derotational osteotomies of the femur and/or tibia, offer the most direct anatomical correction. However, optimal level, extent, and timing of these osteotomies-whether single or double level, staged or simultaneous-are debated. Liße et al.'s proposed diagnostic criteria offer a valuable step towards standardized identification of true miserable malalignment syndrome. Future research, particularly robust multi-center studies with standardized outcome measures, is critically needed to establish clearer, evidence-based guidelines, ultimately improving patient care and long-term outcomes for this challenging condition.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}