Journal of Experimental Orthopaedics最新文献

{"title":"Inside-out tibial tunnel drilling technique is a reliable approach for all-inside ACL reconstruction: A longitudinal MRI assessment","authors":"João Pedro Oliveira,&nbsp;Otília C. d'Almeida,&nbsp;Ricardo Sampaio,&nbsp;José Carlos Noronha","doi":"10.1002/jeo2.70068","DOIUrl":"10.1002/jeo2.70068","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To longitudinally evaluate sockets localization, tunnel morphological changes and graft maturation after the <i>inside-out tibial tunnel drilling technique for all-inside Anterior Cruciate Ligament Reconstruction (ACLR)</i>. We hypothesized that due the necessary angle for the inside-out reaming procedure, the described technique could input changes in the tibial socket.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Fourteen knees treated with the same all-inside ACLR technique were randomly assigned for a magnetic resonance evaluation. All patients were operated by the same surgeon and performed the same follow-up rehabilitation protocol. Socket's localization, shape and widening, as well as graft maturation and integration, were evaluated intraoperatively at 6 months and 4 years after surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both femoral and tibial tunnels had an expected increase at 6 months follow-up. The widening was larger in the tibial tunnel (12.6 ± 10.0% vs. 9.1 ± 8.5%), yet this difference was not statistically different. Tibial tunnel was well centred in the tibial plateau and the integration of the graft was higher in the tibial socket. Four years after surgery, there was a general reduction of diameter in both tunnels. The tunnel occlusion rate was 33.3% for tibia and 16.7% for femur.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Overall, our results show that within a 4-year follow-up period, the <i>inside-out tibial tunnel drilling technique for all-inside ACLR</i> represents a safe technique that did not influence the tibial socket position nor tunnel widening or graft maturation in the long term.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"11 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11551069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628809","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":"Diagnostic performance of deep learning for leg length measurements on radiographs in leg length discrepancy: A systematic review","authors":"Bradley A. Lezak,&nbsp;James A. Pruneski,&nbsp;Jacob F. Oeding,&nbsp;Kyle N. Kunze,&nbsp;Riley J. Williams III,&nbsp;Michael J. Alaia,&nbsp;Andrew D. Pearle,&nbsp;Joshua S. Dines,&nbsp;Kristian Samuelsson,&nbsp;Ayoosh Pareek","doi":"10.1002/jeo2.70080","DOIUrl":"10.1002/jeo2.70080","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To systematically review the literature regarding machine learning in leg length discrepancy (LLD) and to provide insight into the most relevant manuscripts on this topic in order to highlight the importance and future clinical implications of machine learning in the diagnosis and treatment of LLD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic electronic search was conducted using PubMed, OVID/Medline and Cochrane libraries in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Two observers independently screened the abstracts and titles of potential articles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of six studies were identified in the search. All measurements were calculated using standardized anterior-posterior long-leg radiographs. Five (83.3%) of the studies used measurements of the femoral length, tibial length and leg length to assess LLD, whereas one (16.6%) study used the iliac crest height difference to quantify LLD. The deep learning models showed excellent reliability in predicting all length measurements with intraclass correlation coefficients ranging from 0.98 to 1.0 and mean absolute error (MAE) values ranging from 0.11 to 0.45 cm. Three studies reported measurements of LLD, and the convolutional neural network model showed the lowest MAE of 0.13 cm in predicting LLD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Machine learning models are effective and efficient in determining LLD. Implementation of these models may reduce cost, improve efficiency and lead to better overall patient outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Relevance</h3>\u0000 \u0000 <p>This review highlights the potential of deep learning (DL) algorithms for accurate and reliable measurement of lower limb length and leg length discrepancy (LLD) on long-leg radiographs. The reported mean absolute error and intraclass correlation coefficient values indicate that the performance of the DL models was comparable to that of radiologists, suggesting that DL-based assessments could potentially be used to automate the measurement of lower limb length and LLD in clinical practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"11 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11551063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628625","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":"Old but gold: Is the Judet procedure still a viable option for posttraumatic knee stiffness in 2024? A comprehensive systematic review and meta-analysis","authors":"Vito Gaetano Rinaldi,&nbsp;Iacopo Sassoli,&nbsp;Alberto Fogacci,&nbsp;Antongiulio Favero,&nbsp;Giada Lullini,&nbsp;Massimiliano Mosca,&nbsp;Mattia Morri,&nbsp;Stefano Zaffagnini,&nbsp;Giulio Maria Marcheggiani Muccioli","doi":"10.1002/jeo2.70079","DOIUrl":"10.1002/jeo2.70079","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Posttraumatic extension contracture of the knee (PECK) is common after knee injury. Initial management is conservative to improve the range of motion; if it fails, surgery may be necessary. This systematic review analyses existing literature on Judet quadricepsplasty for PECK. We will assess clinical outcomes, complications, patient satisfaction and factors that may influence its success.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A search was conducted on 25 November 2023, adhering to preferred reporting items for systematic reviews and meta-analyses guidelines. PubMed, Embase and Google Scholar were used. Search strings were ([Judet] OR [quadricepsplasty]) AND (knee) AND (stiffness) and ([Judet] OR [quadricepsplasty]) AND (knee). Inclusion criteria: English articles focused on PECK, published between 2003 and 2023, and a minimum follow-up of 24 months. Exclusion criteria: case reports, alternative techniques, knee stiffness cases not only due to trauma, a sample size of &lt;10 patients and articles not reporting functional outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among selected studies, 239 patients were considered. The average time between injury and Judet was 27 months. The population was predominantly male; the mean follow-up was 33 months. An average intraoperative knee range of motion improvement of 79.1 degrees (confidence interval 76.9; 81.3) compared to the average preoperative starting value of 30.7 degrees was observed. This improvement decreased by 13.5 degrees at the first postoperative check and by an additional 2.4 degrees at the follow-up, while maintaining an average value of bending above 90 degrees.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Judet quadricepsplasty appears an effective technique for the management of PECK. The heterogeneity of included studies and the absence of standardized outcome measures limit the ability to draw definitive conclusions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"11 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11540935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605078","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":"Comparative histomorphological assessment of the osteoinductive capacity of a nanofibrillated cellulose-based composite and autologous blood clot","authors":"Berik Tuleubayev,&nbsp;Yevgeniy Kamyshanskiy,&nbsp;Dina Saginova,&nbsp;Saule Akhmetova,&nbsp;Vladimir Vinokurov,&nbsp;Amina Koshanova,&nbsp;Yekaterina Kossilova","doi":"10.1002/jeo2.70067","DOIUrl":"10.1002/jeo2.70067","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The present study aimed to evaluate and compare the effect of nanofibrillated cellulose (NFC)-based composite with dicalcium phosphate dihydrate and an autologous blood clot (ABC) on the formation of new bone tissue in vivo by histological and histomorphometric assessment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A total of 72 rats with created femoral defects (2 mm) were used. The rats were divided into three groups: (1) with filling of the defect with an ABC, (2) NFC-1—with filling of both the cortical plate and intramedullary space in the defect area, and (3) NFC-2—with filling of only the intramedullary space in the defect area. Histological and histomorphometric analysis was performed to assess the healing of the bone defect after 14, 30 and 60 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Complete closure of the cortical plate defect was detected in the NFC-2 group on Day 30 (<i>p</i> &lt; 0.0001). Moreover, in both NFC groups on the 30th and 60th days, ongoing osteogenesis was observed, characterized by a large volume of newly formed circular pattern bone tissue in the intramedullary space.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Сonclusion</h3>\u0000 \u0000 <p>This study demonstrated that the NFC-based composite, which is located below the level of the cortical plate, tamponing only the intramedullary space (NFC-2), improves bone tissue repair at the site of a bone defect of the cortical plate and has the potential of prolonged osteoinductivity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Not applicable.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"11 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591844","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":"Enhancing research methods: The role of systematic and scoping reviews in orthopaedics, sports medicine and rehabilitation","authors":"Robert Prill,&nbsp;Aleksandra Królikowska,&nbsp;M. Enes Kayaalp,&nbsp;Nikolai Ramadanov,&nbsp;Jon Karlsson,&nbsp;Michael T. Hirschmann","doi":"10.1002/jeo2.70069","DOIUrl":"10.1002/jeo2.70069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <p>Efforts to improve research standards in orthopaedics, sports medicine, physical therapy, and rehabilitation are ongoing. Rrehabilitation andomized Controlled Trials (RCTs) are widely regarded as the gold standard for the collection of primary data. Similarly, systematic reviews, due to their methodological rigor, have become the gold standard for evidence synthesis in medicine. However, while narrative reviews often lack scientific rigor and systematic reviews are not suited to addressing all research questions, other robust review formats are necessary. When the outcomes of interest are unknown or difficult to define in advance, scoping or mapping reviews are more appropriate, as they can address a broader range of questions within the field. Consequently, it is essential to establish rigorous methods for conducting scoping reviews across medical disciplines.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"11 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11534858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584663","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":"No clinically relevant relationship between different quantitative measurement methods of the lateral femoral condyle morphology on lateral radiographs in anterior cruciate ligament-injured patients","authors":"Steffen T. Ubl,&nbsp;Johannes C. Harmes,&nbsp;Evamaria Koch,&nbsp;Arasch Wafaisade,&nbsp;Daniel Guenther,&nbsp;Bertil Bouillon,&nbsp;Thomas R. Pfeiffer","doi":"10.1002/jeo2.70078","DOIUrl":"10.1002/jeo2.70078","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To clarify whether different methods of quantifying lateral femoral condyle (LFC) bone morphology as risk factors for anterior cruciate ligament (ACL) injury on lateral radiographs should be considered as individual risk factors and to assess inter- and intraobserver reliability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed 487 patients undergoing primary ACL reconstruction at our institution. Routine lateral radiographs of the injured knees were utilized to measure the following parameters: LFC ratio (LFCR), height of LFC to anteroposterior diameter ratio (HAPR), femur tibia size ratio (FTSR), tibia to posterior femoral condyle ratio (TPFCR) and Porto ratios (XY/AB; B/AB; B/XY). Malrotated radiographs were excluded. Pearson's correlation coefficients were used to identify relationships. Intraclass correlation coefficients were calculated for inter- and intraobserver reliability for two raters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-eight patients were included. Means and standard deviations for LFCR were 63.7% ± 2.8%, HAPR 0.35 ± 0.02, FTSR 1.23 ± 0.07, TPFCR 2.99 ± 0.28, XY/AB 0.41 ± 0.08, B/AB 1.20 ± 0.06 and B/XY 3.05 ± 0.58. Significant correlations were observed between FTSR and XY/AB (<i>r</i> = 0.425), B/AB (<i>r</i> = 0.582) and TPFCR (<i>r</i> = −0.326), between XY/AB and HAPR (<i>r</i> = −0.309) and B/XY (<i>r</i> = −0.933) and between TPFCR and B/AB (<i>r</i> = 0.302). Intraobserver agreement was excellent for LFCR, HAPR, FTSR, TPFCR and B/AB and good for XY/AB and B/XY. Interobserver agreement varied from poor for XY/AB and B/XY, good for HAPR, B/AB, FTSR and TPFCR to excellent for LFCR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Different methods of quantifying LFC bone morphology should be considered as individual risk factors, characterized by good to excellent intraobserver reliability, but highly variable interobserver reliability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"11 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11534868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584669","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":"Fear of reinjury after acute Achilles tendon rupture is related to poorer recovery and lower physical activity postinjury","authors":"Elin Larsson,&nbsp;Agnes LeGreves,&nbsp;Annelie Brorsson,&nbsp;Pernilla Eliasson,&nbsp;Christer Johansson,&nbsp;Michael R. Carmont,&nbsp;Katarina Nilsson Helander","doi":"10.1002/jeo2.70077","DOIUrl":"https://doi.org/10.1002/jeo2.70077","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The aim of this study was to investigate how fear of reinjury to the Achilles tendon affects return to previous levels of physical activity and self-reported Achilles tendon Total Rupture Score (ATRS) outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were collected from a large cohort of patients treated for an acute Achilles tendon rupture at Sahlgrenska University Hospital Mölndal between 2015 and 2020. The ATRS and additional questions concerning fear of reinjury, treatment modality, satisfaction of treatment and recovery were analyzed 1–6 years postinjury. Analysis was performed to determine the impact of fear of reinjury on patient-reported recovery and physical activity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of a total of 856 eligible patients, 550 (64%) answered the self-reported questionnaire and participated in the follow-up. Of the participants, 425 (77%) were men and 125 (23%) were women. ATRS, recovery in percentage, satisfaction of treatment, recovery on a 5-point scale and physical activity level post- versus preinjury were significantly related to fear of reinjury (<i>p</i> &lt; 0.001). Of the nonsurgically treated patients, 59% reported fear of reinjury compared to 48% of the surgically treated patients (<i>p</i> = 0.024) Patients that reported fear of reinjury had a 15-point lower median ATRS score than those who did not (<i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>More than half of patients who have suffered an Achilles tendon rupture are afraid of reinjuring their tendon. Patients who reported fear of reinjury exhibited a significantly lower ATRS score. This indicates the importance of addressing psychological aspects in the treatment after this injury.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level II.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"11 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70077","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142561725","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":"Personalized delayed anticoagulation therapy alleviates postoperative bleeding in total knee arthroplasty (TKA) patients","authors":"Xuefeng Luo,&nbsp;Dehua Wang,&nbsp;Wei Xu,&nbsp;Jing Zou,&nbsp;Runxing Kang,&nbsp;Tao Zhang,&nbsp;Xi Liang,&nbsp;Junyi Liao,&nbsp;Wei Huang","doi":"10.1002/jeo2.70074","DOIUrl":"10.1002/jeo2.70074","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Purpose&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Ecchymosis is one of the most common complications following total knee arthroplasty (TKA), which is closely related to postoperative bleeding. However, it is still controversial whether anticoagulation treatment should be continued for postoperative ecchymosis patients. We suppose that personalized delayed anticoagulation therapy could be beneficial for decreasing postoperative bleeding.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A total of 201 TKA patients were retrospectively included in this study, among whom ecchymosis patients received drug anticoagulation treatment 1–2 days later than usual, while nonecchymosis patients received regular drug anticoagulation treatment. The perioperative blood loss, coagulation state, fibrinolytic state and complications were collected and analyzed.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Eighty-nine patients (44.3%) developed ecchymosis within 3 days after TKA. There were no differences in baseline characteristics between the two groups. In the ecchymosis group, higher K values and lower calculated coagulation index values were observed in thromboelastography, along with greater total blood loss and a more significant decrease in haemoglobin levels on postoperative Day 1 (POD1) compared to the nonecchymosis group. Additionally, the ecchymosis patients exhibited higher levels of fibrinogen degradation products and D-dimer (D-D) on POD1, with no differences noted on POD3, indicating that patients with ecchymosis are in a relatively hypocoagulable and hyperfibrinolytic state compared to those without ecchymosis. Therefore, the delayed anticoagulation treatment proved beneficial for correcting these postoperative conditions. No statistically significant differences were found between the two groups in postoperative complications, demonstrating that delayed anticoagulation treatment is safe.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Patients with ecchymosis exhibited a relatively hypocoagulable and hyperfibrinolytic state with a stronger tendency for postoperative bleeding. Delayed anticoagulation in ecchymosis patients could effectively prevent further exacerbation of postoperative bleeding by avoiding sustained hypocoagulable and hyperfibrinolysis states. Personalized delayed anticoagulation therapy could be beneficial for managing postoperative ecchymosis for TKA patients.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Level of Evidence&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Level IV.&lt;/p&gt;\u0000 &lt;/","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"11 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548110","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":"Kinematic versus mechanical alignment: A systematic review of systematic reviews and meta-analyses of randomised controlled trials","authors":"Amir A. Jamali,&nbsp;Adithya Shekhar,&nbsp;Danton Dungy,&nbsp;Susan L. Stewart","doi":"10.1002/jeo2.70044","DOIUrl":"10.1002/jeo2.70044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The purpose of this study was to review the currently available systematic reviews and meta-analyses comparing kinematic alignment (KA) and mechanical alignment (MA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A literature search was performed to obtain all systematic review and meta-analyses comparing KA to MA that included one or more randomised controlled trials. A total of 18 studies were obtained, three of which were systematic reviews without meta-analysis. Studies were evaluated based on their meta-analysis methodology, appropriate inclusion criteria, the use of correct definitions of each alignment technique, and risk of bias.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>These 18 studies included between 3 and 14 RCTs in each study. From the perspective of study design, the majority of papers had low risk of bias. In contrast, most of these reviews had technical issues pertaining to study inclusion in their meta-analyses that would potentially compromise their conclusions. These included mixing time points in the analysis, duplicate inclusion of patients in a meta-analysis, inclusion of studies with incorrect definitions of KA, inclusion of studies performed with restricted kinematic alignment with the KA group, and inappropriate combination of studies with bilateral total knee arthroplasty (TKA) with studies with unilateral TKA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The current literature is inadequate to determine if there is any advantage to KA compared to MA in TKA. Claims made in systematic reviews and meta-analyses on the subject must be carefully scrutinised based not only on risk of bias but also on the included study populations, the surgical methodology of each underlying study, and the authors' understanding of the definitions of each alignment technique.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level 1 based on this study being a systematic review with the inclusion of only systematic reviews and meta-analyses of randomised controlled trials.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"11 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548100","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":"High preservation rates of the ascending branch of the lateral femoral circumflex artery during total hip arthroplasty through the direct anterior approach","authors":"Christian Matar,&nbsp;Camille Vorimore,&nbsp;ReSurg,&nbsp;Frederic Laude","doi":"10.1002/jeo2.70066","DOIUrl":"10.1002/jeo2.70066","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>(i) To investigate the rate of preservation of the ascending branch of the lateral femoral circumflex artery (a-LFCA) during total hip arthroplasty (THA) through a direct anterior approach (DAA), and (ii) to study factors that contribute to its successful preservation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All patients who underwent primary THA between 1 September 2023 and 29 February 2024 were reviewed. One-hundred seventy-two patients were included in the study, 91 females and 81 males, aged 63.2 ± 12.6, with a body mass index of 26.1 ± 4.6 kg/m². THA was performed through a minimally invasive DAA in all patients, using either a standard vertical DAA or a Bikini incision. Patients were stratified by the preservation of the a-LFCA (preserved, ligated/electrocauterized due to obstruction of the surgical field during dissection, electrocauterized due to bleeding during femoral broaching or stem insertion). Descriptive statistics were used to summarise the data. Logistic regression analyses were performed to explore possible factors associated with the preservation of a-LFCA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The a-LFCA was preserved in 130 patients (75.6%), had to be ligated/electrocauterized due to obstruction of the surgical field during dissection in 31 patients (18.0%), and had to be electrocauterized due to bleeding during femoral broaching or stem insertion in 11 patients (6.4%). Multivariable logistic regression analyses revealed that preservation of a-LFCA was significantly more likely in female patients (odds ratio [OR] = 2.22; 95% confidence interval [CI] = 1.1–4.6; <i>p</i> = 0.029), as well as in patients with younger age (OR = 0.97; 95% CI = 0.9–1.0; <i>p</i> = 0.036) and lower weight (OR = 0.97; 95% CI = 0.9–1.0; <i>p</i> = 0.005).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Preservation of the a-LFCA is possible in the majority of patients (75.6%) undergoing THA through minimally invasive DAA. Furthermore, preservation of the a-LFCA is more likely in female patients, younger patients and patients with lower weight.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"11 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548099","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}