JBJS Open Access最新文献

{"title":"Periprosthetic Joint Infection Surrounding Lower-Extremity Endoprostheses After Tumor Resection: Causative Microorganisms, Effectiveness of DAIR, and Risk Factors for Treatment Failure.","authors":"Philip Sanders, Henk Scheper, Robert van der Wal, Michiel van de Sande, Mark de Boer, Pieter Durk Sander Dijkstra, Michael Bus","doi":"10.2106/JBJS.OA.23.00119","DOIUrl":"10.2106/JBJS.OA.23.00119","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infection (PJI) surrounding an endoprosthesis after reconstruction of a lower extremity following tumor resection is a common complication, and the treatment of these infections is challenging and often requires multiple surgical interventions or even implant removal. Because there has been limited evidence to support treatment strategies and understanding of the epidemiology of the causative microorganisms, we analyzed the effectiveness of debridement, antibiotics, and implant retention (DAIR), risk factors for the failure of DAIR, and causative microorganisms in patients with a PJI surrounding a lower-extremity endoprosthesis after tumor resection.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted in a tertiary referral center for orthopaedic oncology. All patients treated between 2000 and 2018 for PJI surrounding a lower-extremity endoprosthesis after tumor resection were included. Treatment outcomes and risk factors for failure were analyzed in patients primarily treated with DAIR. Causative microorganisms were recorded. The minimum follow-up period was 2 years.</p><p><strong>Results: </strong>Of the 337 patients who underwent endoprosthetic reconstruction of a lower extremity after tumor resection, 67 patients (20%) developed a PJI surrounding the endoprosthesis. Of those patients, 55 were primarily treated with DAIR. The functional cure rate of DAIR was 65% (36 of 55). A median of 2 debridements per patient was needed. Chemotherapy (odds ratio [OR], 3.1 [95% confidence interval (CI), 1.0 to 9.3]) and an erythrocyte sedimentation rate of >50 mm/hr at diagnosis (OR, 4.5 [95% CI, 1.3 to 15.4]) were associated with treatment failure. Nineteen patients (28%) had a polymicrobial infection.</p><p><strong>Conclusions: </strong>Although sequential procedures are often needed, DAIR has acceptable clinical outcomes and should be considered, dependent on expected survival and the risk factors for treatment failure noted in this study.</p><p><strong>Level of evidence: </strong>Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484164","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":"Ten to 15-Year Outcomes of Monoblock Uncemented Dual Mobility Cups: Excellent Survival Rate and Outcome in Primary Total Hip Arthroplasty.","authors":"Cécile Batailler, Sébastien Lustig, Emmanuel Balot, Frédéric Farizon, Michel Henri Fessy, Rémi Philippot","doi":"10.2106/JBJS.OA.24.00074","DOIUrl":"10.2106/JBJS.OA.24.00074","url":null,"abstract":"<p><strong>Background: </strong>Dual mobility cups (DMCs) have effectively prevented dislocations after total hip arthroplasty (THA). However, use of these cups in primary THAs remains controversial, especially in young patients. This study aimed to determine the long-term survival rate and functional outcomes of a contemporary DMC used in primary THA.</p><p><strong>Methods: </strong>This retrospective multicenter study identified a cohort of 614 primary THAs performed with the same uncemented monoblock DMC between 2007 and 2010. Survival analysis included 572 THAs, while clinical analysis involved 394 THAs at a minimal follow-up of 10 years. The mean follow-up was 11.1 ± 1.2 years. The mean age was 71.4 ± 11.7 years, with 4.2% of patients under 50 years old. The mean body mass index was 27.0 ± 5.3 kg/m². The 10-year Kaplan-Meier survival rate was calculated based on cup removal for any reason or cup revision for an aseptic reason as the end point. Harris hip scores were collected at the last follow-up.</p><p><strong>Results: </strong>The cup-revision-free survival rate was 98.6% at 10 years and 96.2% at 13 years. No cup revisions were reported due to aseptic loosening or dislocation. The cup revisions were due to infection (7 of 572; 1.2%), acetabular fracture (1 of 572; 0.17%), and psoas impingement due to cup malpositioning (n = 1 of 572; 0.17%). Only 3 dislocations (0.52%) were observed, and they did not require revision. The mean Harris hip score significantly improved from 54.1 ± 14.4 preoperatively to 88.0 ± 14.3 at the last follow-up (p < 0.0001). For patients under 50 years old at the time of surgery, the mean Harris hip score showed significant improvement from 53.0 ± 10.2 preoperatively to 89.7 ± 12.8 at the last follow-up (p < 0.0001), with no significant difference compared with the older patients (p = 0.50). No revision or complication was reported in the younger patient population at 13 years of follow-up.</p><p><strong>Conclusions: </strong>The monoblock uncemented DMC demonstrated excellent survival rates with no DMC-specific complications during a minimum 10-year follow-up. The dislocation rate was very low, and a younger age was not identified as a risk factor for failure. Therefore, monoblock cementless DMCs can be safely used, even in primary THA.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484169","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":"The Effects of Antibiotic-Impregnated Spacers on Bone Healing in an Animal Model of the Induced Membrane Technique: Healing of a Critical-Size Femoral Defect in a Rat Model.","authors":"Hening Sun, Charles Godbout, Gareth Ryan, Ikran Ali, James Higgins, Graeme Hoit, Jeremy Hall, Mansur Halai, Amir Khoshbin, Emil H Schemitsch, Aaron Nauth","doi":"10.2106/JBJS.OA.24.00059","DOIUrl":"10.2106/JBJS.OA.24.00059","url":null,"abstract":"<p><strong>Background: </strong>Surgeons performing the induced membrane technique (IMT) often incorporate antibiotics into the spacer at the first stage of the surgical procedure to prevent or treat infection. However, the effect of antibiotic use on subsequent bone healing is not clear. This study aimed to investigate if antibiotic-impregnated spacers impact subsequent bone healing in a rat model of the IMT.</p><p><strong>Methods: </strong>Inbred male rats (Fischer 344) were randomly divided into 3 groups according to the antibiotic dose in the spacer: (1) control (no antibiotics), (2) low-dose (1.2 g tobramycin and 1.0 g vancomycin per 40 g of polymethylmethacrylate [PMMA]), and (3) high-dose (3.6 g tobramycin and 3.0 g vancomycin per 40 g of PMMA). We created a 5-mm segmental defect in the right femoral diaphysis. The bone was stabilized with a plate and screws, and the assigned spacer was inserted into the defect. Four weeks later, the spacer was removed and bone graft was placed within the defect. Radiographs made 12 weeks after grafting were scored according to union status and degree of bone healing. Micro-computed tomographic (CT) analysis and biomechanical testing were also performed at 12 weeks.</p><p><strong>Results: </strong>Full radiographic union was achieved in 10 (83%) of 12 control animals, 13 (100%) of 13 low-dose animals, and 8 (62%) of 13 high-dose animals (high-dose compared with low-dose: risk ratio, 11.0; p = 0.039). The control group demonstrated higher bone volume compared with the high-dose group (mean difference, 9.0 mm³; p = 0.039), and there was a trend toward higher bone volume in the low-dose group compared with the high-dose group (mean difference, 8.1 mm³; p = 0.06). The biomechanical results demonstrated that maximum stiffness was significantly higher in the low-dose group compared with the high-dose group (mean difference, 14.1 N*mm/degree; p = 0.009).</p><p><strong>Conclusions: </strong>Our results demonstrated that low doses of antibiotics in PMMA spacers used for the IMT did not impair bone healing. However, high doses of antibiotics demonstrated inferior bone healing.</p><p><strong>Clinical relevance: </strong>The addition of high-dose antibiotics to the PMMA spacers used for the IMT may result in impaired bone healing and should be used with caution.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484174","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":"A Cost-Effectiveness Analysis of Intramedullary Nailing Versus External Fixation for Open Tibial Fractures in Tanzania.","authors":"Jamieson M O'Marr, Patricia Rodarte, Billy Haonga, Patrick Ngunyale, Heather Roberts, Saam Morshed, David Shearer","doi":"10.2106/JBJS.OA.24.00006","DOIUrl":"10.2106/JBJS.OA.24.00006","url":null,"abstract":"<p><strong>Background: </strong>Open tibial fractures are a cause of substantial orthopaedic morbidity in low- and middle-income countries. These injuries represent a substantial cost burden to both individual patients and society because of their high propensity for complications, such as infection, nonunion, and malunion. External fixation and intramedullary (IM) nailing are both utilized for definitive treatment of open tibial fractures, but given the differences in cost and lack of clear superiority of intramedullary nailing, cost-effectiveness becomes important to consider in low- and middle-income countries. The present study aimed to examine the cost-effectiveness of IM nailing versus external fixation within Tanzania.</p><p><strong>Methods: </strong>This study utilized data from a randomized controlled trial conducted at a single tertiary hospital in Dar es Salaam, Tanzania. Direct cost data were collected via an internal audit of operating costs and hospital staff time. Indirect costs data were collected from patients in a long-term follow-up study assessing total lost work. A Markov model was utilized to run the cost-effectiveness simulations. The primary outcome was the incremental cost-effectiveness ratio (ICER) over a lifetime time horizon. Both the payer and societal perspectives were considered. To account for uncertainty, both 1-way and probabilistic sensitivity analyses were performed.</p><p><strong>Results: </strong>From the payer perspective, the cost of external fixation ($396 USD) was lower than that of IM nailing ($529), primarily because of shorter operative times. However, IM nailing was associated with more quality-adjusted life-years (QALYs). From the payer perspective, the ICER was $499 per QALY with a donated nail and $701 per QALY with a purchased locally available nail. From the societal perspective, the ICER was lower among patients undergoing IM nailing, at $70 per QALY, largely because of shorter recovery times.</p><p><strong>Conclusions: </strong>From both the payer and the societal perspective, IM nailing is considered highly cost-effective on the basis of the World Health Organization willingness-to-pay thresholds. This finding was consistent whether the IM nail was donated or purchased from local suppliers. These results are likely generalizable to other tertiary referral centers in low- and middle-income countries.</p><p><strong>Level of evidence: </strong>Economic Level II. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484160","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":"Erratum: Perception of Residency Program Diversity Is Associated With Vulnerability to Race and Gender Stereotype Threat Among Minority and Female Orthopaedic Trainees.","authors":"Risa T Reid, Susan M Odum, Patrick J Rosopa, Jaysson T Brooks, Brian P Scannell, Selina Poon, Tyler Williams, Joshua C Patt, Gabriella E Ode","doi":"10.2106/JBJS.OA.ER.24.00084","DOIUrl":"10.2106/JBJS.OA.ER.24.00084","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.2106/JBJS.OA.24.00084.].</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11838151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469437","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":"Risk of Fracture at External Fixator Pin Hole After Lateral Tibial Plateau Fracture Plating: A Biomechanical Comparison of Different Screw Configurations.","authors":"Patrick A Massey, Wayne Scalisi, Chloe Duval, Michael Lowery, Brad Chauvin, Giovanni F Solitro","doi":"10.2106/JBJS.OA.24.00094","DOIUrl":"10.2106/JBJS.OA.24.00094","url":null,"abstract":"<p><strong>Background: </strong>External fixation of tibial plateau fractures commonly provides temporary stabilization before definitive fixation with plate and screws. The purpose of this study was to determine if an external fixator pin hole distal to a tibial plate in a synthetic fracture model would increase the risk of fracture after fixation. Another objective was to determine the ideal configuration when placing tibial plate screws near an external fixator pin hole.</p><p><strong>Methods: </strong>Thirty synthetic tibiae were tested and evenly divided into 5 groups. Tibial plateau plates were placed with 4 different screw configurations for the distal-most screw near the external fixator pin hole. The 5 groups tested were control (fixation with no external fixator hole), unicortical (distal fixation with a unicortical locking screw), bicortical (distal fixation with a bicortical locking screw), oblique (distal fixation with an oblique cortical screw angled 30° proximally from the external fixator hole), and hole-bridging (hole-bridging fixation in which the plate was placed bridging the external fixator hole). The bone surrogates were potted and tested using an Instron 8874 Testing System.</p><p><strong>Results: </strong>There was a significant difference in failure load among the 5 groups (p = 0.005). The mean peak loads were 1,259 N (control), 835 N (unicortical), 831 N (bicortical), 943 N (oblique), and 993 N (hole-bridging). There was a higher failure load in the control group compared with the bicortical group (p = 0.007) and the unicortical group (p = 0.007). There was no difference in failure load between the control group and the hole-bridging group (p = 0.16) and the oblique group (p = 0.067).</p><p><strong>Conclusions: </strong>External fixator pin holes distal to a tibial plateau plate may increase the risk of tibial fracture through the pin hole. This risk may be mitigated by placing the distal screw oblique and angled proximally away from the external fixator pin hole or by placing the external fixator pin proximally with subsequent bridging of the external fixator pin hole with the plate.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11778079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123834","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":"Does Resident Gender or Race/Ethnicity Affect Orthopaedic Surgery Case Volume During Residency Training?","authors":"Parisun Shoga, Ann Van Heest, S Elizabeth Ames, Sean O Hogan, Eric Holmboe, Mary Klingensmith, Yoon Soo Park, Corey Parker, Erik Solberg, Kimberly Templeton","doi":"10.2106/JBJS.OA.24.00146","DOIUrl":"10.2106/JBJS.OA.24.00146","url":null,"abstract":"<p><strong>Introduction: </strong>Disparities in case volumes have been reported in some surgical specialties. The objective of this study was to evaluate whether gender or racial/ethnicity disparities exist during orthopaedic surgery residency surgical case log volume.</p><p><strong>Methods: </strong>Accreditation Council for Graduate Medical Education Case Log Database for orthopaedic surgery residents for 9 years of cohorts graduating in academic years 2013-2014 to 2021-2022 were analyzed to compare case logs between men and women, as well as race/ethnicity, defined by Association of American Medical Colleges as underrepresented in medicine (URiM) and non-URiM groups.</p><p><strong>Results: </strong>Longitudinal analyses of total required minimum type cases indicate significant gender differences among the initial graduating cohorts with women trainees reporting 33 cases fewer than men; in the most recent years of this study period, women trainees reported 5 cases fewer than men per year. URiM trainees reported 29 cases fewer at baseline, while in the most recent years, there were no significant differences. Significant differences exist for 8 of the 15 case minimum types with fewer women cases at baseline; in the most recent years, women had fewer cases in anterior cruciate ligament Reconstruction, Ankle Fracture Fixation, Closed Reduction Forearm Fracture, Total Hip Arthroplasty, and Total Knee Arthroplasty. There were significant differences for 3 of 15 case minimum types at baseline for URiM trainees with no significant differences in most recent years. Hand was the only anatomic area with women reporting significantly more cases than men, both initially and over the 9 years of study period.</p><p><strong>Conclusion: </strong>Significant differences exist in case volume and case types during orthopaedic surgery residency based on gender for the initial cohort, albeit lessening in most recent years. Although initial differences in cases volumes based on race/ethnicity exist, no significant differences persist in most recent years of the study period.</p><p><strong>Level of evidence: </strong>Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11778099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123830","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":"Robot-Assisted Retrograde Elastic Intramedullary Nailing Versus ORIF with a Plate for Displaced Midshaft Clavicular Fractures.","authors":"Yufu Zhang, Jie Tan, Xigong Zhang, Xiao Han, Yanchao Li, Maoqi Gong, Qiang Huang, Junqiang Wang, Xieyuan Jiang","doi":"10.2106/JBJS.OA.24.00071","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00071","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study was to compare the clinical outcomes of robot-assisted retrograde elastic intramedullary nailing and open reduction and internal fixation (ORIF) with a plate for displaced midshaft clavicular fractures.</p><p><strong>Methods: </strong>All patients diagnosed with displaced midshaft clavicular fractures between November 1, 2022, and June 30, 2023, in our level-III hospital (most advanced level) were enrolled in this retrospective study; a total of 116 patients met the inclusion criteria. Patients were divided into 2 groups on the basis of treatment: robot-assisted retrograde elastic intramedullary nailing (RAN group) and ORIF with a plate (plate group). Operations in the RAN group were carried out using the novel TIANJI Robot system (TINAVI Medical Technologies) for navigation and planning of the optimal retrograde intramedullary nailing trajectory. Patient demographics, perioperative parameters, and complications were documented. Patients were followed at the trauma clinic for clinical and radiographic assessment.</p><p><strong>Results: </strong>There were 74 patients in the RAN group and 42 patients in the plate group. The RAN group exhibited a significantly shorter total operative time (mean, 52.20 ± 20.76 versus 86.83 ± 27.42 minutes), less blood loss (mean, 7.38 ± 5.54 versus 59.05 ± 30.11 mL), shorter incision length (mean, 1.28 ± 0.85 versus 9.79 ± 1.63 cm), and shorter duration of hospital stay (mean, 3.38 ± 0.73 versus 5.50 ± 1.99 days) (all p < 0.05). Nail treatment was also associated with a significantly shorter time to bone union (mean, 7.92 ± 2.46 versus 16.79 ± 5.18 weeks), a higher SCAR score (mean, 9.77 ± 0.51 versus 5.74 ± 1.15), a shorter time to return to sports (mean, 12.70 ± 2.35 versus 20.10 ± 4.10 weeks), and a shorter time to regain full range of shoulder motion (mean, 9.46 ± 2.35 versus 12.05 ± 2.95 weeks) (all p < 0.05). At the final follow-up, the Constant-Murley shoulder score was significantly higher in the RAN group (mean, 97.57 ± 2.77 versus 93.29 ± 7.63) (p < 0.05). Compared with the RAN group, the plate group had more complications (p < 0.05).</p><p><strong>Conclusions: </strong>Robot-assisted retrograde elastic intramedullary nailing is a safe and minimally invasive treatment option for displaced midshaft clavicular fractures that promotes rapid healing, good cosmesis, excellent functional outcomes, and fewer complications compared with ORIF with a plate.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068407","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":"Functional Improvements by Controlled Suture Tension in Arthroscopic Rotator Cuff Repair.","authors":"Shinji Imai","doi":"10.2106/JBJS.OA.24.00031","DOIUrl":"10.2106/JBJS.OA.24.00031","url":null,"abstract":"<p><strong>Background: </strong>Although a certain degree of tension in bridging sutures is required for proper tendon healing following suture-bridge rotator cuff repair, excessive suture tension may be detrimental to tendon healing. This study aimed to investigate the effects of bridging suture tension on clinical outcomes and tendon healing. We hypothesized that fixed, low tension of the bridging sutures would improve the tendon healing rate and clinical outcomes compared with maximum manual tensioning.</p><p><strong>Methods: </strong>A group of 39 patients with a rotator cuff tear were treated with arthroscopic suture-bridge rotator cuff repair, in which the bridging sutures were uniformly tensioned to 20 N (group A). A separate group of 37 patients was treated with the same suture construct, but the sutures were tensioned by maximum manual pulling (mean tension, 36.1 N; group B). The visual analog scale (VAS) score for pain, active anterior elevation, external and internal rotation, and Constant score were compared between the groups preoperatively and at 1, 3, and 6 months and 1 and 2 years postoperatively. Anatomical healing was evaluated using magnetic resonance imaging (MRI) at 1 year after surgery.</p><p><strong>Results: </strong>At 6 months postoperatively, all clinical values had improved in both groups. The Constant score (p < 0.001), VAS pain score (p < 0.001), and anterior elevation (p = 0.004) were significantly better in group A than in group B. Two years postoperatively, there was no significant difference between groups A and B in the Constant score (p = 0.847), VAS pain score (p = 0.991), and anterior elevation (p = 0.855). Group A demonstrated a significantly lower retear rate (3 of 39, 7.7%) than group B (9 of 37, 24.3%) (p = 0.0467).</p><p><strong>Conclusions: </strong>Double-row suture-bridge repairs with fixed, low tension led to superior clinical outcomes at 6 months and a superior tendon healing rate at 1 year compared with repairs with higher suture tension. However, the clinical outcomes did not differ significantly at 2 years between the 2 tensioning methods.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030013","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":"Erratum: Expanding the Pipeline: Exposure and Female Mentorship Increase Interest in Orthopaedic Surgery Among Female Premedical Undergraduate Students: Erratum.","authors":"Victoria E Bergstein, Jessica Schmerler, Alexandra H Seidenstein, Dawn M LaPorte","doi":"10.2106/JBJS.OA.ER.24.00142","DOIUrl":"10.2106/JBJS.OA.ER.24.00142","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.2106/JBJS.OA.24.00142.].</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11737502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013037","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}