Clinics in Orthopedic Surgery最新文献

{"title":"Posterior Osteophyte Resection from the Medial Femoral Condyle Increases Medial Gap of Extension and Mid-Flexion in Total Knee Arthroplasty.","authors":"Ji Hyun Ahn, Ki-Tae Park","doi":"10.4055/cios26098","DOIUrl":"https://doi.org/10.4055/cios26098","url":null,"abstract":"<p><strong>Background: </strong>The present study aimed to determine the effect of posterior osteophyte resection from the medial femoral condyle on the medial gap increase in varus osteoarthritis during posterior-stabilized total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>One hundred and eight cases of primary posterior-stabilized TKA for varus knee osteoarthritis were reviewed retrospectively. In a preoperative lateral view of the knee radiograph, 39 cases had the largest size osteophyte of the posterior femoral condyle > 5 mm (large osteophyte group) and 69 cases had 0 to 5 mm (small osteophyte group). After femoral component trial insertion, the posterior osteophyte of the medial femoral condyle was removed using a curved osteotome. Medial and lateral joint gaps at 0°, 45°, and 90° of flexion were measured intraoperatively before and after the posterior osteophyte resection from the medial femoral condyle.</p><p><strong>Results: </strong>The large osteophyte group showed a significantly larger increase in medial gap change at 0° and 45° of flexion than the small osteophyte group (medial gap increase at 0°: 0.2 ± 0.4 mm in the small osteophyte group and 2.9 ± 1.4 mm in the large osteophyte group, <i>p</i> < 0.001; medial gap increase at 45°: 0.3 ± 0.5 mm in the small osteophyte group and 1.7 ± 0.8 mm in the large osteophyte group, <i>p</i> < 0.001). At 0° and 45° of flexion, medial gap values after osteophyte resection were significantly larger than before osteophyte resection in both groups (<i>p</i> < 0.001). In linear regression analysis, posterior osteophyte size was also significantly associated with medial gap change at 0° and 45° of flexion (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Resection of large posterior osteophytes > 5 mm from the medial femoral condyle can be expected to result in a larger increase in the medial gap than resection of osteophytes ≤ 5 mm. Surgeons need to pay close attention to these intraoperative changes in the medial gap after posterior osteophyte resection to achieve appropriate mediolateral balance during TKA.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 5","pages":"828-836"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of Thoracic Reciprocal Change and Its Relationship to Proximal Junctional Kyphosis Following Lower Thoracic Fusion for Lumbar Flatback Deformity.","authors":"Tae Soo Shin, Jin-Sung Park, Dong-Ho Kang, Chong-Suh Lee, Se-Jun Park","doi":"10.4055/cios26089","DOIUrl":"https://doi.org/10.4055/cios26089","url":null,"abstract":"<p><strong>Background: </strong>Lumbar flatback deformity (LFD) is characterized by the loss of lumbar lordosis (LL) and global sagittal malalignment, often necessitating thoracolumbar corrective surgery. Lumbar correction induces adaptive changes in unfused thoracic segments, known as thoracic reciprocal change (RC); however, its independent clinical significance remains debatable. This study aims to identify factors associated with thoracic RC after lower thoracic fusion for LFD and to evaluate its independent effect on the development of proximal junctional kyphosis (PJK).</p><p><strong>Methods: </strong>This retrospective study included 190 patients who underwent lower thoracic fusion (upper instrumented vertebra at T9 or T10) to the sacrum or pelvis for LFD, with a 2-year follow-up. Sagittal parameters were evaluated preoperatively at 6 weeks postoperatively, and at 2 years. Thoracic RC was defined as the change in thoracic kyphosis (TK) from the preoperative baseline to 6 weeks postoperatively. Thoracic flexibility was assessed using the standing-supine TK difference. Multivariate linear regression was used to identify factors influencing thoracic RC, and multivariate logistic regression was performed to determine independent risk factors for PJK.</p><p><strong>Results: </strong>Mean TK increased from 5.7° (supine) preoperatively to 26.0° at 6 weeks, resulting in a mean thoracic RC of 20.3°. Thoracic RC was significantly associated with lower preoperative TK, greater thoracic flexibility, greater LL correction, and lower postoperative pelvic incidence (PI) minus LL (PI-LL) mismatch (adjusted <i>R</i> ² = 0.647). PJK occurred in 47 patients (24.7%). However, the magnitude of thoracic RC did not differ between patients with and without PJK (20.9° vs. 20.0°, <i>p</i> = 0.678). Higher preoperative TK and lower postoperative PI-LL mismatch were independently associated with PJK, whereas thoracic RC was not.</p><p><strong>Conclusions: </strong>Thoracic RC after lower thoracic fusion is primarily determined by preoperative thoracic characteristics and the magnitude of lordosis correction. Although associated with an early increase in the postoperative junctional angle, thoracic RC itself does not independently predict the development of PJK. These findings suggest that thoracic RC appears to behave as a compensatory adaptation to sagittal realignment rather than an independent driver of PJK.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 5","pages":"861-871"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Mortality and Revision Rates between Cemented and Cementless Fixation in Bipolar Hemiarthroplasty: A Nationwide Cohort Study.","authors":"Jung-Wee Park, Danbee Kang, Hyunsoo Kim, Eunjee Kang, Juhee Cho, Young-Kyun Lee","doi":"10.4055/cios25301","DOIUrl":"https://doi.org/10.4055/cios25301","url":null,"abstract":"<p><strong>Backgroud: </strong>The purpose of this study was to compare the mortality and the revision rates between patients undergoing cementless hemiarthroplasty (HA) and cemented HA using national claims data in South Korea.</p><p><strong>Methods: </strong>We identified patients who received HA from January 2003 to December 2019 using procedural codes and categorized them into 2 groups according to the fixation method: with or without cement. Orthopedic complications including dislocations, periprosthetic fractures (PPFs), and periprosthetic joint infections were evaluated. The revision survivorship was calculated using the following endpoints: stem revision only, conversion to total hip arthroplasty (THA) (including stem revision), any stem revision, conversion to THA (cup only), and any revision. Short-term mortality and adverse cardiac events were also assessed.</p><p><strong>Results: </strong>A total of 175,841 patients including 64,786 (36.8%) with cement and 111,055 (63.2%) without cement received HA. The cemented group (80.5 ± 8.1 years) was older than the cementless group (77.8 ± 10.3 years) (<i>p</i> < 0.001) and had fewer comorbidities. The PPFs were less common in the cemented group (adjusted hazard ratio [aHR], 0.64; 95% CI, 0.58-0.70). The risk of conversion to THA was higher (aHR, 1.66; 95% CI, 1.39-1.98); however, the risks of stem revision only (aHR, 0.61; 95% CI, 0.53-0.70), any stem revision (aHR, 0.88; 95% CI, 0.79-0.98), and any revision (aHR, 0.81; 95% CI, 0.76-0.87) were lower in the cemented group. The cemented group had a 5-fold higher mortality rate (10 / 64,786) on the day of surgery compared to the cementless group (2 / 111,055). The adjusted in-hospital mortality was higher in the cemented group (aHR, 1.53; 95% CI, 1.45-1.62). The cemented group had higher risks of myocardial infarction (aHR, 1.28; 95% CI, 1.09-1.51), stroke (aHR, 1.27; 95% CI, 1.18-1.36), and heart failure (aHR, 1.32; 95% CI, 1.22-1.43) compared to the cementless group.</p><p><strong>Conclusions: </strong>Cemented fixation had a higher risk of short-term mortality and adverse cardiac events after HA, while it had a lower risk of femoral stem revision and PPFs.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 5","pages":"800-812"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Revision Modified Broström Procedure with Periosteal Flap Augmentation in Patients with Recurrent Chronic Ankle Instability.","authors":"Jong Jin Moon, Myeong Jun Song, Jun Young Lee","doi":"10.4055/cios26081","DOIUrl":"https://doi.org/10.4055/cios26081","url":null,"abstract":"<p><strong>Background: </strong>Although the modified Broström procedure (MBP) is widely accepted as the standard surgical treatment for chronic ankle instability (CAI), recurrent instability remains a clinical challenge, particularly in patients with poor tissue quality or high functional demands. To overcome these limitations, periosteal flap augmentation has been proposed as a biological alternative for patients with recurrent CAI after failed MBP. This study evaluated the clinical and radiographic outcomes of revision MBP with periosteal flap augmentation.</p><p><strong>Methods: </strong>Fourteen patients (mean age, 29.5 years; range, 18-45 years) who underwent revision MBP combined with periosteal flap augmentation between 2018 and 2023 were retrospectively reviewed. The mean follow-up duration was 23.7 months (18-32 months). Clinical outcomes were assessed using the visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, and Karlsson-Peterson score. Radiographic evaluation included talar tilt angle and anterior talar displacement.</p><p><strong>Results: </strong>At a mean follow-up of 23.7 months (18-32 months), all clinical scores improved significantly (VAS: 5.9 to 1.6; AOFAS: 64.1 to 90.6; Karlsson-Peterson: 50.7 to 90.0; <i>p</i> < 0.001). Radiographic stability also improved significantly (talar tilt: 10.7° to 4.9°; anterior displacement: 8.9 mm to 4.1 mm; <i>p</i> < 0.001). No recurrent instability was observed. Three patients had minor wound complications, all of which resolved with conservative treatment.</p><p><strong>Conclusions: </strong>Revision MBP with periosteal flap augmentation showed favorable short-term clinical and radiographic outcomes in patients with recurrent CAI after failed MBP. This technique may serve as a useful autologous reinforcement option in selected revision cases.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 5","pages":"944-949"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Sacro-Femoral-Pubic Angle May Estimate Pelvic Tilt in Patients with Severe Developmental Dysplasia of the Hip and Leg Length Discrepancy Undergoing Total Hip Arthroplasty.","authors":"Özgür Avci, Alpaslan Öztürk, Yavuz Akalın, Nazan Çevik, Oğuz Çetin, Furkan Yeşilbursalı","doi":"10.4055/cios26199","DOIUrl":"10.4055/cios26199","url":null,"abstract":"<p><strong>Background: </strong>Spinopelvic movement disorders are associated with instability after total hip arthroplasty (THA). In patients with Crowe type 3-4 developmental dysplasia of the hip (DDH) and leg length discrepancy (LLD), sagittal radiographs may not allow accurate assessment of spinopelvic motion. This study aimed to evaluate the sacro-femoral-pubic (SFP) angle, a coronal plane parameter, as a predictor of calculated pelvic tilt (PT).</p><p><strong>Methods: </strong>Thirty-two patients with neglected unilateral Crowe type 3-4 DDH who underwent THA were retrospectively analyzed. Preoperative SFP angle and sacral slope (SS) were measured, and preoperative PT was calculated using postoperative pelvic incidence and preoperative SS values.</p><p><strong>Results: </strong>The SFP angle showed a strong negative correlation with calculated PT (<i>r</i> = -0.77, <i>p</i> < 0.001). Linear regression analysis demonstrated that the SFP angle was a significant predictor of PT (β = -1.02, 95% CI, -1.32 to -0.72; adjusted <i>R</i> ² = 0.58). The regression model demonstrated a root mean square error of 5.46°.</p><p><strong>Conclusions: </strong>The SFP angle may serve as an indirect surrogate for calculated PT in patients with Crowe type 3-4 DDH and LLD when preoperative sagittal spinopelvic assessment is not feasible prior to THA or spinal deformity surgery.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 5","pages":"821-827"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Second Ray Pathologies Associated with Hallux Valgus: A Radiographic Comparative Study.","authors":"Jahyung Kim, Min Gyu Kyung, Taewook Kim, Yong Cheol Hong, Seongjae Hwang, Kyoung Min Lee, Dong Yeon Lee","doi":"10.4055/cios25438","DOIUrl":"https://doi.org/10.4055/cios25438","url":null,"abstract":"<p><strong>Background: </strong>Specific factors associated with different pathological mechanisms on the second ray in hallux valgus deformity (HV) are underrepresented in the literature. This study aimed to compare radiographic features of HV with distinct second ray pathologies and identify factors associated with specific second ray pathological conditions.</p><p><strong>Methods: </strong>This retrospective cross-sectional study compared preoperative radiographic measurements between patients with HV who underwent isolated HV surgery (HV group), HV surgery with a concurrent procedure for lesser metatarsophalangeal (MTP) joint lesions (MTP group), and HV surgery with arthrodesis for tarsometatarsal (TMT) joint osteoarthritis (TMT group).</p><p><strong>Results: </strong>The TMT group demonstrated significantly higher radiographic parameters representing first ray hypermobility (first metatarsal-medial cuneiform angle and first TMT dorsoplantar gap), midfoot instability (first-second metatarsal distance), and flatfoot deformity (talonavicular coverage angle and lateral Meary's angle) than other groups. The MTP group had a significantly longer second metatarsal length. Factors associated with the MTP group were first metatarsal-medial cuneiform angle (odds ratio [OR], 0.845), lateral Meary's angle (OR, 0.757), and second metatarsal length (OR, 7.384). Factors associated with the TMT group included talonavicular coverage angle (OR, 1.323), first TMT dorsoplantar gap (OR, 5.345), and lateral Meary's angle (OR, 1.387).</p><p><strong>Conclusions: </strong>HV without radiographic features of midfoot instability tended to be associated with lesser MTP joint lesions, whereas HV with radiographic features of midfoot instability was more commonly associated with lesser TMT joint osteoarthritis. Further prospective longitudinal studies are required to clarify causal relationships among these associations.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 5","pages":"934-943"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Accuracy of Acetabular Cup Positioning with an Automatic Impaction Device in Total Hip Arthroplasty.","authors":"Hyeongmin Song, Chan Young Lee, Taek-Rim Yoon, Kyung-Soon Park","doi":"10.4055/cios26102","DOIUrl":"https://doi.org/10.4055/cios26102","url":null,"abstract":"<p><strong>Background: </strong>Traditionally, cementless total hip arthroplasty (THA) has been primarily performed using a manual technique involving a hammer and an impactor. During cup insertion into the acetabulum, the manual technique may cause temporary limitations in visualization, discrepancies in the applied force, and imbalances in the force vector. Recently, automatic impaction devices have been developed and adopted for cup insertion. The purpose of this study was to compare the accuracy of cup positioning in primary THA between the manual technique and the use of an automatic impaction device.</p><p><strong>Methods: </strong>A total of 67 hips that underwent primary THA were retrospectively evaluated: 36 hips using the manual technique and 31 hips using an automatic impaction device. The accuracy of acetabular cup positioning between the 2 groups was compared using the Lewinnek safe zone, which indicates accurate cup placement, based on postoperative measurements of cup anteversion and inclination angle. Six methods for measuring anteversion were applied in this study. In addition, the incidence of acetabular screw augmentation and the occurrence of intraoperative and postoperative complications up to 1 year after surgery were assessed.</p><p><strong>Results: </strong>The proportion of cases positioned within the Lewinnek safe zone was higher in the automatic group than in the manual group across all measurement methods. Regarding postoperative complications, 1 episode of dislocation occurred in the manual group, but the difference between the groups was not statistically significant.</p><p><strong>Conclusions: </strong>An automatic impaction device can improve the accuracy of THA cup positioning compared with the manual technique.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 5","pages":"813-820"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Effects of Acellular Dermal Matrix and Atelocollagen Injections in Intratendinous Partial-Thickness Rotator Cuff Tears: A Retrospective Cohort Study.","authors":"Jae-Yoon Baek, Eun-Ji Yoon, Kyeong-Eon Kwon, Jong-Ho Kim","doi":"10.4055/cios26122","DOIUrl":"https://doi.org/10.4055/cios26122","url":null,"abstract":"<p><strong>Background: </strong>The purpose was to compare the functional and structural outcomes between injectable acellular dermal matrix (ADM) and atelocollagen in patients with intratendinous partial-thickness rotator cuff tears.</p><p><strong>Methods: </strong>From January 2020 to May 2021, 115 consecutive patients with magnetic resonance imaging (MRI)-confirmed intratendinous partial-thickness supraspinatus tears who met the inclusion criteria were retrospectively identified. After applying predefined exclusion criteria, 85 patients remained for final analysis and were categorized into 2 groups: intratendinous injection with 1 mL ADM (group A, n = 40) and 1 mL type I atelocollagen (group B, n = 45). The visual analog scale (VAS) score for pain, American Shoulder and Elbow Surgeons (ASES) score, Constant Shoulder score (CSS), and range of motion (ROM) were evaluated before injection and at 1, 3, 6, and 9 months and the last follow-up after injection. MRI was performed at 6 months after injection to evaluate rotator cuff integrity and healing response.</p><p><strong>Results: </strong>The mean follow-up period was 14.1 months. Both groups demonstrated significant improvements in pain, functional outcomes, and ROM from baseline to final follow-up. ASES scores increased from 60.3 to 88.4 in group A and from 67.4 to 90.2 in group B (both <i>p</i> < 0.001). CSS improved from 58.3 to 73.2 in group A and from 61.1 to 71.9 in group B (both <i>p</i> < 0.001). External rotation at the side improved significantly in both groups (group A: 73.7° to 80.5°, <i>p</i> = 0.035; group B: 74.2° to 79.5°, <i>p</i> = 0.011), and other ROM parameters demonstrated similar longitudinal improvement. Activity VAS decreased from 5.1 to 1.5 in group A and from 5.8 to 1.5 in group B. However, no statistically significant differences were observed between the 2 treatment groups in any clinical outcome measures at final follow-up. MRI demonstrated tendon improvement in 32.5% of ADM-treated and 35.6% of atelocollagen-treated patients (<i>p</i> = 0.821).</p><p><strong>Conclusions: </strong>Both ADM and atelocollagen injections were associated with clinically meaningful improvement in patients with intratendinous partial-thickness rotator cuff tears, with generally maintained MRI-based structural outcomes at follow-up.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 5","pages":"893-904"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geometric Tear Configuration Influences Intraoperative Reparability after Arthroscopic Rotator Cuff Repair.","authors":"Hyun Gon Kim, Yeong Jeon, Dong Hun Suh, Jung Ho Park","doi":"10.4055/cios26041","DOIUrl":"https://doi.org/10.4055/cios26041","url":null,"abstract":"<p><strong>Background: </strong>Rotator cuff (RC) tear morphology is thought to influence reparability and healing potential, yet few clinical studies have compared outcomes across distinct tear patterns. The purpose of this study was to determine whether different RC tear patterns affect reparability and retear rate following arthroscopic repair.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 134 patients who underwent arthroscopic repair for posterosuperior RC tears between 2018 and 2022. Tears were classified arthroscopically into 5 geometric patterns-crescent, anterior L-shaped, posterior L-shaped, U-shaped, and trapezoid-based on a modified Burkhart-Davidson system. Reparability was assessed by the ability to achieve ≥ 50% footprint coverage at the time of surgery. Structural integrity was evaluated by magnetic resonance imaging at 6 months postoperatively. Additionally, a subgroup analysis was performed by matching crescent and anterior L-shaped tears based on tear size using propensity score matching.</p><p><strong>Results: </strong>Crescent-shaped tears were most common (47.8%), followed by anterior L-shaped (28.4%), trapezoid-shaped (11.2%), U-shaped (9.0%), and posterior L-shaped tears (3.7%). Interobserver agreement for tear pattern classification was moderate (κ = 0.634). Incomplete repair was associated with larger tear dimensions and tear pattern, with trapezoid-shaped tears demonstrating the highest rate of incomplete repair. Anterior L-shaped tears showed the lowest incomplete repair rate. Retear was associated with larger tear size, lower muscle occupation ratio, and greater fatty infiltration on univariate analysis; however, no variables remained independently associated with retear on multivariable analysis. In the propensity score-matched cohort (32 anterior L-shaped vs. 32 crescent-shaped tears), anterior L-shaped tears demonstrated a lower rate of incomplete repair (18.8% vs. 43.8%, <i>p</i> = 0.031), while retear rates were similar between groups.</p><p><strong>Conclusions: </strong>RC tear pattern was associated with intraoperative reparability after arthroscopic repair but did not independently predict postoperative structural healing. Anterior L-shaped tears demonstrated higher reparability than crescent-shaped tears, whereas retear rates were comparable. Tear pattern recognition may assist surgical planning rather than serve as a standalone prognostic factor for tendon healing.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 5","pages":"912-923"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conservative Treatment with Adjunctive Use of Teriparatide for Periprosthetic Humeral Fractures after Reverse Total Shoulder Arthroplasty: A Report of 6 Cases.","authors":"Hyuk-Joon Sohn, Bum-Soon Park, Junkyung Hwang, Jong Pil Yoon, Jin-Young Bang, Chul-Hyun Cho","doi":"10.4055/cios26155","DOIUrl":"10.4055/cios26155","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic humeral fractures (PPHFs) after reverse total shoulder arthroplasty (RTSA) are challenging complications, particularly in elderly patients with osteoporotic bone and multiple comorbidities. Although surgical treatment is commonly recommended for displaced fractures, conservative management may be preferable in high-risk patients. This study reports 6 cases of PPHF after RTSA successfully treated with conservative management incorporating adjunctive teriparatide therapy.</p><p><strong>Methods: </strong>Six patients (mean age, 77.2 years; range, 70-87 years) who developed PPHF after RTSA were treated nonoperatively with daily subcutaneous teriparatide (20 µg) and immobilization using an abduction brace. The mean follow-up duration was 23.8 months (range, 12-36 months). Fractures were classified according to the Wright and Cofield classification system. Radiographic outcomes were assessed using serial plain radiographs. Clinical outcomes were evaluated using the visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, and active range of motion.</p><p><strong>Results: </strong>Fracture patterns included type A (n = 1), type B (n = 4), and type C (n = 1). Radiographic union was achieved in all patients (100%) at a mean of 2.7 months (range, 2-4 months). One patient developed malunion. At final follow-up, the mean VAS pain score was 2.2 and the mean ASES score was 69.8. No teriparatide-related adverse events were observed.</p><p><strong>Conclusions: </strong>Conservative management with adjunctive teriparatide therapy resulted in reliable radiographic union of PPHF following RTSA in selected patients. In addition to fracture classification, factors such as fracture displacement, angular deformity, implant stability, and patient-specific clinical characteristics should be carefully considered when determining treatment strategy. This approach may represent a viable alternative for elderly patients with substantial medical comorbidities in whom surgical treatment carries considerable risk.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 5","pages":"905-911"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}