Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine最新文献

{"title":"Satisfactory Functional Outcomes and Low Recurrence Rates at a Mean 10-year Follow-up After Combined Staged Synovectomy and External Radiotherapy for Diffuse Pigmented Villonodular Synovitis of the Knee.","authors":"Fahmy Samir Fahmy, Mohamed ElAttar, Ahmed Hatem Farhan, Sami Ibrahim Sadek, Mahmoud Abdo Mahmoud, Hossam Fathi Mahmoud","doi":"10.1016/j.jisako.2025.100907","DOIUrl":"https://doi.org/10.1016/j.jisako.2025.100907","url":null,"abstract":"<p><strong>Introduction: </strong>Diffuse pigmented villonodular synovitis (PVNS) of the knee is a local destructive lesion that tends to recur following surgical synovectomy. This study aims to evaluate the long-term functional outcomes and recurrence rates of combined staged synovectomy and external radiotherapy in managing diffuse PVNS of the knee.</p><p><strong>Methods: </strong>The data of twenty-three patients who had a diffuse PVNS of the knee between June 2011 and September 2017 were retrospectively collected. The patients underwent combined staged anterior arthroscopic and open posterior synovectomy followed by low-dose external radiotherapy (average 3000 cGy). Functional outcomes were assessed preoperatively and at the final follow-up using the International Knee Documentation Committee (IKDC) score, Musculoskeletal Tumor Society (MSTS) score, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score and SF-36 score, along with the knee motion measurements. Statistical analysis evaluated the changes in functional scores and recurrence rates, with a p-value ˂ 0.05 as the cut-off level of significance.</p><p><strong>Results: </strong>The mean follow-up time was 121.1± 20.2 months, with a minimum of 85 months. At the final follow-up, the mean ROM improved from 84.1 ± 16.2° to 110.4 ± 9.7°. The WOMAC score increased significantly from 44.5 ± 5.1 to 81.5 ± 6.3 (p < 0.00001). The IKDC score improved from 43.7 ± 8.1 to 79.1 ± 7.4 (p < 0.00001), MSTS scores from 6.7 ± 2.1 to 20.3 ± 5.7 (p < 0.00001), and SF-36 scores from 28.6 ± 7.4 to 77.4 ± 11.5 (p < 0.00001). Two recurrent cases were documented at the last follow-up visit (8.6%), with a minor complication rate of 21.7%.</p><p><strong>Conclusion: </strong>Combined staged synovectomy and external radiotherapy is an effective treatment for diffuse PVNS of the knee. It has demonstrated significant functional improvement and low recurrence rates over extended follow-up periods, supporting its role as a durable and reliable treatment strategy.</p><p><strong>Level of evidence: </strong>Level IV, retrospective cohort.</p>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":" ","pages":"100907"},"PeriodicalIF":2.7,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152203","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 sport function subscale of the Copenhagen Hip and Groin Outcome Score could not be an indicator of postural balance in soccer players with groin pain.","authors":"Fatma Chaari, Nicolas Peyrot, Sébastien Boyas, Abderrahmane Rahmani, Haithem Rebai, Sonia Sahli","doi":"10.1016/j.jisako.2025.100906","DOIUrl":"https://doi.org/10.1016/j.jisako.2025.100906","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the association between the Copenhagen Hip and groin outcome score (HAGOS) related to sport and recreation (Sport/Rec) and static and dynamic postural balance in soccer players with groin pain. We hypothesized that better postural balance outcomes would correlate with higher HAGOS Sport/Rec scores in these players.</p><p><strong>Methods: </strong>Eighty-four soccer players with groin pain from seven soccer teams volunteered to take part in the study. An investigator collected static (stabilometric platform) and dynamic (Y-Balance Test (Y-BT)) postural balance, and patient-reported outcome measures (HAGOS) in the research laboratory. To investigate the association between the postural balance outcomes and the HAGOS Sport/Rec scores, Spearman's correlation coefficient (r) was used.</p><p><strong>Results: </strong>The included participants presented the following demographic information: age: 21.56 yrs (2.22), height: 1.78 m (0.06), body mass: 75.10 kg (8.41), body mass index: 23.80 km/m² (2.50). The HAGOS Sport/Rec scores showed a small significant positive correlation with the posteromedial reach distance for the Y-BT on both injured (r =0.21, p=0.04) and non-injured (r =0.22, p=0.04) limbs. However, no significant associations (p>0.05) were found between these scores and the other Y-BT outcomes, nor with the static bipedal and unipedal postural balance findings.</p><p><strong>Conclusion: </strong>Overall, the findings of the present study showed only small positive correlations between the posteromedial direction of the Y-BT and HAGOS Sport/Rec scores. Given the observed small magnitude of correlations and the non-significant associations between the HAGOS Sport/Rec scores and the rest of the Y-BT outcomes or static postural balance outcomes, it appears that Sport/Rec may not serve as a comprehensive indicator for postural balance outcomes. Therefore, coaches and clinicians should consider combining postural balance assessments with HAGOS Sport/Rec scores to comprehensively tailor their interventions to address both the subjective and objective functional aspects of groin pain in soccer players.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":" ","pages":"100906"},"PeriodicalIF":2.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143898","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":"Proximal fibular osteotomy in conjunction with supramalleolar osteotomy in concurrent management of ankle and knee osteoarthritis: A case series","authors":"Ramesh Radhakrishnan MBBS(Spore), MRCS (Eng),&nbsp;Akshay Padki MBBCh BAO (Ire), MRCS (Ire),&nbsp;Rui Xiang Toh MBBS (Spore), MRCS (Edin), MMed (Orth), FRCSEd (Orth),&nbsp;Kae Sian Tay MBBS (S'pore), MMed (Ortho), MRCSEd, FRCSEd (Ortho),&nbsp;Kong Hwee Lee MBBS (Spore), MRCS (Edin), MMed (Ortho), FRCS (Edin),&nbsp;Nicholas Eng Meng Yeo MBBS (Spore), MRCS (Edin), MMed (Ortho), FRCS (Edin), FAMS","doi":"10.1016/j.jisako.2025.100895","DOIUrl":"10.1016/j.jisako.2025.100895","url":null,"abstract":"<div><div>Management of ankle osteoarthritis (OA) remains a challenge due to its profound impact on pain, function, and quality of life. Supramalleolar osteotomy (SMO) is a joint-preserving procedure that addresses malalignment and redistributes joint loads, while proximal fibular osteotomy (PFO) targets varus deformities and lateral instability. This study explores the outcomes of combining SMO and PFO to treat concurrent ipsilateral ankle and knee OA, providing a comprehensive approach to lower limb pathology.</div><div>We report two cases of patients with symptomatic ankle and knee OA managed using a combined surgical strategy. Both patients underwent preoperative clinical evaluations, radiographic assessments, and standardized rehabilitation protocols postoperatively. Surgical procedures included ankle arthroscopic debridement, microfracture, SMO, PFO, and lateral ligament reconstruction as required.</div><div>Postoperative outcomes demonstrated improvements in alignment, pain, and function. Patient-reported outcome measures showed marked improvements 6 months postoperatively, with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores increasing from 40 to 67 in one patient and from 69 to 94 in the other. Pain scores on the visual analog scale (VAS) showed substantial reductions in both cases, and quality of life domains assessed via the RAND 36-item health survey (RAND 36) questionnaire, including physical function and vitality, demonstrated marked gains. Radiographic analysis confirmed effective realignment and increased joint space, with improvements in key angles such as the tibial anterior surface (TAS) angle and talar tilt (TT).</div><div>These cases highlight the synergistic effect of SMO and PFO in managing complex ipsilateral lower limb OA. Radiographic and patient-reported outcomes demonstrated improved alignment, pain relief, and functionality. SMO addressed varus malalignment in the ankle, while PFO facilitated medial opening and enhanced correction of TT. Additionally, combining these techniques reduced mechanical stress on the medial knee compartment.</div><div>This dual approach shows some promise as a joint-preserving alternative for patients with moderate to severe ipsilateral ankle and knee OA. However, meticulous preoperative planning and patient selection remain essential to optimize outcomes. Further studies with larger cohorts and long-term follow-up are needed to validate these findings and refine surgical indications.</div></div><div><h3>Level of evidence</h3><div>Level V, Case report.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"12 ","pages":"Article 100895"},"PeriodicalIF":2.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081217","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":"Comparable clinical outcomes between patients aged over and under 60 ​years undergoing medial meniscus posterior root repair using a soft suture anchor technique: A preliminary retrospective cohort study","authors":"Napatpong Thamrongskulsiri ,&nbsp;Chitapoom Choentrakool ,&nbsp;Thanathep Tanpowpong ,&nbsp;Somsak Kuptniratsaikul ,&nbsp;Danaithep Limskul ,&nbsp;Thun Itthipanichpong","doi":"10.1016/j.jisako.2025.100896","DOIUrl":"10.1016/j.jisako.2025.100896","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to evaluate whether functional outcome scores in patients over 60 years of age improve after arthroscopic medial meniscus posterior root repair using a soft suture anchor. Additionally, it aimed to compare postoperative outcomes between patients over 60 years and those under 60 years of age.</div></div><div><h3>Methods</h3><div>A retrospective cohort study of 30 patients who underwent medial meniscus posterior root repair between June 2019 and February 2023. The patients were divided into two groups (≥60 years, n ​= ​15; &lt;60 years, n ​= ​15). Outcomes were assessed using the International Knee Documentation Committee (IKDC) and Lysholm scores at two years, along with MRI-based meniscus healing and radiographic osteoarthritis progression.</div></div><div><h3>Results</h3><div>Both age groups demonstrated statistically significant improvement in functional scores at two years. In the ≥60 years age group, IKDC improved from 31.9 ​± ​8.8 to 61.5 ​± ​11.3 (<em>P</em> ​&lt; ​0.001) and Lysholm from 49.1 ​± ​14.9 to 87.6 ​± ​10.5 (<em>P</em> ​&lt; ​0.001). In the &lt;60 years group, IKDC improved from 35.7 ​± ​10.4 to 54.3 ​± ​8.1 (<em>P</em> ​&lt; ​0.001) and Lysholm from 52.1 ​± ​19.3 to 82.0 ​± ​12.4 (<em>P</em> ​&lt; ​0.001). No statistically significant differences were observed between the groups for functional scores, meniscal healing (<em>P</em> ​= ​0.352) or osteoarthritis progression (<em>P</em> ​= ​0.762).</div></div><div><h3>Conclusions</h3><div>The patients aged ≥60 years who underwent arthroscopic medial meniscus posterior root repair using a soft suture anchor demonstrated functional improvements comparable to younger patients. Age alone should not be a contraindication for this procedure, though long-term follow-up is warranted to assess osteoarthritis progression.</div></div><div><h3>Level of Evidence</h3><div>Level III—retrospective cohort study.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"12 ","pages":"Article 100896"},"PeriodicalIF":2.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081216","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":"Tibial shaft fracture with knee and proximal tibiofibular dislocation: case report.","authors":"Cristian Camilo Fajardo Cantillo, Oriana Pérez Gibson, Daniel Gaitan Vargas","doi":"10.1016/j.jisako.2025.100902","DOIUrl":"https://doi.org/10.1016/j.jisako.2025.100902","url":null,"abstract":"<p><p>Tibial shaft fractures are the most common type of long bone fracture frequently associated with high-energy traumas such as traffic accidents, which carry a high mortality rate in Colombia. The combination of an open tibial shaft fracture with knee and proximal tibiofibular joint dislocation is extremely rare. The presented case involves these injuries, which were managed surgically in a single-stage with a follow-up of six months and good functional outcomes. Intramedullary nailing of the tibia was performed using an extra-articular, extra-synovial, semi-extended technique, which optimized tibial alignment for reduction and mitigated one of the common complications of intramedullary nailing: anterior knee pain. The proximal tibiofibular dislocation was reduced and stabilized using two screws, followed by a bucket-handle suture of the lateral meniscus, single-bundle posterior cruciate ligament and anterior cruciate ligament reconstructions. This injury combination has not been previously reported, highlighting its clinical and academic relevance in advancing medical knowledge and serving as a reference for similar cases. Furthermore, this case underscores the importance of a well-structured management approach for victims of high-energy trauma and the necessity for surgeons to be adept for addressing multifaceted surgical challenges. Finally, it emphasizes the benefits of a single-stage surgical approach in facilitating early rehabilitation and optimizing outcomes. LEVEL OF EVIDENCE: V.</p>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":" ","pages":"100902"},"PeriodicalIF":2.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081218","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":"Quadriceps muscle strength of adolescents recovers faster than those of adults after anterior cruciate ligament reconstruction using hamstring graft","authors":"Marc Dauty ,&nbsp;Loïc Geffroy ,&nbsp;Antoine Chalopin ,&nbsp;Pierre Menu ,&nbsp;Jérôme Grondin ,&nbsp;Thomas Hirardot ,&nbsp;Vincent Crenn ,&nbsp;Alban Fouasson-Chailloux","doi":"10.1016/j.jisako.2025.100901","DOIUrl":"10.1016/j.jisako.2025.100901","url":null,"abstract":"<div><h3>Objectives</h3><div>Knee muscle strength recovery after anterior cruciate ligament reconstruction is usually evaluated using isokinetic limb symmetry index to help take the decision to allow return to the previous sport. However, the role of age on knee strength recovery is not well known. So, we aimed to compare the isokinetic knee muscle strength recovery according to age at 4 and 7 months after anterior cruciate ligament reconstruction using hamstring graft.</div></div><div><h3>Methods</h3><div>From a historical cohort (2018-2023) of patients who completed isokinetic monitoring at 4 and 7 months after anterior cruciate ligament reconstruction using hamstring graft, two groups were compared according to age: ≤19 and ​&gt; ​20 years old. The quadriceps and hamstring limb symmetry indexes were studied as the main parameters. A multivariate analysis was realized to assess the weight of potential inter-subject explanatory parameters on knee strength evolution.</div></div><div><h3>Results</h3><div>Two hundred fifty-three adolescents were compared with 247 adults. The adolescent quadriceps symmetry index at 60°/s was significantly higher than that of adults (79% vs 72% and 88% vs 82% at 4 and 7 months of follow-up, respectively). The hamstring symmetry index was not statistically significantly different. No inter-subject explanatory parameters were found after the multivariate analysis.</div></div><div><h3>Conclusion</h3><div>Knee strength recovers faster in adolescents than in adults after anterior cruciate ligament reconstruction using hamstring graft. This result should be carefully considered because adolescents could be exposed to return to sport too early, while the risk of graft rupture is still high, if strength cutoff is only considered.</div></div><div><h3>Level evidence</h3><div>III.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"12 ","pages":"Article 100901"},"PeriodicalIF":2.7,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038565","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 shortened Knee Injury and Osteoarthritis Outcome Score (KOOS) is sufficient for measuring change in a cohort of patellofemoral instability patients","authors":"Kate E. Webster PhD ,&nbsp;Julie Agel MA ,&nbsp;Julian A. Feller MB, BS(Hons) ,&nbsp;Robert Magnussen MD ,&nbsp;Elizabeth A. Arendt MD","doi":"10.1016/j.jisako.2025.100899","DOIUrl":"10.1016/j.jisako.2025.100899","url":null,"abstract":"<div><h3>Introduction</h3><div>Various knee-related patient-reported outcome measures (PROMs) have been used for patients who undergo surgical treatment for patellofemoral instability. There has been limited evaluation of their suitability and no agreement about an optimal set of measures.</div></div><div><h3>Objectives</h3><div>To evaluate the Knee injury and Osteoarthritis Outcome Score (KOOS) and published shorter versions to determine their suitability for patients with patellofemoral instability.</div></div><div><h3>Methods</h3><div>The study cohort consisted of patients who underwent surgical stabilization with medial patellofemoral ligament reconstruction for recurrent lateral patellar dislocations. The full KOOS was administered preoperatively and the 6, 12, and 24 months postoperative. Four short form versions were calculated: KOOS-12, KOOS-Physical Function, KOOS-Joint Replacement, and KOOS-Global. Floor and ceiling effects were determined (threshold &gt;15%). Individual items were evaluated to identify where &gt;67% of patients had preoperative responses of “≥ moderate” (demonstrating item relevance). The standardized response mean (SRM) was calculated to assess responsiveness from baseline to each postoperative assessment time, as well as between postoperative assessments.</div></div><div><h3>Results</h3><div>289 patients completed the full KOOS at least once. No ceiling effects were present at any time point for the quality of life (QoL) or symptoms subscales, KOOS-12, or KOOS-global. Only 11 of the items passed the &gt;67% threshold for item relevance. These included all Sport/Recreation (SR) and QoL items, as well as one item (knee stiffness after sitting/resting later in the day) from the symptom subscale and one item (pain frequency) from the pain subscale. Given these individual item results, a two-subscale “composite” score was calculated that included the 9 items of the KOOS SR and QoL subscales (KOOS-SR ​+ ​QoL). Excellent responsiveness was seen for all preoperative to postoperative comparisons, especially the composite SR ​+ ​QoL measure (SRM &gt;1). Between 6- and 12-month assessments, the composite SR ​+ ​QoL score was also shown to be the most responsive measure.</div></div><div><h3>Conclusion</h3><div>The composite KOOS SR ​+ ​QoL score may be an improved option for measuring patient-related outcomes in this more active population, as it focuses on the most relevant constructs for this patient group. The full 42-item KOOS was shown to have limited applicability in this patient group.</div></div><div><h3>Level of evidence</h3><div>Level II.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"12 ","pages":"Article 100899"},"PeriodicalIF":2.7,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064843","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":"Nanofractures are inferior compared to other one-step treatments for chondral lesions in the patella: a controlled preclinical experiment in New Zealand rabbits.","authors":"Juan Pablo Martinez-Cano, Juliana Henao-Giraldo, María Camila Gómez-Ayala, Jacobo Triviño-Arias, José Oscar Gutierrez-Montes","doi":"10.1016/j.jisako.2025.100897","DOIUrl":"https://doi.org/10.1016/j.jisako.2025.100897","url":null,"abstract":"<p><strong>Introduction: </strong>Patellofemoral chondral injuries pose a significant challenge due to their functional impact and potential progression to osteoarthritis. Bone marrow stimulation procedures, such as nanofractures and bone marrow aspirate (BMA), as well as use of autologous cartilage fragments (ACF), may enhance cartilage repair. This study aims to evaluate the efficacy of four one-step procedures plus a control group, for patellofemoral cartilage repair in an animal model.</p><p><strong>Methods: </strong>A randomized preclinical trial was conducted in 20 New Zealand rabbits. A central chondral defect was created in the patella without affecting the subchondral bone. Knees were randomly assigned to five treatment groups: control, nanofractures, nanofractures-plus (fibrin glue), BMA and ACF. Histological assessment of defect filling and cartilage quality were performed using the International Cartilage Repair Society (ICRS) II score.</p><p><strong>Results: </strong>All rabbits completed the follow-up period (20 weeks). The highest defect filling percentage was observed in the BMA group (61%, SD 36%), followed by nanofractures-plus (53%, SD 33%) and ACF (52%, SD 41%), followed by the control group (37%, SD 26%) and nanofractures (30%, SD 22%). Regarding tissue quality, the best mean ICRS II score was found in both nanofractures-plus (64.2%) and BMA (64.2%), followed by ACF (59.1%). Significant inferior cartilage quality was observed in nanofractures group when compared with other groups in certain items of ICRS II score.</p><p><strong>Conclusion: </strong>All treatment strategies promoted some degree of cartilage regeneration; however, none achieved complete defect filling. Nanofractures group demonstrated the poorest outcomes in terms of subchondral bone and tissue integration; nanofractures-plus, BMA and ACF exhibited the greatest regenerative potential in terms of quality. BMA showed the highest defect filling. Given the limited regenerative capacity of these lesions and the high cost and limited accessibility of some treatments, exploring cost-effective alternatives is essential.</p><p><strong>Level of evidence: </strong>Not applicable.</p>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":" ","pages":"100897"},"PeriodicalIF":2.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054427","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":"Lateral opening wedge distal femoral osteotomy for symptomatic lateral compartment osteoarthritis: Survivorship and predictive factors at mean 10-year follow-up","authors":"Fabio Mancino ,&nbsp;Giacomo Dal Fabbro ,&nbsp;Kevin Qian ,&nbsp;David A. Parker","doi":"10.1016/j.jisako.2025.100898","DOIUrl":"10.1016/j.jisako.2025.100898","url":null,"abstract":"<div><h3>Introduction</h3><div>Lateral opening wedge distal femoral osteotomy (LOWDFO) is a reliable joint-preserving surgical procedure for isolated lateral compartment knee osteoarthritis (OA) and overload in valgus knees.</div><div>The aim of this study was to evaluate the long-term survivorship and clinical outcomes of patients undergoing LOWDFO, and to identify the factors associated with conversion to total knee arthroplasty (TKA).</div></div><div><h3>Methods</h3><div>This was a retrospective study of prospectively collected patients who underwent LOWDFO for isolated lateral osteoarthritis and mechanical overload between 2003 and 2023. Clinical outcomes including the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Veterans RAND-12 (VR-12) Physical and Mental scores, and the International Knee Documentation Committee subjective evaluation form (IKDC) were collected and analyzed. Radiographic parameters included hip-knee-ankle angle (HKA) and lateral distal femoral angle (LDFA). Postoperative complications and further reoperations during the follow-up period were recorded. Survivorship was from conversion to TKA and investigated using Kaplan–Meier curve. Logistic regression was used to identify factors associated with conversion, and p values ​&lt; ​0.05 were considered significant.</div></div><div><h3>Results</h3><div>A total of 48 patients (56% males, mean age 36.5 ​± ​11.3 years) were included for analysis. The complication rate was 35.4%, and the reoperation rate was 29.2% at a mean 10.1 ​± ​4.9-year follow-up. Removal of metal hardware due to pain and/or discomfort was the main cause of reoperation in 20.8% of the patients. The cumulative rate of conversion to TKA at 5 years was 7.0%, 10 years 15.0% and 15 years 29%. Older age was significantly associated with an odd ratio (OR) of 1.16 (R²_N ​= ​0.31; 95% CI: 1.03 to 1.30). The survival analysis showed that patients &gt;45 years at the time of index surgery had an increased hazard ratio (HR) for conversion to TKA of 5.16 (95% CI: 1.32 to 10.10).</div></div><div><h3>Conclusion</h3><div>LOWDFO yields a 10-year cumulative survivorship of 85% in young patients with lateral compartment isolated knee OA and overload in valgus knees. Age at the time of index surgery is associated with an increased odds of conversion. Removal of metal hardware can affect one in five patients.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"12 ","pages":"Article 100898"},"PeriodicalIF":2.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004902","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":"Preoperative computer tomography scans can accurately evaluate tibial bone mineral density for selecting bone fixation in total knee arthroplasty","authors":"Yoshinori Mikashima ,&nbsp;Hitoshi Imamura ,&nbsp;Koichiro Yano ,&nbsp;Katsunori Ikari ,&nbsp;Hiroshi Takagi ,&nbsp;Ken Okazaki","doi":"10.1016/j.jisako.2025.100894","DOIUrl":"10.1016/j.jisako.2025.100894","url":null,"abstract":"<div><h3>Introduction/objective</h3><div>The mechanical quality of bone at the proximal tibia is an important factor for the success of cementless total knee arthroplasty (TKA). The purpose of this study was to evaluate the relationship between preoperative bone mineral density (BMD) at the tibial resection level (tibial BMD) using computed tomography (CT) and intraoperative cancellous bone durability (ICBD) in TKA.</div></div><div><h3>Methods</h3><div>All consecutive cemented and cementless TKAs performed by a single surgeon between April 2024 and October 2024 were evaluated. All patients were examined preoperatively for tibial BMD via CT, hip BMD via dual-energy X-ray absorptiometry. A block of cancellous bone with a diameter of 10 ​mm and a height of 10 ​mm was harvested at the center of the tibia. The fixation method was selected intraoperatively according to the macroscopically evaluated bone quality. Using a pusher tension gauge and a metal measure, the force required to compress the harvested bone from 10 ​mm to 5 ​mm was measured and defined as ICBD. Pearson product-moment correlations were calculated to assess the relationships between tibial and hip BMD and ICBD.</div></div><div><h3>Results</h3><div>A consecutive series of 74 TKAs were included. There were 50 cementless fixations and 24 cemented fixations. Tibial BMD, hip BMD and mean ICBD were significantly greater in the cementless group than in the cemented group (tibial BMD: 70.3 ± 26.2 vs 37.5 ± 14.4, and hip BMD: 87.3 ± 11.8 vs 65.6 ± 10.5, ICBD: 85.6 ± 35.6 vs 49.8 ± 18.1, respectively, <em>P</em> &lt; 0.01). The cut-off value of tibial BMD indicating a cementless prosthesis was 46.4 HA/cm³. There was a very strong correlation between tibial BMD and ICBD (r = 0.88, <em>P</em> &lt; 0.01) and a strong correlation between hip BMD and ICBD(r = 0.62, <em>P</em> &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>This study is the first report to focus on the relationships between CT-based tibial BMD and the actual bone quality of the proximal tibia . Assessment of bone quality via CT is accurate, relatively simple, and potentially useful for determining whether cementless fixation in TKA is indicated. For cementless fixation, 46.4 HA/cm3 and 55.7 N were found as tibial BMD and ICBD cut-off values.</div></div><div><h3>Level of evidence</h3><div>Retrospective cohort study, Level Ⅳ.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"12 ","pages":"Article 100894"},"PeriodicalIF":2.7,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049933","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}