MUSCULOSKELETAL SURGERY最新文献

{"title":"Uncemented hip resurfacing in patients over 65: 16-year outcomes from a large, single-surgeon series.","authors":"D Gaillard-Campbell, T Gross","doi":"10.1007/s12306-025-00929-2","DOIUrl":"10.1007/s12306-025-00929-2","url":null,"abstract":"<p><strong>Background: </strong>Hip resurfacing is often reserved for younger, active patients due to concerns over implant durability and fracture risk in older patients. However, there is a lack of long-term data evaluating outcomes in patients over 65 years old at time of surgery. This study addresses this gap by directly comparing implant survivorship, failure and complication rates, and clinical outcomes in a younger control cohort from the same large single-surgeon series (> 6000 cases).</p><p><strong>Methods: </strong>We queried a large, prospective institutional clinical database comprising over 7000 hip resurfacing cases performed by a single, high-volume surgeon; findings may not be generalizable to lower-volume or less-experienced centers. From this cohort, we identified 395 cases in patients ≥ 65 years (mean age 68.8) and 5,106 cases in patients < 65 years of age at time of surgery. All included patients had a minimum of 2-year follow-up, and 88.4% of the study cohort had up-to-date follow-up.</p><p><strong>Results: </strong>There was no difference in the 98.6% 10- and 98.2% 16-year Kaplan-Meier implant survivorship of our over-65 study group when compared to a younger under-65 control group. These results exceed the NICE (National Institute for Clinical Excellence) criteria and registry benchmarks for total hip replacement from three major registries. The early femoral failure rate (femoral failure occurring < 1 year postoperative) was only 0.3%, which compares favorably with total hip arthroplasty perioperative fracture data. The long-term femoral fracture rate over the duration of this study was 1.3% for this older cohort, lower than what was reported for total hip arthroplasty.</p><p><strong>Conclusions: </strong>This is the first known long-term study to demonstrate that hip resurfacing patients over 65 can achieve implant survivorship rates equivalent to younger resurfacing patients and superior to national total hip arthroplasty registry benchmarks. These findings challenge age-based restrictions and support expanded candidacy for hip resurfacing in select older adults when managed by experienced surgeons.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":"325-333"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145459269","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":"Are outcomes of proximal row carpectomy and four-corner fusion dependent on the diagnosis of scapholunate advanced collapse or scaphoid non-union advanced collapse? a systematic review.","authors":"Daniel Cadoux-Hudson, Duncan Muir, Mark Brewster","doi":"10.1007/s12306-025-00939-0","DOIUrl":"10.1007/s12306-025-00939-0","url":null,"abstract":"<p><p>Scapholunate advanced collapse (SLAC) and scaphoid non-union advanced collapse (SNAC) are well-recognised degenerative wrist conditions. Debate persists over optimal treatment, particularly since 4 corner fusion (4CF) emerged in the 1980s. Reviews have compared the outcomes of 4CF and PRC; however, none of these have looked at whether the initial diagnosis determines the final outcome. This systematic review hypothesises that the outcome of PRC and 4CF for the treatment of stage 2 and 3 SNAC and SLAC varies depending on the initial diagnosis. Searches of PubMed, Google Scholar and Cochrane database using the terms 'SNAC' and 'SLAC' were performed. Studies were excluded based on results recorded, study nature and whether results were separated according to the initial diagnosis. Studies were assimilated using weighted averages and further analysed using Microsoft Excel and GraphPad Prism software. A total of 3320 studies were identified; however, only 6 studies (8 study arms) were included. Of these, 7 study arms recorded pre- and post-operative range of movement data, 4 with pre- and post-operative disabilities of the arm, shoulder and hand (DASH) scores and 5 with pre- and post-operative Visual Analogue Score (VAS) pain scores. There was no statistical difference in these outcome measures with a mean follow-up of 62 months (38-120). This review found no significant difference in the outcomes of these procedures; however, there is a high level of uncertainty. Further studies should focus on reporting data by procedure as well as initial diagnosis with appropriate power calculations and should be designed as prospective randomised control trials.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":"281-286"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145846764","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":"Mechanical failure of modular hip stems due to titanium alloy neck breakage: a single-center case series.","authors":"N Papapietro, B Zampogna, C Caria, S Giusti, A Marinozzi, A Di Martino, R Papalia, V Denaro","doi":"10.1007/s12306-025-00935-4","DOIUrl":"10.1007/s12306-025-00935-4","url":null,"abstract":"<p><strong>Backround: </strong>Modular neck implants in total hip arthroplasty (THA) allow control of length, offset, and version. However, these implants showed problems such as implant fracture and adverse reactions due to metal debris. This study aims to analyze our modular titanium-titanium neck THA stems, focus on mechanical complications related to its breakage, conduct a metallurgical analysis on these broken implants, and report revision surgery outcomes.</p><p><strong>Methods: </strong>We performed a retrospective review to identify patients who had undergone THA with a specific modular (H2M-C2F Implants) implant at our institute (Fondazione Policlinico Universitario Campus Bio-Medico, Rome). Patient demographics, implant characteristics, clinical follow-up, and revision outcomes were obtained. A metallurgical examination was conducted on the broken implants.</p><p><strong>Results: </strong>Out of thirty-eight patients eligible patients, seventeen had a titanium alloy neck, whereas the remaining twenty-one had CrCo necks. Thirteen of seventeen patients with titanium necks reported spontaneous ruptures of the neck due to fretting corrosion phenomena. Revision surgery was offered to all patients, including the ones who did not experience spontaneous rupture (four patients). Neither intraoperative nor long-term complications were reported, except for one patient who showed gluteal insufficiency. No clinical differences were reported between the patients who underwent revision surgery and those who were revised preventively.</p><p><strong>Conclusion: </strong>Using modular implants should be limited to strict indications. Patients' characteristics are vital in selecting the ideal candidate for a modular THA. Modular implants should answer all the questions regarding durability and fracture risk to become a valid alternative to fixed-neck stems.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":"335-342"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145482575","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":"Meta-analytic evaluation of complications and longevity of bone-anchored prostheses in lower extremity amputees: does design matter?","authors":"Hugh Milchem, Yasmine J Khair, Maamoun Adra, Shayndhan S Sivanathan, Shreehari Suresh, Dilip K Vankayalapati, Aslam Mohamed Haroon, Christian A Than, Nadim Tarazi, Hayato Nakanishi, Peter J Smitham","doi":"10.1007/s12306-026-00946-9","DOIUrl":"10.1007/s12306-026-00946-9","url":null,"abstract":"<p><p>Bone-anchored prostheses (BAPs) are an alternative option for lower-limb amputees with problematic suspended socket prostheses (SSPs). We sought to meta-analytically quantify complication burden and revision-free survival for BAPs, whilst investigating possible differences in complication rates between common screw-fit (OPRA) and press-fit (ILP/OPL) designs. A multi-database search of PubMed, EMBASE, CiNAHL, Cochrane Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus and Web of Science from inception to September 2025 was conducted. Proportions were pooled using a random-effects model. This review was registered in PROPSPERO (ID: CRD42024507070). A total of 22 studies reporting 979 patients were included. An overall complication rate of 65% (95% CI: 0.53-0.75, I² = 69%) was found. The most common complication was breakage of the abutment or dual-cone adaptor (DCA) (0.38, 95% CI: 0.19-0.62, I² = 97%), which constituted 94% of all mechanical failures (95% CI: 0.87-0.98, I² = 51%). Second was infection (0.36, 95% CI: 0.25-0.50, I² = 92%) with 72% of infections being grade I (95% CI: 0.57-0.83, I² = 72%). Estimated revision-free survival was 89% (95% CI: 0.84-0.93, I² = 0%) at five years and 77% (95% CI: 0.70-0.82, I² = 0%) at ten years. The largest difference between implant designs was for overall proportion of mechanical failure, OPRA at 68% (95% CI: 0.34-0.90, I² = 98%), ILP/OPL at 19% (0.09-0.36, I² = 85%). BAPs do carry appreciable risks for superficial infection and mechanical (abutment/DCA) breakage, with screw-fit designs appearing to have a higher mechanical failure rate. However, the revision-free survival rate overall remains acceptable up to 10 years demonstrating the viability of BAPs in lower-limb amputees.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":"287-301"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966418","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":"Accuracy in predicting 135° neck-shaft angle short-stem and glenoid components size in reverse shoulder arthroplasty with 3D preoperative planning.","authors":"Alessandro Donà, Rocco Bonfatti, Gian Mario Micheloni, Andrea Giorgini, Davide Basile, Anna Pirozzi, Giuseppe Porcellini","doi":"10.1007/s12306-025-00938-1","DOIUrl":"10.1007/s12306-025-00938-1","url":null,"abstract":"<p><strong>Background: </strong>Reverse shoulder arthroplasty (RSA) is a widely used procedure for glenohumeral joint degeneration. Despite advancements in 3D preoperative planning, the concordance between planned and intraoperatively implanted components remains unclear. This study evaluates the accuracy of 3D preoperative planning in predicting humeral and glenoid components size in RSA with a 135° neck-shaft angle (NSA) short-stem.</p><p><strong>Materials and methods: </strong>A retrospective study was conducted on 84 RSA cases performed between October 2023 and September 2024 at a specialized shoulder surgery center. All cases underwent standardized preoperative imaging, including anteroposterior and axillary radiographs and a 3D CT scan-based planning protocol using BluePrint software. The planned and intraoperatively implanted humeral stems, glenoid baseplates, and glenospheres were compared. Statistical analyses were performed to assess concordance in term of size and identify factors influencing deviations from the preoperative plan.</p><p><strong>Results: </strong>The preoperative plan was fully respected in 23.1% of cases for both the humeral and glenoid components. The humeral stem size matched the preoperative plan in 28.6% of cases, with a deviation within one adjacent size in 67.9%. The glenoid baseplate size was concordant in 92.6%, while the glenosphere size matched in 60.7%. Kappa values indicated slight agreement for stem size (κ = 0.12) and moderate agreement for glenosphere size (κ = 0.54). A statistically significant correlation was observed between changes in humeral stem and glenosphere size (p < 0.05). No significant correlation was found with patient age, while sex significantly influenced stem and glenosphere size variation (p < 0.05).</p><p><strong>Conclusion: </strong>3D preoperative planning demonstrated moderate to high accuracy for glenoid component selection but lower concordance for humeral stem size. Intraoperative adjustments were mainly related to metaphyseal bone quality and soft tissue tension. Future improvements in planning software should incorporate bone mineral density and humeral osteotomy variability to enhance predictive accuracy.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":"351-357"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892994","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":"Retrospective analysis of ultrasound-guided hydrodistension in patients with post-traumatic adhesive capsulitis of the shoulder.","authors":"F Vita, D Donati, L Langone, F Origlio, R Tedeschi, M Miceli, S M Stella, S Galletti, C Faldini","doi":"10.1007/s12306-025-00937-2","DOIUrl":"10.1007/s12306-025-00937-2","url":null,"abstract":"<p><strong>Background: </strong>Adhesive capsulitis (AC) is a painful shoulder condition characterized by limited motion due to fibrosis and contracture of the joint capsule. Secondary AC frequently occurs after upper limb fractures and immobilization, delaying recovery.</p><p><strong>Methods: </strong>This retrospective study analyzed 11 patients with post-traumatic AC (< 3 months) following non-displaced humeral fractures treated conservatively with a median immobilization period of 25 days. The cohort included seven men and four women (mean age 52.6 years), five of whom also had rotator cuff injuries. Treatments involved hydrodistension, with glenohumeral drainage in seven cases and subacromial bursa drainage in four cases. Range of motion (ROM), pain (VAS), and functionality (DASH) were assessed at baseline, 1-, 2-, and 3-month post-treatment.</p><p><strong>Results: </strong>Significant improvements in ROM were seen across all planes: flexion increased from 80° to 150°, extension from 15° to 60°, abduction from 55° to 160°, internal rotation from 10° to 85°, and external rotation from 10° to 80° (all p < 0.001). Pain levels (VAS) decreased from a mean score of 8 at baseline to 3 at 3 months (p < 0.001), and functional capacity (DASH) improved from a score of 45-10 (p < 0.001). Among the five patients with rotator cuff injuries, despite improved ROM and pain, strength deficits persisted, leading to subsequent arthroscopic repairs.</p><p><strong>Conclusion: </strong>Hydrodistension resulted in significant improvements in ROM, pain relief, and functionality, suggesting it is a promising treatment for post-traumatic AC. Early intervention may aid faster recovery after shoulder immobilization.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":"359-370"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827806","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":"Kinematic alignment versus mechanical alignment in total knee arthroplasty: a systematic review and meta-analysis of medium to long-term outcomes.","authors":"Abdelrahman Abdalla Mohamed, Abdalla Ahmed Mohamed, A F Alkarghali, A Amirat, A H Zein, M E Abdelsattar, M Al-Badaineh, M F Hammad","doi":"10.1007/s12306-026-00970-9","DOIUrl":"https://doi.org/10.1007/s12306-026-00970-9","url":null,"abstract":"<p><strong>Purposes: </strong>To compare medium- to long-term patient-reported outcomes, objective function, pain, range of motion, and revision/reoperation risk between kinematic (KA) and mechanical alignment (MA) in primary total knee arthroplasty (TKA) using randomized trials.</p><p><strong>Methods: </strong>A systematic review and meta-analysis followed PRISMA and Cochrane guidelines. Randomized controlled trials comparing KA and MA in primary TKA with ≥ 24 months follow-up were identified through PubMed, Scopus, Cochrane, and Web of Science. Pooled mean or standardized mean differences and risk ratios were calculated using random-effects models. Outcomes were stratified into mid-term (24-60 months) and long-term (> 60 months) windows. Certainty of evidence was assessed using GRADE.</p><p><strong>Results: </strong>Ten unique RCTs (13 articles, 934 knees, follow-up 2-13 years) were included. Mid-term analyses favored KA in Forgotten Joint Score (MD 4.06, 95% CI 2.39-5.74), WOMAC (MD -5.51, 95% CI -10.27 to -0.74), and VAS pain (MD -0.39, 95% CI -0.58 to -0.19). Long-term follow-up revealed no significant functional differences. Revision risks were comparable (RR 1.32, 95% CI 0.59-2.93). Certainty of evidence ranged from moderate (OKS, VAS) to very low (FJS, WOMAC, KSS, ROM).</p><p><strong>Conclusion: </strong>KA yields modest mid-term improvements in awareness and pain over MA, though differences rarely reached clinical importance thresholds. Long-term outcomes, survivorship, and complications were comparable. KA is a viable personalized TKA strategy, pending confirmation from larger randomized trials.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795561","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":"Metal-backed patella: a reasonable alternative in a bone-preserving approach in revision TKA.","authors":"Joshua L Tidd, Ignacio Pasqualini, Shlok V Patel, Shujaa T Khan, Khaled A Elmenawi, Viktor E Krebs, Nicolas S Piuzzi, Matthew E Deren","doi":"10.1007/s12306-026-00974-5","DOIUrl":"https://doi.org/10.1007/s12306-026-00974-5","url":null,"abstract":"<p><strong>Introduction: </strong>Patellar management during revision TKA (rTKA) remains challenging. Metal-backed patella (MBP) with highly porous titanium coating applied by 3D printing may provide improved fixation in TKA, especially in patients with limited bone stock. The primary aim of this study was to assess implant survivorship among patients who received a new-generation MBP during revision TKA. Secondary aims were to assess (1) healthcare utilization, and (2) preoperative and 1-year PROMs.</p><p><strong>Methods: </strong>This was a retrospective review of patients who received a MBP during rTKA from 2017 to 2022. In total, 31 patients achieved an average follow-up of 3.0 years (SD 1.5 years). Knee injury and Osteoarthritis Outcome Score (KOOS) Pain, KOOS Physical Function Shortform (PS), KOOS Joint Replacement (JR) and Veterans RAND 12-Item Health Survey Mental Component Score (VR-12 MCS) were obtained preoperatively and at 1-year. Most patients had prior ipsilateral prosthetic joint infection (PJI; n = 22, 71%).</p><p><strong>Results: </strong>MBP implant survivorship was 96.8%. No patients had evidence of patellar component aseptic loosening. The average patellar thickness was 11.8 mm (SD 2.3 mm). After rTKA, most patients were discharged home following surgery (n = 24, 77.4%). There were 5 patients (16.1%) readmitted within 90-days, and no deaths within 1-year. Significant improvement was found in KOOS Pain ( p< 0.001), and KOOS JR (p = 0.005), but not KOOS PS ( p= 0.080) or VR-12 MCS (p = 0.279).</p><p><strong>Conclusions: </strong>Titanium 3D-printed MBP resulted in excellent implant survivorship with major improvements in pain and overall joint health. Thus, MBP appears to be a viable patellar component option in revision TKA.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761452","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":"Multimodal pain management in foot and ankle surgery and trauma: a narrative review.","authors":"Gabriele Colò, Federico Fusini, Ettore Vulcano, Massimiliano Leigheb, Michele Francesco Surace","doi":"10.1007/s12306-026-00972-7","DOIUrl":"https://doi.org/10.1007/s12306-026-00972-7","url":null,"abstract":"<p><p>Foot and ankle procedures are frequently associated with significant acute pain, with studies reporting moderate-to-severe pain measured on the Visual Analog Scale (VAS) at 5-6, in up to 67% of patients in the first 24 h. Crucially, uncontrolled acute pain is a major risk factor for chronic pain, with an estimated prevalence ranging from 10 to 50%, and a 3% risk of developing persistent neuropathic pain one year post-surgery. Given the complex innervation of the distal lower limb, effective pain management is paramount to prevent central sensitization and chronification. This narrative review provides a comprehensive synthesis of the current evidence on the pathophysiology and management of acute and chronic pain following foot and ankle procedures. The analysis critically assesses the efficacy of multimodal analgesic strategies, including peripheral nerve blocks (PNBs), systemic analgesics, and non-pharmacological interventions, across the continuum of care (pre-, intra-, postoperative, and chronic phases). A multimodal approach is widely recognized as a highly effective approach for acute pain control. PNBs, such as popliteal and saphenous blocks, significantly reduce pain intensity and opioid requirements for up to 24 h. The combination of acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) provides superior analgesia to monotherapy. Postoperative pain with a numeric rating scale (NRS) score greater than 4 is observed in 68% of patients within 24 h, highlighting the need for vigilance. The incidence of chronic post-surgical pain (CPSP) varies considerably (10%-50%), often evolving into complex syndromes such as complex regional pain syndrome (CRPS), which requires early, multidisciplinary intervention. Chronic pain management relies on pharmacological adjuvants (e.g., pregabalin, duloxetine), minimizing long-term opioid consumption. Effective and prompt pain management in foot and ankle surgery and trauma is critical to improve patient outcomes and prevent long-term disability. A personalized multimodal strategy, integrating PNBs, tiered systemic analgesics, and timely recognition of chronification signals, is strongly recommended to optimize recovery outcomes. The integration of non-pharmacological modalities, including physiotherapy and psychological support, completes the comprehensive approach to reduce pain burden and enhance functional recovery.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764345","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 myth of the ankle centre of rotation: definitions, misconceptions and clinical implications.","authors":"Vincenzo Leone, Antonio Mazzotti, Simone Ottavio Zielli, Cesare Faldini","doi":"10.1007/s12306-026-00977-2","DOIUrl":"https://doi.org/10.1007/s12306-026-00977-2","url":null,"abstract":"<p><p>The ankle joint complex is a sophisticated structure whose kinematic behaviour is frequently oversimplified in both clinical and biomechanical practice. The hinge model, with a fixed axis aligned with the line joining medial and lateral malleoli, remains prevalent despite evidence of a migrating centre of rotation (COR) and three-dimensional motion. This paper addresses common misconceptions surrounding the COR and axis of rotation (AOR) at the ankle joint, clarifying their purely kinematic nature. A conceptual framework is provided, introducing mechanical notions of COR, centrode, helical axis and axode with reference to their application in the ankle joint analysis. The clinical relevance of accurate COR localisation is discussed, spanning the topics of muscles moment arm estimation and total ankle arthroplasty (TAA). Current limitations are critically reviewed, including the absence of standardised in vivo protocols and the insufficient integration of subject-specific kinematic assessment. Emerging acquisition technologies are proposed as the most promising avenue to bridge the gap between biomechanical knowledge and clinical translation, ultimately moving beyond the oversimplified single-axis model in the management of ankle pathology.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761463","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}