Orthopaedic Surgery最新文献

{"title":"Robotic Assisted Versus Manual Unicompartmental Knee Arthroplasty: A Systematic Review and Meta-Analysis.","authors":"Sree Kanakala, Kapil Sugand, Jennifer Tasong, Adrisa Prashar, Harjas Singh Shinmar, Srikar Reddy Namireddy, Saran Singh Gill","doi":"10.1111/os.70424","DOIUrl":"10.1111/os.70424","url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted unicompartmental knee arthroplasty (rUKA) aims to enhance the precision and reproducibility of implant positioning compared with manual UKA (mUKA). This systematic review and meta-analysis compared radiographic, clinical, and patient-reported outcomes between rUKA and mUKA.</p><p><strong>Methods: </strong>A systematic search was conducted in PubMed, MEDLINE, EMBASE, Scopus and Web of Science (July 2025) for comparative studies of rUKA and mUKA, in line with the PRISMA statement. Data were pooled using random-effects models, with effect sizes expressed as mean difference (MD), standardized mean change (SMC), or odds ratio (OR) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Thirty-four studies encompassing 68,196 UKAs (22,585 robotic; 45,611 manual) were included. rUKA demonstrated significantly lower complication (OR 0.66, 95% CI 0.44-0.99; p = 0.045) and revision rates (OR 0.54, 95% CI 0.39-0.75; p < 0.001). Operative time was longer for rUKA (+16.1 min; 95% CI 10.8-21.4), while length of stay trended shorter (MD -0.2 days; p = 0.44). rUKA was associated with greater functional outcomes, including higher KSS Knee (MD 2.49; p = 0.007), KSS Function (MD 2.33; p = 0.008), and Oxford Knee Score (SMC 1.06; p = 0.049). Radiographically, rUKA yielded lower tibial slope deviation (MD -1.75°; p < 0.001) and reduced variability in tibial slope and hip-knee-ankle alignment.</p><p><strong>Conclusion: </strong>rUKA may offer benefit compared to mUKA across radiographic precision, complications, revisions, and functional outcomes, though high heterogeneity in study design and the absence of UKA-specific minimal clinically important difference thresholds limits the relevance of any rUKA benefit at present. Further large, multicenter, and methodologically robust studies are needed to confirm long-term results and better define the role of rUKA in clinical practice.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13687996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149238943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Residual Positive Buttress Displacement After Femoral Neck System Fixation for Acute Femoral Neck Fractures: A Retrospective Cohort Study.","authors":"Jian Xing, Yanan Ren, Pengfei Wang, Kun Zhang","doi":"10.1111/os.70450","DOIUrl":"https://doi.org/10.1111/os.70450","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;When anatomical reduction cannot be safely achieved, the functional relevance of residual positive-buttress displacement after FNS fixation remains uncertain. Few clinical studies have quantified how its magnitude relates to hip function. To determine whether hip function after femoral neck system fixation differs by postoperative reduction pattern and, within positive-buttress reduction, by residual medial cortical displacement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective cohort study included 180 adults with isolated acute femoral neck fractures treated with femoral neck system fixation between September 1, 2023, and April 30, 2024, and followed for at least 12 months. The overall analysis included Garden I-IV fractures; the exploratory five-group displacement analysis was restricted to Garden I-III fractures. Postoperative reduction was classified as anatomical reduction, positive-buttress reduction, or negative-buttress reduction. Positive-buttress displacement was measured on anteroposterior radiographs and categorized as PR-2 (≤ 2 mm), PR-4 (&gt; 2-4 mm), or PR-6 (&gt; 4 mm). The primary outcome was 12-month Harris Hip Score. Group comparisons used one-way analysis of variance, Kruskal-Wallis tests, chi-square or exact tests, and multivariable linear regression. Multivariable linear regression adjusted for age, sex, and Garden classification. Additional analyses evaluated continuous displacement, retained Garden IV fractures in the five-group comparison, and incorporated the available clinical covariates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The cohort included 45 anatomical, 98 positive-buttress, and 37 negative-buttress reductions. Median 12-month Harris Hip Score was 95.8, 86.0, and 69.5, respectively. Compared with anatomical reduction, adjusted Harris Hip Score was lower by 9.40 points in positive-buttress reduction and 25.62 points in negative-buttress reduction. In the exploratory analysis restricted to Garden I-III fractures, median Harris Hip Score declined across anatomical reduction, PR-2, PR-4, PR-6, and negative-buttress reduction (95.8, 90.0, 80.0, 74.0, and 68.9). Among the 82 positive-buttress cases in this restricted analysis, each additional millimeter of displacement was associated with a 3.89-point lower score (95% confidence interval, 3.12-4.66 points lower). The additional five-group analysis retaining Garden IV fractures showed the same direction of association.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In the overall cohort, reduction pattern was associated with 12-month hip function. Garden IV fractures and open reduction were unevenly distributed across reduction patterns, and adjustment cannot eliminate residual confounding from fracture complexity, reduction difficulty, surgeon decisions, and unmeasured factors; these associations do not show that changing reduction pattern improves function. In the exploratory analysis restricted to Garden I-III fractures, PR-2 had the highest 12-month Harri","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13691225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149271606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Antibiotic Duration and Treatment Failure After Aseptic Revision Arthroplasty With a Single Unexpected Positive Culture: A Retrospective Cohort Study.","authors":"Hao-Chang Hsieh, Feng-Chih Kuo, Allen Herng Shouh Hsu, Shih-Hsiang Yen, Po-Chun Lin, Cheng-Ta Wu","doi":"10.1111/os.70452","DOIUrl":"10.1111/os.70452","url":null,"abstract":"<p><strong>Objectives: </strong>The clinical significance of a single unexpected positive intraoperative culture (UPC) during aseptic revision arthroplasty remains unclear. This study primarily aimed to evaluate the association between postoperative antibiotic duration and treatment failure in patients with a single UPC after aseptic revision total hip or knee arthroplasty. A secondary aim was to compare failure-free survival between patients with a single UPC and those with multiple UPCs.</p><p><strong>Methods: </strong>We retrospectively reviewed 51 presumed aseptic revision hip or knee arthroplasties with UPCs performed between January 1999 and December 2023. Cases meeting the 2018 ICM criteria for periprosthetic joint infection were excluded. Postoperative antibiotic duration was the exposure of interest. Treatment failure, defined as infection-related re-revision, was the primary outcome; failure-free survival was the secondary outcome. Continuous variables were compared using the Mann-Whitney U test, and categorical variables were compared using chi-square or Fisher's exact tests. Factors associated with failure were examined using univariate logistic regression, and failure-free survival was assessed using Kaplan-Meier analysis with the log-rank test.</p><p><strong>Results: </strong>Among 39 patients with one UPC, treatment failure occurred in 18%. Antibiotic courses longer than 21 days were associated with failure (OR 28.1). In the small subgroup with available data (n = 13), synovial biomarkers did not show a statistically significant difference between success and failure groups. Patients with one UPC had better failure-free survival than those with ≥ 2 UPCs.</p><p><strong>Conclusion: </strong>The observed association between prolonged antibiotic therapy and treatment failure may reflect underlying infection severity rather than a causal effect of antibiotic duration. Individualized management is recommended for UPCs in aseptic revision arthroplasty.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13686786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149238978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Treatment of Tumor-Induced Osteomalacia With Causative Tumors Affecting the Long Bones.","authors":"Shuzhong Liu, Jinyi Xing, An Song, Mingjing Zhang, Jin Jin, Xi Zhou, Yong Liu, Weibo Xia","doi":"10.1111/os.70449","DOIUrl":"10.1111/os.70449","url":null,"abstract":"<p><strong>Background: </strong>The causative tumor for tumor-induced osteomalacia (TIO) locating in the long bone is hidden and has diverse locations, resulting in great challenges to orthopedists. This study aimed to investigate and summarize the clinical features and surgical outcomes of TIO patients with culprit tumors involving the long bones to enhance clinical understanding and improve orthopedic surgical management of this rare disease.</p><p><strong>Methods: </strong>A retrospective analysis was performed on the clinical data of TIO patients with causative tumors located in the long bones who underwent surgery by the Orthopedic Bone and Soft Tissue Tumor Sub-specialty Group at our hospital between January 2013 and January 2023. This article described the clinical symptoms, location of causative tumors, tumor sizes, and other clinical features of TIO patients, and analyzed the trend of changes in blood phosphorus levels before and after surgery and pathological results. At the same time, clinical surgical experience and strategies for TIO patients with culprit tumors located in long bones were summarized.</p><p><strong>Results: </strong>All 49 patients included in the study had been pathologically confirmed and met clinical diagnostic criteria for TIO. All patients experienced bone pain (49/49), often accompanied by limited mobility, fatigue, difficulty turning over, and difficulty sitting up or walking. Importantly, 65.3% (32/49) experienced height loss during disease progression. A total of 65 operations were performed on these 49 patients, with culprit tumors located in the humerus (five cases), femur (33 cases), tibia (seven cases), fibula (three cases), and foot (one case). Twenty-nine cases involved skeletal lesions, seven cases affecting the periosteum (outside-in), while 13 showed both bone and soft tissue involvement. Following the final orthopedic procedure, serum phosphorus levels increased in 45 patients, and the median follow-up duration was 45 months (interquartile range, 28-61 months; range, 2-215 months). Nine patients showed no remission after the first orthopedic surgery, and five experienced recurrence. One patient was diagnosed with a malignant culprit tumor.</p><p><strong>Conclusion: </strong>Surgical planning for TIO with long bone involvement should account for the anatomical location and extent of the causative tumor. Currently, no standardized surgical strategy exists for this rare condition. Recurrence, non-remission, or malignant transformation remains possible due to incomplete resection or local relapse. Based on the single center experience of this case series, we summarized the surgical classification and feasible surgical strategies for TIO's orthopedic surgery with causative tumors located in the long bones. The actual clinical application effect of this classification system needs further clinical data verification.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trochlear Morphological Parameters Based on Measurements at the Trochlear Groove Entry Plane Demonstrate Excellent Predictive Efficacy for Identifying the High-Grade J-Sign.","authors":"Jianzhong Sun, Yang Liu, Daofeng Wang, Zhengjie Tang, Chengcheng Lv, Zhijun Zhang, Tianjiao Mao, Hui Zhang","doi":"10.1111/os.70404","DOIUrl":"10.1111/os.70404","url":null,"abstract":"<p><strong>Objective: </strong>The correction of high-grade J-sign is critical for improving clinical outcomes in patients with trochlear dysplasia, but insufficient attention has been given to anatomical abnormalities at the trochlear groove entry plane, the established gold standard for describing trochlear morphology. We aim to compare the diagnostic accuracy and reliability of axial computed tomography (CT) measurements at the trochlear groove entry plane versus the Roman arch plane in predicting the J-sign among patients with patellar instability.</p><p><strong>Methods: </strong>This retrospective study enrolled 120 knees diagnosed with recurrent patellar dislocation. Based on patellar tracking assessments, the J-sign was categorized into a low-grade group (J-sign negative and Grade I) and a high-grade group (J-sign Grades II and III). Preoperative measurements of trochlear depth, sulcus angle (SA), and lateral trochlear inclination (LTI) were obtained at both the trochlear groove entry plane and Roman arch plane using computed tomography (CT). Receiver operating characteristic (ROC) curve analysis was utilized to evaluate the predictive accuracy of the three parameters measured at both anatomical planes for J-sign severity.</p><p><strong>Results: </strong>Parameters measured at the trochlear groove entry plane demonstrated superior diagnostic accuracy on ROC curves compared with those obtained at the Roman arch plane. In both planes, the trochlear depth and LTI of the high-grade group were significantly lower than that of the low-grade group, while the SA was significantly higher than that of the low-grade group (all p < 0.01). At the trochlear groove entry plane, the area under the curve (AUC) values for distinguishing low-grade and high-grade J-sign were as follows: AUC_{Trochlear depth} = 0.858, AUC_SA = 0.912, and AUC_LTI = 0.803. For SA, sensitivity was 0.87, specificity 0.87, and the optimal cutoff value 149.8°. In contrast, measurements at the Roman arch plane exhibited lower discriminative performance with AUC_{Trochlear depth} = 0.714, AUC_SA = 0.740, and AUC_LTI = 0.694. Specifically, SA demonstrated reduced sensitivity of 0.67, comparable specificity of 0.77, and a lower cutoff threshold of 140.2°.</p><p><strong>Conclusions: </strong>When evaluating knee parameters in patients with recurrent patellar instability, axial CT measurements at the trochlear groove entry plane demonstrate superior predictive efficacy for the J-sign compared to the Roman arch plane. Specifically, CT-based measurement of the SA enables enhanced differentiation between low-grade and high-grade J-sign subgroups, providing critical preoperative insights of patellar maltracking.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison Between Interlaminar and Transforaminal Endoscopic Lumbar Discectomy for Sciatic Scoliosis Secondary to Lumbar Disc Herniation: A Retrospective Study With a Minimum 1 Year Follow-Up.","authors":"Shicheng Zheng, Xincheng Cai, Bolu Zhang, Qinghua Zhao, Zongshan Hu, Bin Wang, Zezhang Zhu, Yong Qiu, Xu Sun","doi":"10.1111/os.70447","DOIUrl":"10.1111/os.70447","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to compare the clinical and radiographic outcomes of interlaminar and transforaminal endoscopic lumbar discectomy (IELD and TELD) in the treatment of lumbar disc herniation (LDH) with sciatic scoliosis.</p><p><strong>Methods: </strong>Patients with sciatic scoliosis secondary to LDH who had undergone IELD or TELD between January 2022 to June 2024 were reviewed. Radiographic parameters, including Cobb angle, apical vertebral translation (AVT), and coronal balance distance (CBD), were measured preoperatively and postoperatively to assess curve evolution. Clinical outcomes were evaluated using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). Meanwhile, perioperative data were also collected. Comparisons between the groups were made by independent t-tests and χ² tests.</p><p><strong>Results: </strong>A total of 134 patients in the IELD group and 103 patients in the TELD group were included in this study. There was no significant difference in intraoperative blood loss (13.4 ± 7.8 mL vs. 11.5 ± 7.1 mL, p = 0.067) and postoperative length of stay (2.5 ± 0.6 days vs. 2.5 ± 0.8 days, p = 0.378) between the two groups; however, the IELD group demonstrated shorter operation time (87.2 ± 17.4 min vs. 96.1 ± 23.3 min, p = 0.001) and fewer intraoperative fluoroscopy times (4.9 ± 0.7 vs. 10.3 ± 2.7, p < 0.001) compared to the TELD group. Both groups showed significant improvements in VAS and ODI scores (p < 0.05), with no significant differences between the groups. Before surgery, 86.9% (206/237) patients had a disc herniation at the convex side of the lumbosacral curve and 86.5% (205/237) patients showed a trunk shift toward the opposite side of disc herniation. After surgery, 91.8% (123/134) of the IELD group and 90.3% (93/103) of the TELD group achieved resolution of scoliosis (AVT ≤ 10 mm) within 12 months. At the final follow-up, the AVT, Cobb angle, CBD, and SVA in the IELD group were 2.7 ± 2.0 mm, 1.0° ± 0.8°, 1.2 ± 0.9 mm, and 3.4 ± 3.1 mm, respectively, with no significant differences compared to the 2.8 ± 2.7 mm, 1.1° ± 0.8°, 1.2 ± 0.8 mm, and 3.7 ± 3.5 mm in the TELD group.</p><p><strong>Conclusions: </strong>Both IELD and TELD are effective and safe for LDH with sciatic scoliosis, with comparable radiographic and clinical outcomes in terms of scoliosis correction. IELD is associated with shorter operation time and fewer intraoperative fluoroscopy times in this cohort.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Excellent 2-Year Outcomes of MUIB All-Inside ACL Reconstruction: A Registry-Based Analysis of 63 Patients With Zero Graft Failure.","authors":"Badrul Akmal Hisham Md Yusoff, Mohamad Helmi Bin Hamid, Norlelawati Mohamad, Karbela Reza Ramlan, Nik Kamarul Arif Nik Kamaruzman, Aliff Omar, Zhafir Asikin, M Azwan Aziz","doi":"10.1111/os.70442","DOIUrl":"10.1111/os.70442","url":null,"abstract":"<p><strong>Background: </strong>Anterior cruciate ligament reconstruction (ACLR) remains a cornerstone of orthopedic sports medicine, yet graft failure rates are high despite advances in surgical techniques. The Modified UKM Internal Bracing (MUIB) technique combines all-inside ACLR with internal suture augmentation, potentially offering enhanced graft protection and improved outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study evaluated 63 patients who underwent isolated primary all-inside ACLR using the MUIB technique (19 allograft, 44 autograft) between 2020 and 2024. Outcome measures included International Knee Documentation Committee (IKDC) scores, Visual Analog Scale (VAS) pain scores, graft failure rates, Single Leg Hop Test (SLHT) performance, and complication profiles at 3, 6, 12, and 24 months postoperatively.</p><p><strong>Results: </strong>Both allograft and autograft groups demonstrated significant improvement from preoperative to 2-year follow-up (p < 0.001). There were no statistically significant differences observed between allograft and autograft groups across all outcome measures, suggesting that the MUIB technique may yield comparable outcomes regardless of graft type. Complete pain resolution (VAS 0) was achieved by 6 months in both groups. Notably, no graft re-tears were documented throughout the 2-year follow-up period, with 95.2% of patients achieving SLHT > 90% at 12 months. No infections, arthrofibrosis, or hardware-related complications requiring reoperation were recorded.</p><p><strong>Conclusion: </strong>The MUIB all-inside ACLR technique yielded excellent 2-year outcomes in this cohort, characterized by a zero graft failure rate, complete pain resolution, and exceptional functional recovery. However, given the retrospective, uncontrolled design, these findings should be interpreted as preliminary and hypothesis-generating. Prospective comparative studies are necessary to establish the efficacy and potential superiority of the MUIB technique relative to conventional ACLR approaches.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Tension Suspension\" Remnant-Preserving ACL Reconstruction Promotes the Early Maturity of the Graft Ligament.","authors":"Jiamin Liang, Gengen Huang, Wenhan Yang, Junming Wei, Yingzhen Yang, Zirong Huang, Weimin Zhu","doi":"10.1111/os.70443","DOIUrl":"10.1111/os.70443","url":null,"abstract":"<p><strong>Purpose: </strong>The clinical application of anterior cruciate ligament (ACL) remnant preservation remains controversial, and conventional remnant-preserving techniques cannot fully maximize the biological potential of ACL remnants. To compare graft ligamentization, femoral tunnel enlargement, and clinical functional scores between \"tension suspension\" remnant-preserving anterior cruciate ligament reconstruction (ACLR) and single-bundle anatomical ACLR.</p><p><strong>Methods: </strong>Forty-eight patients enrolled from December 2021 to June 2023 were divided into non-preserving remnant (NPR, n = 18) and preserving remnant (PR, n = 30) groups. At 3 and 6 months postoperatively, magnetic resonance imaging (MRI) of the knee was performed to measure graft signal noise quotient (SNQ) of the region of interest (ROI) and femoral tunnel diameter changes. Lysholm, IKDC, and Tegner scores were assessed at 6 months. Demographic and preoperative data were analyzed; intergroup comparisons of graft SNQ, femoral tunnel diameter changes, and clinical scores were conducted. Spearman correlation analysis evaluated the relationship between graft SNQ and knee function scores.</p><p><strong>Results: </strong>No intergroup differences were noted in age, sex, BMI, or graft diameter. At 3 months, significant differences were observed in graft SNQ (most prominent at the distal end) and femoral tunnel diameter changes (p < 0.05). At 6 months, no significant differences were found in SNQ (except near-significant proximal SNQ, p = 0.058) or femoral tunnel diameter changes; clinical scores showed no intergroup differences. Tegner scores were moderately to significantly positively correlated with 6-month SNQ (< 0.05).</p><p><strong>Conclusion: </strong>\"Tension suspension\" remnant-preserving ACLR has significant advantages in early graft ligamentization and inhibiting femoral tunnel enlargement. Subjective knee function may be related to graft signal intensity.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Cardiometabolic Multimorbidity Increases the Risk of Hip Fracture: A Longitudinal Cohort Study Based on CHARLS\".","authors":"Harun Sağlıcak","doi":"10.1111/os.70446","DOIUrl":"10.1111/os.70446","url":null,"abstract":"<p><p>In the CHARLS cohort of Tian et al., the abstract's 13% versus 8% are column percentages from Table 1: the prevalence of cardiometabolic multimorbidity (CMM) among participants with and without hip fracture. Read across rows, the same counts give a nine-year hip fracture incidence of 6.6% (36/544) with CMM and 4.4% (251/5770) without, an absolute difference of 2.3 percentage points (95% CI 0.4-4.7) rather than 5.0. The adjusted hazard ratio of 1.70 is unaffected; its lower confidence limit reads 1.318 in the abstract and 1.18 in Table 2. STROBE item 16(c) asks for such absolute risks.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-Arm Assisted Direct Anterior Approach Total Hip Arthroplasty Facilitates Tensor Fasciae Latae Preservation and Early Functional Recovery in Obese Patients.","authors":"Shijie Chen, Dasheng Lin, Huihuang Chen, Wentao Lin, Dongmin Xu, Eryou Feng","doi":"10.1111/os.70444","DOIUrl":"10.1111/os.70444","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to evaluate the efficacy and safety of robotic-arm assisted (RA) direct anterior approach (DAA) total hip arthroplasty (THA) in facilitating tensor fasciae latae (TFL) preservation and subsequent functional recovery, and to explore the correlation between TFL preservation and postoperative inflammation, pain, and early functional recovery in obese patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We retrospectively reviewed 69 obese patients (BMI ≥ 30 kg/m&lt;sup&gt;2&lt;/sup&gt;) undergoing primary DAA-THA from September 2023 to December 2024 with 12-month follow-up. Surgical procedures were performed by RA technology in 31 patients (RA group) and manual technology in 38 patients (M group). Demographic characteristics, perioperative parameters, TFL injury index, unsupported ambulation duration, creatine kinase (CK), C-reactive protein (CRP), Visual Analog Scale scores (VASs), Harris Hip Scores (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Forgotten Joint Score-12 (FJS-12), radiologic measurements, and complications were retrieved from patients. Student's t-test and Mann-Whitney U test were used to compare continuous data. Fisher test and Chi-square test were used to compare the categorical data. Longitudinal data were evaluated by generalized estimating equations. The relationships between TFL injury index and early clinical outcomes were evaluated using Spearman's correlation analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Baseline demographic characteristics of both groups were comparable. RA group demonstrated significantly lower TFL injury index (18.05 [IQR 14.51-30.05] % vs. 38.31 [IQR 20.58-50.70] %, p = 0.001) and shorter unsupported ambulation duration (3.00 [IQR 2.00-4.00] week vs. 5.00 [IQR 3.00-6.00] week, p &lt; 0.001) compared to M group. Besides, TFL injury index showed a strong positive correlation with unsupported ambulation duration (ρ = 0.775) (p &lt; 0.001). Compared to M group, RA group significantly reduced CK, CRP, and VASs at the initial 72 h postoperatively (all p &lt; 0.05). RA group exhibited significantly superior HHS, WOMAC, and FJS-12 compared to M group at postoperative 1 month (all p &lt; 0.01). TFL injury index demonstrated strong positive correlations with CK (ρ = 0.619), CRP (ρ = 0.628), and VASs (ρ = 0.652) at postoperative 72 h (all p &lt; 0.001). Furthermore, it showed a strong negative correlation with HHS (ρ = -0.615) and FJS-12 (ρ = -0.759), and moderate positive correlations with WOMAC-pain (ρ = 0.410) and WOMAC-function (ρ = 0.583) at postoperative 1 month (all p &lt; 0.001). Despite longer operative duration in RA group, it exhibited a significantly higher proportion of acetabular components positioned within the Lewinnek safe zone and a significantly lower incidence of incision-related adverse events compared to M group (all p &lt; 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In obese patients undergoing DAA-THA, RA technology significantly reduced intraoperative injury t","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}