Bone & Joint Open最新文献

{"title":"CT-RSA with induced displacement used for assessment of aseptic loosening of distal femur reconstructions with megaprostheses in patients reporting pain.","authors":"Christina Berger, Bita Sharegi, John Hutchins, Olof Sandberg, Helena Brisby","doi":"10.1302/2633-1462.79.BJO-2026-0094.R1","DOIUrl":"10.1302/2633-1462.79.BJO-2026-0094.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to evaluate the relationship between experienced pain and findings of suspected pathological movement on CT-radiostereometric analysis (RSA) with induced displacement.</p><p><strong>Methods: </strong>Patients with reported pain after distal femur reconstruction with a megaprosthesis between January 2000 and December 2022 indicated the pain they experienced at rest and during activity using a visual analogue scale (VAS) and a pain drawing. Two consecutive CT scans with induced displacement were performed for each patient. The translational and rotational movement between bone and implant in the tibia and femur were calculated and compared with reported pain location and type at rest and during activity.</p><p><strong>Results: </strong>A total of 12 patients were examined; ten had measured movement above the preset cutoff values for pathological movement in either femur, tibia, or both. A large inter-patient variability in translation and rotation was found. The movements for the femur components were up to 3.46 mm/1.14° (translation/rotation). For the tibia components, these values were 2.16 mm/2.95°. Overall, six of 12 patients reported a severe type of pain. All six had a suspected loose implant at the location marked on their pain drawing. Six of 12 patients had a > 30 mm difference on VAS between rest and activity; five of those six had a suspected loose implant according to CT-RSA.</p><p><strong>Conclusion: </strong>CT-RSA with induced displacement appears useful for diagnosing suspected pathological movements in megaprosthesis implants. Pain locations on drawings seem to match detected suspected loose implants. Further studies with repeated CT-RSA examinations are needed to establish reliable cutoff values and assist decisions on revision surgery.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 9","pages":"1187-1193"},"PeriodicalIF":3.3,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intramedullary nailing compared with primary total hip arthroplasty for pertrochanteric fractures in autonomous elderly patients : a prospective randomized study.","authors":"Antoine Piercecchi, Alice Bordet, Ludovic Labattut, Alexandre Maczynski, Emmanuel Baulot, Pierre Martz","doi":"10.1302/2633-1462.79.BJO-2026-0142.R1","DOIUrl":"10.1302/2633-1462.79.BJO-2026-0142.R1","url":null,"abstract":"<p><strong>Aims: </strong>The optimal surgical strategy for pertrochanteric fractures in elderly patients remains debated. While intramedullary nailing is the standard of care, primary total hip arthroplasty (THA) has been proposed to enhance early recovery. This study compared functional outcomes, complications, and survival between both techniques in autonomous elderly patients.</p><p><strong>Methods: </strong>This monocentric randomized controlled trial was conducted between January 2015 and October 2017. Patients aged ≥ 70 years with pertrochanteric fractures and a pre-fracture Parker score ≥ 5 (indicating outdoor walking ability) were randomized to intramedullary nailing (n = 35) or cementless dual-mobility THA with trochanteric fixation (n = 34). Immediate full weightbearing was allowed in both groups. Functional outcomes were assessed at six weeks, six months, and 12 months using the Harris Hip Score (HHS), Postel-Merle d'Aubigné score, Parker mobility score, and visual analogue scale for pain. The primary endpoint was HHS at six months. Mortality, complications, and long-term survival were recorded.</p><p><strong>Results: </strong>A total of 69 patients were analyzed. At six months, the mean HHS was 85.7 (SD 11.2) in the osteosynthesis group and 82.5 (SD 10.7) in the THA group (p = 0.291). Functional recovery, autonomy, and pain were comparable up to 12 months. Operating time was longer in the THA group (p < 0.001), while complication rates were similar. One-year mortality was 21.7% with no between-group difference. At a median follow-up of 4.1 years, 80% of patients had died. Kaplan-Meier analysis showed no difference in overall survival (p = 0.953). No secondary conversion to arthroplasty occurred.</p><p><strong>Conclusion: </strong>No clinically meaningful difference in functional outcomes or overall survival was detected. The observed HHS difference (3.2 points) fell below our a priori threshold and well below the closest available minimal clinically important difference estimate. In the absence of a detectable functional or survival benefit, routine primary THA does not appear justified in this population.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 9","pages":"1178-1186"},"PeriodicalIF":3.3,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can you FORCE research implementation? A PERUKI survey to evaluate knowledge translation of the FORCE study.","authors":"Marianne Jenkins, Jack F Bennett, Damian Roland, Daniel C Perry","doi":"10.1302/2633-1462.79.BJO-2025-0298.R1","DOIUrl":"10.1302/2633-1462.79.BJO-2025-0298.R1","url":null,"abstract":"<p><strong>Aims: </strong>To assess the uptake of the Forearm Fracture Recovery in Children Evaluation (FORCE) trial findings into clinical practice, and to identify the influence of targeted dissemination tools on implementation.</p><p><strong>Methods: </strong>A cross-sectional electronic survey was distributed via the Paediatric Emergency Research in the UK and Ireland (PERUKI) network. The survey captured data on clinician awareness of the FORCE trial, current management of paediatric torus fracture, the use of dissemination materials, and perceived barriers and enablers to implementation.</p><p><strong>Results: </strong>A total of 113 responses were analyzed. Most respondents (84.5%) were aware of the FORCE trial. Following publication of the findings, 54.0% reported managing torus fractures in line with trial recommendations - offering a soft bandage or no immobilization, compared with 1.8% prior to the trial. Clinicians involved in delivering the trial were significantly more likely to adopt the recommended management (p = 0.021) and follow-up approach (p = 0.004). Of respondents, 43.4% reported encountering barriers to implementation, the most common being colleague or parent expectations. Peer-to-peer influence (40.8%) and the use of FORCE dissemination tools (38.8%) were the most frequently cited enablers. Among those using the dissemination tools, 79.5% implemented the recommended management compared with 18.2% who did not (p < 0.001).</p><p><strong>Conclusion: </strong>The findings of the FORCE trial have been adopted across paediatric Emergency Departments in the UK, representing a substantial shift from pretrial practice. Active involvement in research, peer influence, and practical dissemination tools were key drivers of this change. Publication alone appeared insufficient; implementation required engagement, ownership, and resources designed for real-world use. When these were present, practice changed most consistently - supporting the theory that you can FORCE research implementation.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 9","pages":"1172-1177"},"PeriodicalIF":3.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implant size distribution and mid-term outcomes of transfibular total ankle arthroplasty in a Japanese cohort.","authors":"Koichiro Yano, Katsunori Ikari, Takumi Koseki, Ayako Tominaga, Ken Okazaki","doi":"10.1302/2633-1462.79.BJO-2026-0177.R1","DOIUrl":"10.1302/2633-1462.79.BJO-2026-0177.R1","url":null,"abstract":"<p><strong>Aims: </strong>Total ankle arthroplasty (TAA) is a widely accepted alternative to ankle arthrodesis for end-stage ankle arthritis. Preserving ankle motion is particularly relevant in Japanese populations, in which kneeling and squatting are integral to routine activities. However, Japanese individuals generally have smaller bone morphology than Western patients, raising concerns regarding the suitability of implant size variations originally designed for Western populations. This study aimed to examine implant size distribution, clinical and radiological outcomes, and implant survival rate following transfibular TAA in a Japanese cohort.</p><p><strong>Methods: </strong>This retrospective analysis included 50 patients (51 ankles) who underwent transfibular TAA between March 2019 and October 2022 with three or more more years of follow-up (mean 4.3 years (3.0 to 6.0, SD 0.9)). Clinical outcomes were evaluated preoperatively and at three, six, 12, and 24 months postoperatively, and at final follow-up using the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and ankle range of motion. Radiological assessment comprised the lateral distal tibial angle, anterior distal tibial angle, tibiotalar angle, and tibiotalar ratio. Complications and implant survival were analyzed using Kaplan-Meier curves, with implant removal as the endpoint.</p><p><strong>Results: </strong>Smaller implant sizes predominated, with size 2 (33.3%) and size 3 (37.3%) used most frequently; no patients required size 5 or 6. All SAFE-Q domains improved significantly from baseline, with mean changes exceeding the minimal clinically important difference. Range of motion increased by three months postoperatively and subsequently stabilized. Radiological parameters demonstrated satisfactory alignment and reduced coronal variance. Delayed wound healing occurred in 15.7% and medial malleolar fractures in 9.8%; all cases achieved bone union without additional intervention. Implant survival rate was 98.0% at three years and 95.5% at four years.</p><p><strong>Conclusion: </strong>Transfibular TAA produced favourable mid-term clinical, radiological, and survival outcomes in Japanese patients. The available implant size range adequately accommodated the smaller ankle morphology typical of Japanese patients. These findings may inform implant development and preoperative planning for populations with similar anatomical characteristics.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 9","pages":"1163-1171"},"PeriodicalIF":3.3,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interlocking plate compared with conventional pin fixation for undisplaced femoral neck fractures: a randomized controlled trial with radiostereometric analysis.","authors":"Magnus Høgevold, Michaela Manalili Hansen, Jan Egil Brattgjerd, Stephan Maximillian Röhrl","doi":"10.1302/2633-1462.79.BJO-2026-0008.R1","DOIUrl":"10.1302/2633-1462.79.BJO-2026-0008.R1","url":null,"abstract":"<p><strong>Aims: </strong>In undisplaced femoral neck fractures, fixation failure remains a concern. In vitro studies suggest that interlocking plates increase torsional stability. However, whether this leads to clinically relevant improvement in fixation stability in vivo remains unclear. Accordingly, we tested whether interlocking plate fixation provides increased in vivo fixation stability over 52 weeks in undisplaced femoral neck fractures.</p><p><strong>Methods: </strong>Having been recruited from the Emergency Departments of two hospitals between May 2016 and January 2019, patients were randomized to Hansson pin fixation (n = 12) or Hansson Pinloc plate fixation (n = 13). Postoperative fracture motion was quantified using radiostereometric analysis (RSA) at baseline and at four, 12, 26, and 52 weeks. Clinical outcomes (Harris Hip Score, EuroQol five-dimension (EQ-5D) questionnaire, Timed Up and Go test, and pain and satisfaction using the Numeric Rating Scale) were assessed at the same timepoints. Data were analyzed using linear mixed model to account for missing RSA points.</p><p><strong>Results: </strong>A total of 17 patients completed the 52-week follow-up. The Pinloc group showed a smaller mean total rotation than the pin group, with a mean difference of -7.77° (95% CI -13.27° to -2.28°; p = 0.006) at 52 weeks. The groups diverged significantly in torsional stability at 12 weeks, with a larger between-group difference during follow-up. No between-group differences were observed in total translation or clinical outcomes. Five patients required reoperation: three in the Pinloc group and two in the pin group. Avascular necrosis occurred in three patients. Sub-trochanteric fractures occurred in two patients, both in the Pinloc group.</p><p><strong>Conclusion: </strong>Interlocking plate fixation resulted in increased torsional stability compared with pin fixation during healing of undisplaced femoral neck fractures, consistent with previous in vitro studies. The clinical implications of this finding remain uncertain.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 9","pages":"1154-1162"},"PeriodicalIF":3.3,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the association between insulin dependence and the incidence of postoperative complications, perioperative glucose control, and five-year reoperation rates after total joint replacement?","authors":"Justin Wong, Jonathan Umelo, Gabriel Ramirez, Thomas G Myers, John G Ginnetti, Caroline P Thirukumaran, Benjamin F Ricciardi","doi":"10.1302/2633-1462.79.BJO-2026-0056.R1","DOIUrl":"10.1302/2633-1462.79.BJO-2026-0056.R1","url":null,"abstract":"<p><strong>Aims: </strong>Diabetes mellitus (DM) is associated with adverse outcomes following total hip arthroplasty (THA) and total knee arthroplasty (TKA), yet optimal perioperative risk stratification remains unclear. This study evaluated the association of insulin dependence with: 1) 90-day complications; 2) perioperative glucose control; and 3) mid-term reoperations in diabetic patients undergoing primary THA and TKA.</p><p><strong>Methods: </strong>We performed a retrospective, single-centre study of patients with DM undergoing primary THA or TKA between 2015 and 2022. Patients with preoperative glycated haemoglobin (HbA1c) ≥ 6.5 were categorized as insulin-dependent DM (IDDM) or insulin-independent DM (NIDDM). Demographic and clinical variables including preoperative haemoglobin A1C and oral DM medication usage were recorded. The primary outcome was 90-day complications. Secondary outcomes included mean and maximum perioperative glucose levels and reoperations. Multivariable logistic and linear regression analyses were used to evaluate association between insulin dependence and outcomes while adjusting for relevant confounders.</p><p><strong>Results: </strong>A total of 830 patients were included: 351 (42.3%) with IDDM and 479 (57.7%) with NIDDM. Overall, 90-day complications were more common in the IDDM cohort (35.9% vs 16.3%, p < 0.01). Insulin dependence was associated with increased odds of 90-day complications (odds ratio 2.81, 95% CI 1.98 to 3.98). Male sex, metformin use, and glucagon-like peptide-1 receptor agonist use were associated with lower complication risk. Preoperative HbA1c was not independently associated with complications. Insulin dependence and preoperative haemoglobin A1C were associated with worse perioperative glucose control. Reoperation rates were similar between groups.</p><p><strong>Conclusion: </strong>Insulin dependence is an independent risk factor for 90-day complications and poorer perioperative glucose control, but not reoperation, following primary THA and TKA. These findings suggest insulin dependence is a clinically meaningful risk marker beyond glycaemic indices. Further investigation into optimization strategies to mitigate this perioperative risk is warranted.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 9","pages":"1145-1153"},"PeriodicalIF":3.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13537884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orthopaedic surgeons' perceptions of individual feedback from a national arthroplasty quality register : a phenomenographic study.","authors":"Per Jolbäck, Maziar Mohaddes, Fredrika Sundberg","doi":"10.1302/2633-1462.79.BJO-2026-0082","DOIUrl":"10.1302/2633-1462.79.BJO-2026-0082","url":null,"abstract":"<p><strong>Aims: </strong>Our aim was to explore Swedish orthopaedic surgeons' and trainees' perceptions of receiving individual surgeon feedback following total hip arthroplasty (THA) from a national arthroplasty quality register.</p><p><strong>Methods: </strong>A qualitative study with a phenomenographic approach was conducted. Informants were strategically selected to maximize variation in perceptions, based on hospital type (according to the national arthroplasty register classification) and level of surgical experience (trainee or years since specialist certification). A total of 15 orthopaedic specialists and four trainees from 15 hospitals in Sweden were interviewed. Data were analyzed using the established seven-step phenomenographic analysis procedure.</p><p><strong>Results: </strong>Four qualitatively distinct perceptions of individual surgeon feedback from a national quality register were identified: 1) progression in the profession; 2) exposure to inaccurate criticism; 3) potential impairment of patient benefit; and 4) does not contribute to enhanced feedback for surgeons. Feedback was perceived as a means of professional development but was also considered to carry a risk of misinterpretation and unfair criticism if results were used inappropriately. Participants further expressed concern that surgeon-specific outcome reporting could shift the focus from patient benefit to performance metrics, potentially influencing patient selection and clinical decision-making. Finally, some informants questioned the need for a national feedback programme, citing existing local and organizational mechanisms that already provide meaningful feedback.</p><p><strong>Conclusion: </strong>Swedish orthopaedic surgeons and trainees hold diverse perceptions of individual surgeon feedback from a national arthroplasty quality register. Awareness of these perceptions is important when refining or designing future surgeon-specific feedback programmes. Development and refining of feedback systems should occur in close collaboration with orthopaedic surgeons to ensure clinical relevance and acceptance.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 9","pages":"1137-1144"},"PeriodicalIF":3.3,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13533586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early recognition of limb necrotizing fasciitis and surgery within six hours is associated with a lower mortality risk and improved patient-reported outcomes.","authors":"Andrew D Ablett, Chryssa Neo, Tony Feng, Nick D Clement, Andrew D Duckworth, Timothy O White","doi":"10.1302/2633-1462.79.BJO-2026-0170.R1","DOIUrl":"10.1302/2633-1462.79.BJO-2026-0170.R1","url":null,"abstract":"<p><strong>Aims: </strong>Necrotizing fasciitis (NF) is a rapidly progressive surgical emergency. The effects of time from hospital presentation to theatre on short- and long-term outcomes, as well as specific modifiable aspects of the care pathway that would enable early surgery, remain poorly defined.</p><p><strong>Methods: </strong>A retrospective cohort study of all suspected cases of limb NF presenting across a large health board region over ten years (January 2015 to April 2025) was undertaken. Early surgery was defined as ≤ six hours from presentation (triage time) to theatre (operation start time). The independent associations between surgical timing and 30-day mortality or amputation were assessed. A timeline analysis identified areas where delays occurred. Survivors completed the EuroQol five-dimension five-level questionnaire (EQ-5D-5L) and Toronto Extremity Salvage Score (TESS) outcome assessments.</p><p><strong>Results: </strong>Of 359 referrals, four patients died prior to surgery and 80 patients underwent emergency surgery due to surgeon suspicion of NF. For cases of intraoperatively confirmed NF (n = 63/80), early surgery was associated with a five-fold reduction in 30-day mortality rate (overall rate 22% (n = 14/63); adjusted hazard ratio 0.19, 95% CI 0.04 to 0.87, p = 0.032; absolute risk difference 25%). Additionally, early surgery was associated with reduced rates of 30-day amputation (overall rate 30% (n = 19/63); adjusted hazard ratio 0.19, 95% CI 0.05 to 0.66, p = 0.009; absolute risk difference 32%). At a median of 27 months' follow-up (IQR 16 to 48), only 35 patients (56%) were alive. Survivors having early surgery reported significantly better patient-reported outcomes (EQ-5D: 0.785 vs 0.133, p = 0.003; TESS combined: 64.9 vs 28.7, p = 0.007).</p><p><strong>Conclusion: </strong>Early surgery for patients with NF was associated with a lower risk of mortality, amputation, and severe long-term disability. Early recognition and transfer to theatre represent modifiable targets for improving survival and outcomes.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 9","pages":"1126-1136"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior cruciate ligament resection has no clinical effect on mediolateral gap laxity assessment in robotic-assisted total knee arthroplasty.","authors":"Filippo Leggieri, Samuel Grant, Jil A Wood, Natasha Sergis, Gregory C Wernecke, Darren B Chen, Samuel J MacDessi","doi":"10.1302/2633-1462.78.BJO-2025-0343.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.78.BJO-2025-0343.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this investigation was to assess the effects of anterior cruciate ligament (ACL) resection on assessment of mediolateral laxity gaps during robotic-assisted total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>We conducted a prospective study on 251 patients undergoing robotic-assisted primary TKA between January and June 2025. Patients with previous ACL or other knee ligament injury, and cases with missing data on outcomes of interest were excluded. Pre-resection mediolateral stressed laxity gaps in extension (10°) and flexion (90°) were measured in millimetres using optical navigation data before and after ACL resection. The primary outcome was paired mean difference in medial and lateral laxity gap measurements. The secondary outcome was prediction of factors associated with gap measurement differences. Paired <i>t</i>-tests with mean differences (MDs) compared pre- and post-resection measurements, with multivariate linear regression models examining independent predictors.</p><p><strong>Results: </strong>ACL resection did not alter medial extension gaps (MD 0.0 mm, p = 0.317) and lateral extension gaps (MD 0.1 mm, p = 0.172). Clinically negligible but statistically significant changes in medial flexion (MD 0.1 mm, p = 0.001) and lateral flexion gaps (MD 0.2 mm, p < 0.001) were noted, with all below the established minimum clinically important difference threshold of 0.3 mm. Multivariate regression identified mechanical hip-knee-ankle angle and medial posterior tibial slope as significant predictors for lateral extension gap differences (<i>β</i> 0.05, p < 0.001 and β -0.04, 95% CI 0.06 to -0.01, p = 0.006, respectively).</p><p><strong>Conclusion: </strong>These findings indicate that routine ACL sacrifice is not necessary when evaluating extension and flexion gap measurements used for functional positioning in robotic-assisted TKA.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 8","pages":"1118-1125"},"PeriodicalIF":3.3,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814450","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":"Asymptomatic nonossifying fibroma-like lesions in neurofibromatosis type 1 patients.","authors":"Maciej J K Simon, Johannes Salamon, Said Farschtschi, Lan Kluwe, Annika Erdmann, Victor Mautner, Andreas Niemeier","doi":"10.1302/2633-1462.78.BJO-2026-0044.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.78.BJO-2026-0044.R1","url":null,"abstract":"<p><strong>Aims: </strong>Neurofibromatosis type 1 (NF1) is genetic syndrome involving multiple tissues and organs including the skeleton. Because of prevalent tumours, NF1 patients often receive an MRI scan for the whole body. On MRI, skeletal findings resembling nonossifying fibroma (NOF) are frequently found. The clinical relevance of these lesions is unknown, so that diagnosis often leads to uncertainty for patients and physicians. The present study aims to explore the frequency of MRI-detectable NOF-like lesions and retrospectively evaluate associated clinical symptoms.</p><p><strong>Methods: </strong>A total of 333 NF1 patients who received at least one whole-body MRI were included. These MRI scans were assessed by a radiologist and an orthopaedic surgeon for NOF-like signals. For patients with NOF-like findings, medical records were re-evaluated to identify associated clinical symptoms.</p><p><strong>Results: </strong>A total of 127 NOF-like lesions were observed in 63 out of the 333 patients (19%). The most frequent region of the radiological lesions was the femur (57%), followed by the tibia (25%). Histology of two such lesions were NOF and fibrous dysplasia. For the majority (84%) of the patients with such NOF-like lesions, no associated symptoms were identified. Ten patients (16%) had mild transient symptoms in the proximity of their NOF-like lesions. However, extensive and follow-up examination excluded an association of these symptoms with the radiological lesions.</p><p><strong>Conclusion: </strong>NOF-like lesions are frequent on whole-body MRI scans of NF1 patients. However, there is no association with clinical symptoms. No specific treatment is indicated. These NOF-like lesions should be recognized as 'no-touch' lesions.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 8","pages":"1110-1117"},"PeriodicalIF":3.3,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13489698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}