The Journal of Bone & Joint Surgery最新文献

{"title":"Differences in Practice Patterns in the Use of Temporary External Fixation for the Management of Open Lower-Extremity Fractures.","authors":"Augustine M Saiz,Christina A Stennett,Nicholas M Romeo,Kevin D Phelps,Joshua L Gary,Christopher M Domes,Mark J Gage,Nathan N O'Hara,Sheila Sprague,Gerard P Slobogean,Stephen J Warner,","doi":"10.2106/jbjs.24.01250","DOIUrl":"https://doi.org/10.2106/jbjs.24.01250","url":null,"abstract":"BACKGROUNDExternal fixation is often used in the management of open lower-extremity fractures. The objectives of this study were to identify hospital characteristics that are associated with greater use of temporary external fixation and to determine if external fixation reduces the odds of surgical site infection (SSI) and unplanned reoperation among patients with open lower-extremity fractures.METHODSThis is a secondary analysis of the Aqueous-PREP and PREPARE-Open trials involving open lower-extremity fractures. Wilcoxon rank-sum and Fisher exact tests were used to assess if temporary external fixation use varied between hospital clusters. Mixed-effects logistic regression models controlling for hospital cluster and participant characteristics estimated the associations between temporary external fixation and SSI or unplanned reoperation.RESULTSThere were 2,438 patients with an open lower-extremity fracture identified, with 568 (23.3%) undergoing temporary external fixation. There were 34 participating hospitals with a median external fixation rate of 21.5%. Hospitals with higher temporary external fixation use had a higher number of surgeons treating patients with fracture (p = 0.02). There was no difference in SSI at 90 days (odds ratio [OR], 1.16 [95% confidence interval (CI), 0.82 to 1.66]; p = 0.40) or 1 year (OR, 1.30 [95% CI, 0.97 to 1.75]; p = 0.08) between patients who did and did not undergo temporary external fixation. Patients who underwent temporary external fixation were more likely to have unplanned reoperations within 1 year (OR, 1.40 [95% CI, 0.96 to 1.79]; p = 0.05).CONCLUSIONSMore temporary external fixation for open lower-extremity fractures was performed at hospitals with more surgeons treating fractures. There was no difference in SSI at 90 days or 1 year between patients who did and did not undergo temporary external fixation. Temporary external fixation tended to be used in more critically ill patients and patients with more severe fractures but was not associated with increased unplanned reoperations at 90 days or at 1 year.LEVEL OF EVIDENCETherapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"15 1","pages":"43-50"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319934","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":"A Renewed Sense of Optimism: A Brave New World of Biologics in Orthopaedics: Commentary on an article by Ding Xu, MD, PhD, et al.: \"Muscle-Derived Mitochondria as a Novel Therapy for Muscle Degeneration After Rotator Cuff Tears\".","authors":"Ian J Whitney","doi":"10.2106/jbjs.25.00246","DOIUrl":"https://doi.org/10.2106/jbjs.25.00246","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"600 1","pages":"e68"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320207","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":"Impact of Living in a Food Desert on Complications After Fracture Surgery.","authors":"I Leah Gitajn,Joseph D Phillips,Yinzhou Wang,Christina A Stennett,Gerard Chang,Nathan N O'Hara,Devon T Brameier,Arvind G von Keudell,Michael J Weaver,Gregory J Della Rocca,Holly T Pilson,Patrick F Bergin,Sheila Sprague,Gerard P Slobogean,","doi":"10.2106/jbjs.24.01184","DOIUrl":"https://doi.org/10.2106/jbjs.24.01184","url":null,"abstract":"BACKGROUNDFood deserts-communities with limited access to healthy food-have been linked with poor surgical outcomes; however, their impact on orthopaedic trauma outcomes remains unknown. The aims of this study were to determine the prevalence of food desert residency among orthopaedic trauma patients and to investigate the impact of food desert residency on the rate of unplanned reoperation with use of a large, high-quality, prospectively collected dataset with adjudicated outcomes. We hypothesized that orthopaedic trauma patients would reside in food deserts at a higher rate than the general U.S. population and that living in a food desert would be independently associated with an increased rate of unplanned reoperation.METHODSWe included all patients from the Aqueous-PREP and PREPARE trials who had documented ZIP codes. The primary outcome was unplanned reoperation within 1 year, and the secondary outcomes included the reasons for reoperation. Residing in a food desert was the independent variable and was defined by the United States Department of Agriculture (USDA). Census tracts were converted to ZIP codes in order to assign food access for an individual's residence with use of the USDA Food Access Research Atlas.RESULTSOf the 2,607 patients included, 1,453 (55.7%) lived in a ZIP code containing a food desert compared with 49% of the U.S. population. Patients residing in a food desert were 42% female, 26.6% non-White, and 64% employed prior to injury, whereas patients not residing in a food desert were 41% female, 15% non-White, and 63% employed prior to injury, all of which was collected via patient self-report. Multivariable analysis demonstrated that living in a food desert was independently associated with 40% higher odds of unplanned reoperation (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.06 to 1.85; p = 0.019). This was driven by reoperation for delayed union or nonunion (OR, 1.75; 95% CI, 1.19 to 2.57; p = 0.004) and reoperation for a wound-healing complication (OR, 1.60; 95% CI, 1.01 to 2.54; p = 0.044).CONCLUSIONSThis study found a strong association between residing in a ZIP code containing a food desert and an increased rate of unplanned reoperation, which was primarily driven by delayed union or nonunion and wound-healing complications. Addressing nutritional deficiencies in this population may help to effectively triage the use of health-care resources. Further research should focus on clarifying specific deficiencies and assessing the effectiveness of targeted interventions.LEVEL OF EVIDENCEPrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"51 1","pages":"60-70"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319933","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":"Skin Antisepsis in the Surgical Treatment of Extremity Fractures: Should We Reject the Null Hypothesis?","authors":"Iberê Pereira Datti","doi":"10.2106/jbjs.25.00202","DOIUrl":"https://doi.org/10.2106/jbjs.25.00202","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"44 1","pages":"1403-1404"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320208","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":"Antibiotic Holiday in 2-Stage Exchange for Periprosthetic Joint Infection: A Scoping Review.","authors":"Andrew Fraval,Daniel Gould,Mehmet Kursat Yilmaz,Alex Soriano,Javad Parvizi","doi":"10.2106/jbjs.24.01275","DOIUrl":"https://doi.org/10.2106/jbjs.24.01275","url":null,"abstract":"BACKGROUNDThe use of a 2-stage exchange remains a common management strategy for periprosthetic joint infection (PJI). The use of an \"antibiotic holiday\" before the second stage to confirm the clearance of infection is often employed, but there is little evidence to guide this practice. The aim of this review was to systematically map the literature reporting on the use of an antibiotic holiday as part of a 2-stage revision for chronic PJI and to answer the question: is there a role for an antibiotic holiday in patients undergoing 2-stage exchange arthroplasty for PJI?METHODSGiven the heterogeneity of the literature on this topic, a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant scoping review was conducted. Two reviewers developed and refined the search strategy and study eligibility criteria and pilot-tested the data charting form prior to data extraction. Data were analyzed descriptively.RESULTSThree databases were screened, with 504 full-text articles retrieved for review after screening 2,579 titles and abstracts. Of these, 243 were included for data charting. Most studies (238 of 243; 97.9%) were case series, and the remaining 5 (2.1%) were cohort studies that incorporated a direct comparison between continuous therapy and an antibiotic holiday. Most case series (202 of 238; 84.9%) utilized an antibiotic holiday. The proportion of patients who experienced treatment failure in the continuous therapy group (271 of 2,074 patients; 13.1%) was lower than that in the antibiotic holiday group (2,843 of 17,329 patients; 16.4%; p < 0.001). There was a greater proportion of studies with a between-stage interval of <3 months among case series utilizing continuous antibiotic therapy (66.7%) compared with those utilizing an antibiotic holiday (27.2%; p < 0.001).CONCLUSIONSThere is no proven superiority of an antibiotic holiday during a 2-stage exchange to treat chronic PJI. Due to the need to extend the duration of the interval between the first and second stages in order to accommodate an antibiotic holiday, patients may be subjected to unnecessary prolongation of their treatment duration without an improvement in outcome.LEVEL OF EVIDENCETherapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"132 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145914","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":"Immediate Weight-Bearing Compared with Non-Weight-Bearing After Operative Ankle Fracture Fixation: Results of the INWN Pragmatic, Randomized, Multicenter Trial.","authors":"Ramy Khojaly,Fiachra E Rowan,Vinay Shah,Matthew Nagle,Muhammad Shahab,Amir Sohaib Ahmad,Darren Dahly,Colm Taylor,Ruairí Mac Niocaill,May Cleary","doi":"10.2106/jbjs.24.00965","DOIUrl":"https://doi.org/10.2106/jbjs.24.00965","url":null,"abstract":"BACKGROUNDThere has been weak consensus and a paucity of robust literature with regard to the best postoperative weight-bearing and immobilization regime for operatively treated ankle fractures. This trial compared immediate protected weight-bearing (IWB) with non-weight-bearing (NWB) with cast immobilization following ankle fracture fixation (open reduction and internal fixation [ORIF]), with a particular focus on functional outcomes, complication rates, and cost utility.METHODSThis INWN (Is postoperative Non-Weight-bearing Necessary?) study was a prospective, pragmatic, randomized controlled trial (RCT), with participants allocated in a 1:1 ratio to 1 of 2 parallel groups. IWB from postoperative day 1 in a walking boot was compared with NWB and immobilization in a cast for 6 weeks, following ORIF of all standard types of unstable ankle fractures. Skeletally immature patients and patients with tibial plafond fractures were excluded. The type of surgical fixation was at the surgeon's discretion. Patients were randomized postoperatively by an operating room nurse using computerized block randomization (20 patients per block). Surgeons were blinded until after the operation. The study was multicenter and included 2 major orthopaedic centers in Ireland. Analysis was performed on an intention-to-treat basis. The primary outcome was the functional outcome assessed by the Olerud-Molander Ankle Score (OMAS) at 6 weeks. A cost-utility analysis via decision tree modeling was performed to derive an incremental cost-effectiveness ratio (ICER).RESULTSWe recruited 160 patients between January 1, 2019, and June 30, 2020, with 80 patients per arm, who were 15 to 94 years of age (mean age, 45.5 years), and 54% of patients were female. The IWB group demonstrated a higher mean OMAS at 6 weeks (43 ± 24 for the IWB group and 35 ± 20 for the NWB group, with a mean difference of 10.4; p = 0.005). The complication rates were similar in both groups, including surgical site infection, wound dehiscence, implant removal, and further operations. Over a 1-year horizon, IWB was associated with a lower expected cost (€1,027.68) than NWB (€1,825.70) as well as a higher health benefit (0.741 quality-adjusted life-year [QALY]) than NWB (0.704 QALY). IWB dominated NWB, yielding cost savings of €798.02 and a QALY gain of 0.04.CONCLUSIONSIWB in a walking boot following ankle fracture fixation demonstrated superior functional outcomes, greater cost savings, earlier return to work, and similar complication rates compared with NWB in a cast for 6 weeks. These findings support the implementation of IWB as the routine mobilization protocol following ankle fracture fixation.LEVEL OF EVIDENCETherapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144130704","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 Effect of Traction and Spinal Cord Morphology on Intraoperative Neuromonitoring Alerts in Adolescent Idiopathic Scoliosis.","authors":"William J Hadden,Evan Fene,Lydia Klinkerman,Yuhan Ma,Chanhee Jo,Michelle R Christie,Jaysson T Brooks,Charles Johnston,Megan Johnson","doi":"10.2106/jbjs.24.01353","DOIUrl":"https://doi.org/10.2106/jbjs.24.01353","url":null,"abstract":"BACKGROUNDPatients with apical spinal cord deformity have been shown to be at a greater risk for intraoperative neuromonitoring (IONM) alerts when undergoing posterior spinal instrumented fusion (PSF) for adolescent idiopathic scoliosis (AIS). The use of intraoperative traction during deformity correction has also been associated with an increased risk of IONM alerts. With use of the Spinal Cord Shape Classification System (SCSCS), we investigated the interaction between spinal cord type and the use of intraoperative traction and their impact on IONM alerts during the surgical correction of AIS.METHODSA total of 441 consecutive patients who underwent PSF or combined PSF plus anterior spinal fusion (ASF) for AIS between 2003 and 2022 were retrospectively reviewed. Those with major thoracic curves of ≥70° and available preoperative magnetic resonance images (MRIs) were included. Charts were reviewed for IONM alerts and the use of intraoperative traction. Spinal cord morphology was determined using the SCSCS. A multivariable regression model was used to assess the risk factors for an IONM alert.RESULTSPreoperative MRIs were available for 102 patients. Type-3 cords were present in 15 (14.7%) of the 102 patients. Intraoperative traction was used in 15 (14.7%) of the 102 patients, including 5 with type-3 cords. Patients with type-3 cords were more likely to have an IONM alert than those with type-1 or 2 cords (40.0% [type 3] versus 12.6% [type 1 or 2]; odds ratio [OR], 4.60; 95% confidence interval [CI], 1.34 to 15.53). No such difference was observed between patients with type-1 cords and those with type-2 cords (12.5% and 12.7%, respectively; p > 0.9999). All patients with type-3 cords placed in intraoperative traction experienced IONM alerts, whereas only 10% of patients with type-3 cords not placed in traction experienced such alerts (p = 0.002). Multivariable regression modeling revealed intraoperative traction to be the only independent risk factor for an IONM alert (OR, 9.37; 95% CI, 2.47 to 38.24).CONCLUSIONSThis study demonstrated that 14.7% of patients with AIS and curves of ≥70° had a type-3 cord. Intraoperative traction carried a ninefold increased risk of an IONM alert. When intraoperative traction is used for type-3 cords, surgeons should expect IONM alerts to occur. The SCSCS can be condensed into 2 groups for a pediatric population.LEVEL OF EVIDENCEPrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"142 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144130703","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":"Surgical Correction of Severe Scoliosis Leads to Changes in Central Airway Resistance Evaluated with CT-Based 3D Reconstruction and Impulse Oscillometry.","authors":"Hanwen Zhang,Yong Hai","doi":"10.2106/jbjs.24.01434","DOIUrl":"https://doi.org/10.2106/jbjs.24.01434","url":null,"abstract":"BACKGROUNDPrevious studies have not compared airway resistance and morphological parameters before and after the treatment of severe scoliosis. In the present study, 3-dimensional (3D) computed tomographic (CT) reconstruction and impulse oscillometry (IOS) were used to evaluate the changes in airway dilation and airway resistance caused by posterior spinal fusion for the treatment of severe kyphoscoliosis.METHODSThirty-four patients with severe scoliosis (Cobb angle, >100°) underwent posterior spinal fusion. Preoperative and postoperative evaluations included CT scans, radiographic assessment, and IOS. Changes in bronchial dilation were evaluated with use of 3D CT reconstruction, and changes in airway resistance were evaluated with use of IOS. Differences were assessed with use of 2-tailed paired Student t tests, and correlations were evaluated with use of the Spearman rank test.RESULTSNearly all spinal radiographic measurements improved after posterior spinal fusion. The mean Cobb angle was 133.21° ± 22.15° preoperatively and 50.92° ± 13.37° postoperatively (p < 0.001). The mean thoracic kyphosis angle was 121.42° ± 32.42° preoperatively and 50.67° ± 5.21° postoperatively (p < 0.001). The IOS measurements improved, with the reactance at 20 Hz (R20) decreasing from 0.4029 ± 0.0747 to 0.3100 ± 0.0837 kPa/(L/s) (p = 0.0004). Following posterior spinal fusion, the trachea, left main bronchus, and right main bronchus expanded. Moreover, the diameter and lumen area of the trachea were moderately correlated with R20 (r = -0.5071, p = 0.0114; r = -0.5537, p = 0.0050) and the diameter and lumen area of the right main bronchus were correlated with R20 (r = -0.5583, p = 0.0056; r = -0.6389, p = 0.0008). R20 and the lumen area of the trachea were correlated with the thoracic kyphosis angle (r = 0.6394, p = 0.0004; r = -0.6160, p = 0.0023).CONCLUSIONSPosterior spinal fusion can safely and effectively improve the curve and relieve airway obstruction in patients with severe scoliosis. Impulse oscillometry analysis suggested that R20 substantially increased after posterior spinal fusion, primarily because of altered central airway enlargement as measured with CT reconstruction.LEVEL OF EVIDENCETherapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144130706","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":"Three Hundred Periprosthetic Tibial Fractures Around a Total Knee Replacement: Classification and Outcomes from a Single Institution.","authors":"Evan M Dugdale,Thomas D Alter,Michael J Stuart,Stephen A Sems,Brandon J Yuan,Mark J Spangehl,Bryan D Springer,Daniel J Berry,Matthew P Abdel","doi":"10.2106/jbjs.24.01407","DOIUrl":"https://doi.org/10.2106/jbjs.24.01407","url":null,"abstract":"BACKGROUNDPeriprosthetic tibial fractures around a total knee replacement (TKR) remain challenging to manage, with little published information for guidance. The purpose of this study was to review the types, management techniques, and outcomes of periprosthetic tibial fractures in the largest series to date.METHODSWe identified 300 periprosthetic tibial fractures (285 patients) around a TKR (43% in primary TKRs and 57% in revision TKRs) sustained between 1996 and 2020. Fractures were classified according to Felix et al. as Type I (tibial plateau), Type II (adjacent to stem), Type III (distal to stem), or Type IV (tibial tubercle), with subtypes A (well-fixed component), B (loose component), and C (intraoperative fracture). Of the fractures in this study, 53% were Type I, 24% were Type II, 16% were Type III, and 8% were Type IV. A total of 46% of fractures occurred intraoperatively, and 54% of fractures occurred postoperatively (61% subtype A, 39% subtype B). The mean patient age at fracture was 67 years, and 64% of patients were female. The mean follow-up was 6 years.RESULTSThe intraoperative fracture incidence was 1.40% in revision TKRs and 0.10% in primary TKRs. Among intraoperative fractures, the 2-year survivorship free from tibial component revision was highest in Type I (100%) and lowest in Type IV (67%) (p < 0.001). For postoperative fractures, the 2-year survivorship free from any reoperation was 29% and the 2-year survivorship free from tibial component revision was 51%. Type-I postoperative fractures had the lowest 2-year survivorship free from tibial component revision (10%), whereas Type-III fractures had the highest survivorship (88%) (p < 0.001).CONCLUSIONSIntraoperative periprosthetic fracture of the tibia was fourteenfold more likely in revision TKRs compared with primary TKRs. Among all intraoperative fractures, Type-I fractures were well-tolerated, with 100% survivorship free from tibial component revision at 2 years. Conversely, Type-I postoperative fractures had only 10% survivorship at 2 years.LEVEL OF EVIDENCETherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"133 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144130709","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 Effect of Implant Constraint and Ligament Repair on Compartment Balancing After Medial Collateral Ligament Injury in TKA.","authors":"Alirio J deMeireles,Mouhanad M El-Othmani,Thomas R Gardner,Hui Zhang,Nana O Sarpong,Carl L Herndon,Roshan P Shah,H John Cooper,Jeffrey A Geller,Alexander L Neuwirth","doi":"10.2106/jbjs.24.01327","DOIUrl":"https://doi.org/10.2106/jbjs.24.01327","url":null,"abstract":"BACKGROUNDAn intraoperative midsubstance injury to the medial collateral ligament (MCL) is a devastating complication of total knee arthroplasty (TKA). No single treatment method has been shown to yield optimal stability. This cadaveric study compared primary MCL repair, increasing prosthetic constraint, and a combination of both techniques on tibiofemoral compartment gapping after an iatrogenic MCL injury.METHODSWe performed 16 cadaveric, robotic-assisted TKAs (CORI; Smith+Nephew) and recorded tibiofemoral gap measurements at 10°, 30°, 60°, and 90° of flexion with a posterior-stabilized (PS) prosthesis as the control group. The experimental groups had no MCL repair and a PS component, no MCL repair and a varus-valgus constrained (VVC) component, MCL repair with a PS component, and MCL repair with a VVC component. The MCL was repaired with 2 figure-8 nonabsorbable sutures. Gap measurements were manually tensioned by the same surgeon for all specimens. The mean medial tibiofemoral gap with the 3 different methods of interest (the no MCL repair with VVC component group, the MCL repair with PS component group, and the MCL repair with VVC component group) was compared with the control group for the rate of deficit (RD) and was compared with the no MCL repair and PS component group for the rate of improvement (RI). Simple statistics were used to calculate the mean medial balance for the groups, and analysis of variance (ANOVA) modeling was used to determine the mean changes in RD and RI, with significance set at p < 0.05.RESULTSThe mean RD was highest for the no MCL repair with PS component group at 621.13%, demonstrating an approximately 6-fold increase in medial tibiofemoral gapping compared with the control group. This was followed by the no MCL repair with VVC component group at 93.02%, the MCL repair with PS component group at 65.66%, and the MCL repair with VVC component group at 20.01% (p < 0.001). The mean RI for the MCL repair with VVC component group was highest at 83.08%, meaning that the combination of VVC component and MCL repair resulted in an 83% improvement in medial tibiofemoral gapping from no MCL repair with PS component. This was followed by the MCL repair with PS component group at 76.62% and the no MCL repair with VVC component group at 72.95% (p < 0.001).CONCLUSIONSThis cadaveric study demonstrates that primary MCL repair with VVC component was the best for minimizing the deficit after an MCL injury and provided the highest RI. MCL repair with PS component and no MCL repair with VVC component were less effective reconstructive choices. This study supports the combination of a simple MCL repair with VVC component as the most stable reconstructive option following an intraoperative MCL injury.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144130712","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}