Orthopaedic Surgery最新文献

{"title":"Medial Compartment Knee Osteoarthritis Altered Tibiofemoral Joint Kinematics and Contact Pattern During Daily Weight-Bearing Extension.","authors":"Zheng Jiang, Axiang He, Nan Zheng, Yanjie Mao, Weiming Lin, Xiaoyin Zhang, Han Guo, Yuyan Liu, Tsung-Yuan Tsai, Wanjun Liu","doi":"10.1111/os.70023","DOIUrl":"https://doi.org/10.1111/os.70023","url":null,"abstract":"<p><strong>Objective: </strong>With the advancement of digital orthopedics, the growing prevalence of medial compartment knee osteoarthritis (MCKOA) and the widespread adoption of knee-preserving surgical techniques have heightened new interest in predicting the onset of MCKOA and promoting surgical outcomes. This study was to clarify the differences in kinematics and contact patterns between the MCKOA knee and its native sides during knee extension.</p><p><strong>Methods: </strong>From March 2023 to June 2024, thirty-two patients who suffered from unilateral MCKOA, with their contralateral extremities asymptomatic and intact, were enrolled in this descriptive research. Three-dimensional models were created from computed tomography scans, and all patients performed continuous stair climbing under the surveillance of a dual fluoroscopic imaging system (DFIS) to determine the accurate 6-degrees-of-freedom (6-DOF) of their medial OA knees and the contralateral knees. The volume penetration centers between tibial and femoral cartilage models were defined as contact centers. All measured parameters were tested for significant differences using the Wilcoxon Rank-Sum test.</p><p><strong>Results: </strong>Compared to native knees, the MCKOA tibia showed increased flexion (mean 3.6°) and varus rotation (mean 1.6°), with more posterior (mean 1.4 mm), lateral (mean 1.2 mm) and proximal translations (mean 0.5 mm) relative to the femur during extension (p < 0.05). The tibiofemoral contact patterns on the medial and lateral tibial plateau of the MCKOA knee both shifted more medially (mean 1.4 mm and 1.3 mm, respectively, p < 0.05) than the native side, which was consistent with the lateral translations observed in 6-DOF.</p><p><strong>Conclusion: </strong>Our findings offer valuable insights into the in vivo kinematics of MCKOA knee, its tibiofemoral joint (TFJ) and contact pattern. In MCKOA knees, the tibia exhibited increased flexion and varus rotation, along with more posterior, lateral, and proximal translation relative to the femur compared to the native side during extension. These changes aligned with the more medial shifts in contact patterns of the tibial plateau on the MCKOA side. These findings provide data support for the digital diagnosis and treatment of MCKOA.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomical Study of Lateral Compression II Screw Path and Entry Parameters Based on Three-Dimensional CT Image Reconstruction Techniques.","authors":"Xingye Du, Yong Liu, Xuefeng Jiang","doi":"10.1111/os.70011","DOIUrl":"https://doi.org/10.1111/os.70011","url":null,"abstract":"<p><strong>Objective: </strong>Lateral compression II (LC-II) fractures, a common type of pelvic injury, often require closed reduction and percutaneous screw fixation due to posterior pelvic ring instability. However, existing methods fail to adequately account for the internal structure of the screw path and lack precise anatomical guidance, increasing surgical risks. This study utilized digital medical software to analyze the LC-II screw path and entry parameters, providing the anatomical references.</p><p><strong>Methods: </strong>This retrospective study enrolled 43 adult patients (21 males and 22 females) who underwent a complete computed tomography (CT) scan examination from February 2017 to February 2019. The digital three-dimensional (3D) pelvic model was reconstructed, and the ideal LC-II screw path was designed by the cross-section method. The primary evaluation parameters included the screw path length (D_AP), maximum diameter (D_max), distances at narrow points (D1 and D2), bone thickness parameters (OW1 and IW1; OW2 and IW2), and screw entry angles (∠α, ∠β, ∠γ).</p><p><strong>Results: </strong>Of 43 patients, 42 successfully completed LC-II screw path construction. Among 21 female patients, 5 (23.8%) could accommodate screws with a maximum diameter of < 6.5 mm. Compared with female patients, male patients exhibited significantly higher D_AP, D_max, D₂, OW₁, IW₁, IW₁/OW₁, and IW₂/OW₂ (p < 0.05). The ∠γ was significantly lower in male patients. Furthermore, digital 3D pelvic model observations revealed that LC-II screws bone entry points in the anterior iliac region were all located posterior to the anterior inferior iliac spine (AIIS). The angles between the LC-II screw and coronal plane were 48.06° in males and 45.10° in females, while the angles between the LC-II screw and sagittal plane were 27.14° and 25.60°, respectively.</p><p><strong>Conclusion: </strong>This study utilized digital medical software to construct the LC-II screw path and analyze sex-based differences, highlighting the importance of individualized preoperative path planning and providing essential anatomical evidence for the precise and safe percutaneous insertion of LC-II screws.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Knee Arthroscopy Be Considered Entirely Safe for Patients Over 50 Years Old With no Risk of Osteonecrosis? Case Series and Literature Review on Post-Artrhoscopy Osteonecrosis of the Knee (PAONK).","authors":"Panagiotis Ntagiopoulos, Georgios Kalinterakis, Pierrenzo Pozzi, Dimitris Fligkos, George Themistocleous, Sotirios Themistokleous, Triantafyllia Dimou, Riccardo Compagnoni, Paolo Ferrua, Pietro Simone Randelli","doi":"10.1111/os.70020","DOIUrl":"https://doi.org/10.1111/os.70020","url":null,"abstract":"<p><strong>Objective: </strong>Although post-arthroscopy osteonecrosis of the knee is well-documented in the literature, its etiology and prognosis remain unclear. The purpose of this study is to present a group of individuals who experienced avascular necrosis following knee arthroscopy, to examine the factors leading to this condition and assess the outcomes of treatment, as well as to perform a literature review on the subject.</p><p><strong>Methods: </strong>We retrospectively studied patients between January 2015 and March 2024 who had developed knee osteonecrosis following a standard arthroscopic procedure for treating meniscal tears. All adult patients with isolated meniscus tears and grade 2 or less chondral lesions were included. Patients with evidence of bone edema on MRI performed 4-6 weeks after the onset of preoperative symptoms were not included in the study. The Knee injury and Osteoarthritis Outcome Score (KOOS) was used as an outcome measure. A correlation analysis was performed to explore the degree of association between variables, with significance set at p < 0.05.</p><p><strong>Results: </strong>Eight patients out of 974 arthroscopies met the inclusion criteria. There was one woman and seven men (mean age 57 [range: 51-71]). The lesions noted at arthroscopy included seven medial meniscus tears that were treated with excision and one lateral meniscal tear that was treated with suture repair and still developed osteonecrosis. None of them were traumatic while all patients had early degenerative changes in the compartment of interest.</p><p><strong>Conclusions: </strong>Osteonecrosis should be suspected in older patients experiencing worsening symptoms following knee arthroscopy for degenerative meniscus tears and partial meniscectomy. Increased age, a higher BMI, and a delayed diagnosis appear to be associated with more severe disease progression and the need for operative treatment.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Analysis of Wrist Motions During Daily Activities From a Directional Perspective: The Significance of Directions Beyond the Dart-Throwing Motion.","authors":"Qipei Wei, Shijie Jia, Shengfang Zhang, Xiaofeng Qiao, Zhixin Wang, Chang Liu, Shanlin Chen","doi":"10.1111/os.70024","DOIUrl":"https://doi.org/10.1111/os.70024","url":null,"abstract":"<p><strong>Background: </strong>Previous studies on Activities of Daily Living (ADL) suggest that the wrist demonstrates different ranges of motion and frequencies in various directions. However, the specific directional characteristics of wrist activities remain unexplored. This study aims to investigate the directional characteristics of wrist motions during ADL with optical motion capture technology.</p><p><strong>Method: </strong>This is a basic science study. Twenty-six right-handed subjects executed 22 ADLs, with angular wrist positions tracked via retroreflective markers on the dominant limb. The Cartesian coordinate system formed by wrist flexion-extension and radial-ulnar deviation angles was transformed into a polar coordinate system, enabling the directional analysis and the calculation of the directional range of motion (ROM). The directional distribution of trajectory points was analyzed using the Rayleigh test and visualized. The values and trends of directional RoM in 72 directions for both aggregated and individual ADLs were examined. The peaks of ROMs across ADLs were clustered using K-means to identify key directions. Differences in gender and age were analyzed with a two-way ANOVA.</p><p><strong>Result: </strong>The trajectories exhibited a strong directional preference across all ADLs (p < 0.01). In the majority of ADLs, the trajectories favored the ulnar extension direction (19/22) and were distributed along the radial flexion-ulnar extension plane (12/22). ROM was calculated for each of the 72 directions in each ADL. The aggregated ADL analysis provided the directional functional ROM (fROM). Three types of ADLs were identified, each with 1, 2, and 3 peaks in their directional ROM, respectively. Three key directions were identified as clusters of peak ROMs in the ADLs. Comparisons across gender and age groups revealed varying preferences for directional ROM in each group.</p><p><strong>Conclusion: </strong>This study identified three key wrist motion directions essential for daily functions, highlighting the critical role of ulnar extension. Additionally, it demonstrated variations in directional wrist motion preferences across different genders and age groups.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Choice of Hip Arthroplasty: HRA or THA? Revealed by Meta-Analysis.","authors":"Xiao Fan, Yimin Zhou, Tianyu Zhou, Justin P Cobb, Tengbo Yu","doi":"10.1111/os.70019","DOIUrl":"https://doi.org/10.1111/os.70019","url":null,"abstract":"<p><strong>Background: </strong>Total hip arthroplasty (THA) is the gold standard for end-stage hip arthrosis, while hip resurfacing arthroplasty (HRA) is considered a more bone-conserving alternative. This meta-analysis aimed to compare the safety and clinical efficacy of HRA and THA.</p><p><strong>Methods: </strong>The databases of PubMed, EMBASE, Cochrane Library, and CNKI were searched for RCTs comparing HRA and THA in treating hip arthrosis from database initiation to April 2024. Inclusion and exclusion criteria were defined, and data extraction, quality evaluation, and risk bias assessment were performed. A meta-analysis was conducted using appropriate RevManv5.4 and Stata v14.0 software.</p><p><strong>Results: </strong>Twenty RCTs from six countries were included. HRA had a similar revision rate, function scores (WOMAC, HSS, OHS, UCLA activity score, EQ-D, EQ-5D VAS), and blood levels of cobalt and chromium compared to THA. HRA had fewer complications and less blood loss but required more operating time.</p><p><strong>Conclusions: </strong>HRA is a safe and effective alternative to THA, with similar revision and functional outcomes, less blood loss, and is particularly suitable for young male patients with a demand for high-level activities.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors and Experiences Associated With Unscheduled Hospital Readmission After Lateral Lumbar Interbody Fusion: A Case-Controlled Study.","authors":"Wangmi Liu, Feng Zhang, Yiqing Tao, Hao Li, Qixin Chen, Fangcai Li","doi":"10.1111/os.70022","DOIUrl":"https://doi.org/10.1111/os.70022","url":null,"abstract":"<p><strong>Purpose: </strong>Understanding the risk factors associated with unscheduled readmission following lateral lumbar interbody fusion (LLIF) is crucial for mitigating the occurrence of these costly events. This study aims to ascertain the incidence and factors of unscheduled hospital readmission subsequent to LLIF.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on patients who underwent LLIF at our institution from March 2016 to February 2023. Instances of unscheduled hospital readmission after LLIF were meticulously recorded, including baseline demographics, characteristics of spine pathology, surgical interventions, duration between two hospitalizations, and hospitalization costs and duration. Reasons for readmission were categorized based on their etiology. A case-control methodology was employed to compare unscheduled hospital readmission patients against planned readmission patients due to staged surgery. Parametric data were analyzed with a two-tailed T-test, nonparametric data with the Wilcoxon rank-sum test, and categorical data with the χ² test.</p><p><strong>Results: </strong>A total of 1521 patients who received LLIF at our institution were included in the study. A total of 59 patients (3.88%) were unscheduled readmitted due to adjacent segment disease (ASD), cage subsidence, the original surgical segments remaining narrow, spondylodiscitis, and pain. 51 patients (3.35%) experienced reoperation, predominantly attributable to ASD. Compared to planned readmission patients, unscheduled readmission patients tended to be younger, had a lower likelihood of having scoliosis, and were more likely to have short-segment surgery and higher initial hospitalization costs. Among unscheduled readmission patients, patients receiving short-segment surgery, as well as those who paid less during the initial hospitalization, demonstrated a higher likelihood of a 90-day readmission rate.</p><p><strong>Conclusion: </strong>Our findings indicated the heightened risks of unscheduled hospital readmission after LLIF. Taking targeted measures against these risk factors is expected to reduce the healthcare burden caused by unplanned readmissions in the future.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopic Upper Third Subscapularis Tendon Repair Using H-Loop Technique: A Case Series.","authors":"Yi-Tao Yang, Zhuo Wang, Chen-Yang Meng, Xing-Hao Deng, Yi Long, Jing-Yi Hou, Rui Yang","doi":"10.1111/os.70014","DOIUrl":"https://doi.org/10.1111/os.70014","url":null,"abstract":"<p><strong>Objective: </strong>Arthroscopic repair of upper one-third subscapularis tendon tears remains challenging due to suture management difficulties and repair quality limitations. We proposed a simpler knotless technique-the H-Loop technique. This study evaluates its early clinical and imaging outcomes.</p><p><strong>Method: </strong>This is a case series of 38 patients (9 males and 29 females), who underwent arthroscopic H-Loop technique repair for upper one-third subscapularis tendon tears between January 2021 and August 2023. Postoperative assessments include the American Shoulder and Elbow Surgeons (ASES) score, the University of California, Los Angeles (UCLA) shoulder score, the Constant-Murley score, the visual analog scale (VAS), range of motion (ROM) (internal and external rotation), and internal rotation strength. In addition, MRI (30 patients) evaluated fatty infiltration, re-tears, and subscapularis integrity, comparing tendon dimensions and signal-to-signal ratios with a control group of patients with normal subscapularis tendons.</p><p><strong>Result: </strong>Preoperative symptom duration ranged from 3 to 36 months, with an average of 9 months. Follow-up ranged from 12 to 14 months, with an average duration of 12.6 months. No complications were observed in any patient. Postoperative ASES scores increased significantly compared to preoperative scores (55.63 ± 15.85 vs. 88.92 ± 8.24), as did UCLA scores (21.82 ± 4.44 vs. 29.74 ± 3.55) and Constant-Murley scores (69.76 ± 15.30 vs. 86.34 ± 14.48). VAS scores decreased significantly (5.16 ± 1.84 vs. 0.89 ± 0.76). Postoperative ROM showed significant improvement in internal rotation (7.79 ± 2.07 vs. 8.45 ± 1.33) and external rotation (57.63° ± 15.84° vs. 66.58° ± 9.08°) (p < 0.05). Internal rotation strength ratios increased markedly (78.00% ± 15.86% vs. 91.97% ± 6.62%). MRI indicated no re-tears or fatty infiltration in the 30 patients, and compared to the control group, there were no statistically significant differences in the vertical diameter of the subscapularis muscle (62.89 mm ± 9.30 mm vs. 59.41 mm ± 7.55 mm; p = 0.153), transverse diameter of the upper subscapularis muscle (17.82 mm ± 3.79 mm vs. 19.43 mm ± 4.76 mm; p = 0.395), transverse diameter of the lower subscapularis muscle (24.09 mm ± 5.84 mm vs. 25.23 mm ± 5.41 mm; p = 0.870), cross-sectional area of the subscapularis muscle (1338.54 mm² ± 277.26 mm² vs. 1247.94 mm² ± 210.55 mm²; p = 0.098), signal-to-signal ratio of the upper subscapularis muscle (1.18 ± 0.28 vs. 1.24 ± 0.28; p = 0.792), or the signal-to-signal ratio of the lower subscapularis muscle (1.02 ± 0.24 vs. 1.03 ± 0.16; p = 0.128).</p><p><strong>Conclusion: </strong>The arthroscopic H-Loop technique significantly restores function, improves range of motion, and enhances internal rotation strength, maintaining good tendon integrity in the early postoperative period.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autonomic Nervous System in Bone Remodeling: From Mechanisms to Novel Therapies in Orthopedic Diseases.","authors":"Ruihao Xia, Hongjun Peng, Xishan Zhu, Wangdui Suolang, Steve T L Pambayi, Xiao Yang, Yi Zeng, Bin Shen","doi":"10.1111/os.70010","DOIUrl":"https://doi.org/10.1111/os.70010","url":null,"abstract":"<p><p>Recent literature has increasingly demonstrated the significant function of autonomic nerves in regulating physiological and pathological changes associated with the skeletal system. Extensive studies have been conducted to understand the contribution of the autonomic nervous system (ANS) to skeletal metabolic homeostasis and resistance to aseptic inflammation, specifically from the viewpoint of skeletal neurobiology. There have been plenty of studies on how the sympathetic nervous system (SNS) and parasympathetic nervous system (PNS), the two main branches of the ANS, regulate bone remodeling, which is the process of bone formation and resorption. The following studies have revealed critical neurological pathways that induce significant alterations in bone cell biology and uncover the intricate linkages between the ANS and the skeletal system. Furthermore, inspired by the connection between the ANS and bone remodeling, neuromodulation has been utilized as a therapeutic method for patients with orthopedic diseases: by directly influencing the ANS, it is possible to alter the excitability of nerve fibers and the release of neurotransmitters, which can lead to anti-inflammatory and analgesic effects, thereby directly or indirectly impacting bone formation and bone resorption. Our work aims to review the most recent findings on the impact of the ANS on bone remodeling, enhance the current understanding of the interaction between nerves and bones, and explore potential neuromodulation methods that could be used to treat orthopedic conditions, thereby drawing attention to the significant role of the ANS in the skeletal system.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Patellar Tracking Following Kinematic Alignment Versus Mechanical Alignment Total Knee Arthroplasty via the Mini-Subvastus Approach.","authors":"Bochen Sun, Yiyang Xu, Guiguan Wang, Long Chen, Fenqi Luo, Guoyu Yu, Yuan Lin, Jie Xu","doi":"10.1111/os.70016","DOIUrl":"https://doi.org/10.1111/os.70016","url":null,"abstract":"<p><strong>Objectives: </strong>Different alignment strategies (kinematic alignment [KA] versus mechanical alignment [MA]) during total knee arthroplasty (TKA) significantly influence postoperative patellar tracking. This study aimed to compare radiological parameters of patellar tracking and clinical outcomes between KA-TKA and MA-TKA via the mini-subvastus approach.</p><p><strong>Methods: </strong>This prospective randomized controlled study included 234 patients who underwent KA-TKA and MA-TKA from January 2022 to October 2023. The preoperative and postoperative patellar tilt, lateral patellar shift, knee society score (KSS), oxford knee score (OKS), and intraoperative patellar lateral retinacular release (LRR) rate were measured. In addition, radiological parameters and clinical outcomes were compared between the LRR and non-LRR groups. Independent samples t test and chi-square test were used to compare the differences between groups.</p><p><strong>Results: </strong>Two-hundred and thirty-four patients were followed up for 12 months post-TKA. No significant differences were observed between the two groups in terms of the demographics and pre- or post-operative radiological parameters of patellar tracking (p > 0.05). The postoperative KSS and OKS were significantly higher in the KA group than in the MA group (p < 0.05). The LRR rate was 6.7% (8/120) in the KA group and 25.4% (29/114) in the MA group, and the difference was statistically significant (x² = 15.476, p < 0.001). The preoperative patella tilt and lateral patellar shift were greater in the LRR group (p < 0.001) and the postoperative OKS was lower (p < 0.05).</p><p><strong>Conclusions: </strong>KA-TKA via the mini-subvastus approach can achieve both good patellar tracking and clinical outcomes. Avoiding muscle damage and refraining from excessive soft tissue release are crucial to improving postoperative patient comfort. In our opinion, KA-TKA via the mini-subvastus approach may be a more suitable surgical option.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterolateral Tibial Plateau Fractures in Adult Anterior Cruciate Ligament Avulsion Effect on Postoperative Knee Function.","authors":"Bin Feng, Jian Peng, Weizhi Ren, Zhenghui Hu, Jiawei Ouyang, Wei Xu","doi":"10.1111/os.70015","DOIUrl":"https://doi.org/10.1111/os.70015","url":null,"abstract":"<p><strong>Background: </strong>The impact of posterior lateral tibial plateau fractures (PLTPFs) on knee joint stability after anterior cruciate ligament (ACL) reconstruction has garnered widespread attention. However, limited literature exists on the co-occurrence of ACL tibial avulsion fractures (ACLAFs) and PLTPFs. The objective of this study is to investigate the prevalence of PLTPFs in adult ACLAF patients and assess the impact of concurrent PLTPFs on postoperative knee function.</p><p><strong>Methods: </strong>This retrospective study analyzed adults, who underwent arthroscopic surgery for ACLAF at our institution between January 2016 and January 2022. Demographic and preoperative/postoperative imaging data were collected, focusing on meniscus and ligament injuries, Segond fractures, PLTPFs, and tibial plateau slope. Patients were grouped into isolated ACLAF (I-ACLAF) and ACLAF with concurrent PLTPFs (ACLAF-PLTPF). The ACLAF-PLTPF group was further divided into Group A (PLTPFs not exceeding the anterior edge of the lateral meniscus posterior horn) and Group B (PLTPFs exceeding this edge). Clinical outcomes were evaluated using International Knee Documentation Committee and Tegner scores. The study also examined the morphology of PLTPFs and their specific affected areas. Statistical analysis was performed using the Mann-Whitney U tests for continuous variables and Fisher's exact tests for categorical variables.</p><p><strong>Results: </strong>The study included 62 patients with a mean follow-up of 41 ± 17 months. Among these, 71.0% (44/62) patients with ACLAF also had PLTPFs. The ACLAF-PLTPF group showed a significantly steeper lateral tibial plateau slope than the I-ACLAF group (10.86° ± 5.47° vs. 7.17° ± 3.68°, p = 0.011). Segond fractures were present in 22.7% of the ACLAF-PLTPF group, compared to none in the I-ACLAF group (p = 0.027). IKDC and Tegner scores were lower in the ACLAF-PLTPF group (80.7 ± 5.2 and 4, respectively) than in the I-ACLAF group (87.4 ± 6.4 and 4.5, respectively), with statistical significance (p < 0.001 and p = 0.008, respectively). Older age correlated with a greater extent of concurrent PLTPFs (p = 0.038). Additionally, Patients in Group B exhibited a significantly higher incidence of meniscal injury (22.2% vs. 53.8%, p = 0.036) and poorer postoperative knee joint function compared to those in Group A (IKDC 82.3 ± 2.8 vs. 78.5 ± 5.6, p = 0.013). More extensive PLTPFs were linked to increased fracture collapse and a higher rate of lateral meniscus injuries.</p><p><strong>Conclusion: </strong>PLTPFs demonstrated a high prevalence in adults with ACLAF. Additionally, the ACLAF-PLTPF cohort frequently showed reduced postoperative knee function. Simultaneous management of severe concomitant PLTPFs may improve long-term outcomes in patients with ACLAF.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}