Clinics in Orthopedic Surgery最新文献

{"title":"Kinematic Alignment in Total Knee Arthroplasty: Unresolved Challenges and Barriers to Overcome for Universal Application.","authors":"Gio Song, Cheol Hee Park, Sang Jun Song","doi":"10.4055/cios25336","DOIUrl":"10.4055/cios25336","url":null,"abstract":"<p><p>Restoring patient-specific alignment in total knee arthroplasty has emerged as a promising approach to improve joint kinematics and reduce the need for soft-tissue release. Kinematic alignment (KA) and its variants-including restricted, inverse, and functional alignment-seek to replicate the patient's native joint line obliquity (JLO) and pre-arthritic alignment, often guided by classification systems such as the Coronal Plane Alignment of the Knee (CPAK). However, despite the theoretical appeal, the universal adoption of KA remains controversial. This review highlights several concerns, including the risk of early loosening in varus-positioned components, the limited applicability of KA in advanced osteoarthritic knees, the difficulty of applying KA in severe valgus deformity, and the uncertainty in aligning the femoral cylindrical axis with the tibial rotational axis. Moreover, CPAK classification oversimplifies the spectrum of alignment phenotypes, even though JLO exhibits substantial variability in its distribution and its functional significance remains uncertain. Static measurements of JLO may not accurately reflect the dynamic behavior of the joint during gait, especially given compensatory mechanisms in adjacent joints. Evidence also shows poor correlation between 2-dimensional joint line parameters and 3-dimensional joint surface orientation. While restoring native alignment and JLO might remain a worthwhile goal, the limitations of existing classification systems and the paucity of supporting evidence should be acknowledged. KA and its variants offer the potential to restore patient-specific alignment and JLO while minimizing soft-tissue releases, but widespread adoption is limited by unresolved issues such as variability in JLO, unequal CPAK boundaries, and uncertain functional relevance. Until high-quality, long-term studies address these concerns, KA strategies should be applied selectively within safe limits.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 5","pages":"777-787"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185193","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":"Which Injection Is More Effective for Partial-Thickness Rotator Cuff Tear? Atelocollagen Versus Acellular Dermal Matrix.","authors":"Kyoung-Geun Lee, Sung-Hyun Cho, Yang-Soo Kim","doi":"10.4055/cios25167","DOIUrl":"10.4055/cios25167","url":null,"abstract":"<p><strong>Backgroud: </strong>Collagen-inducing injections are emerging as new treatments for partial-thickness rotator cuff tears (PTRCTs). This study aimed to directly compare the effects of atelocollagen and acellular dermal matrix (ADM) injections on PTRCTs.</p><p><strong>Methods: </strong>Between July 2019 and December 2021, 183 patients with PTRCTs who were treated with ultrasound-guided collagen injections were retrospectively enrolled. Two injections were administered at 3-month intervals at the supraspinatus tear site, and tendon integrity was evaluated 6 months after the first injection using magnetic resonance imaging (MRI). The patients were divided into 2 groups: atelocollagen injection (group 1, n = 49) and ADM injection (group 2, n = 41). Supraspinatus tear size was measured in T2 coronal and sagittal views. Outcomes were categorized into 3 groups by tear size change from initial to final follow-up: improved (< 0-2 mm), no interval change (-2 to 2 mm), and worsened (> 2 mm). Clinical scores and range of motion (ROM) were measured in both groups.</p><p><strong>Results: </strong>The atelocollagen group showed improved outcomes in 34.7% of the patients, whereas 55.1% and 10.2% showed no interval change and worsening in the coronal plane, respectively. The ADM group showed improved outcomes in 48.8% of the patients, whereas 48.8% and 2.4% showed no interval change and worsened results in the coronal plane, respectively. The mean change in tear size was -1.02 ± 2.87 mm for group 1 and -2.31 ± 3.62 mm for group 2 (<i>p</i> < 0.05). In the sagittal plane, 20.4% of the patients in group 1 showed improvement, 77.6% showed no interval change, and 2% showed worsened outcomes. Group 2 showed improvement in 31.7% of patients, 58.5% showed no interval change, and 9.8% showed worsened outcomes. Tear size changed by -0.56 ± 1.90 mm for group 1 and -0.8 ± 2.37 mm for group 2 (<i>p</i> > 0.05). No significant differences were noted in the ROM between the 2 groups at any time. Clinical scores also showed no significant differences between the 2 groups, except for the Constant Shoulder Score at the 3-month follow-up.</p><p><strong>Conclusions: </strong>Compared with atelocollagen injection, ADM injection resulted in a superior improvement in rotator cuff tendon integrity. However, clinical outcomes were comparable between the groups.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 5","pages":"872-879"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185137","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":"Learning Curve for Biportal Endoscopic Transforaminal Lumbar Interbody Fusion in a Junior Endoscopic Spine Surgeon: A Phase-Specific Retrospective Analysis.","authors":"Tae Hoon Kang, Sang-Min Park, Byungjun Kang, Minjoon Cho, Jae Hyup Lee","doi":"10.4055/cios25345","DOIUrl":"10.4055/cios25345","url":null,"abstract":"<p><strong>Background: </strong>Biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) is an emerging minimally invasive spinal fusion technique with unique technical demands. Understanding its learning curve is essential for improving surgical efficiency and ensuring patient safety, particularly for junior surgeons with prior biportal decompression experience but limited fusion background.</p><p><strong>Methods: </strong>We retrospectively analyzed 70 consecutive BE-TLIF levels performed by a single junior surgeon with extensive biportal decompression but limited minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) experience (< 10 cases). Learning progression was assessed using learning curve-cumulative summation (LC-CUSUM) and exponential regression analyses. Operative times were evaluated across 6 surgical phases, and perioperative and clinical outcomes were compared between groups stratified by LC-CUSUM proficiency.</p><p><strong>Results: </strong>LC-CUSUM identified procedural competence after 62 levels, while exponential regression demonstrated plateauing around 43 cases. Phase-specific analysis revealed significant reductions in approach and decompression times, with the greatest improvement in cage insertion (37.1% reduction). Bone grafting time increased with experience, reflecting more meticulous technique. Clinical outcomes, including Oswestry Disability Index and Functional Rating Index scores, improved significantly in both groups, with greater functional recovery and fewer complications observed in later cases.</p><p><strong>Conclusions: </strong>BE-TLIF demonstrates a phase-specific learning curve, with proficiency achieved after sufficient case volume. Structured training focusing on decompression and cage insertion may accelerate skill acquisition. Comprehensive inclusion of multi-level cases and phase-specific time analysis provide a robust framework for evaluating technical proficiency in endoscopic spine surgery training.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 5","pages":"848-860"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185213","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":"Identification of Mitochondrial Dynamics-Related Genes as Diagnostic Biomarkers for Osteoarthritis Using Weighted Gene Co-expression Network Analysis and Machine Learning.","authors":"Hui Wang, Peng Zhang, Xinqiang Ren, Kaitao Tan, Yongfeng Qiu, Linqing Li","doi":"10.4055/cios25386","DOIUrl":"https://doi.org/10.4055/cios25386","url":null,"abstract":"<p><strong>Background: </strong>Osteoarthritis (OA) is a chronic, painful joint disease whose early diagnosis is critical for effective treatment. Since mitochondrial dynamics have been implicated in the onset and progression of OA, this study aimed to explore the diagnostic value of mitochondrial dynamics-related genes (MDRGs) in OA.</p><p><strong>Methods: </strong>Weighted gene co-expression network analysis and 3 machine learning algorithms, including least absolute shrinkage and selection operator regression, support vector machine-recursive feature elimination, and Boruta, were used to screen signature genes. The intersection of genes identified by all 3 algorithms was taken as the candidate set. Expression levels of these genes were compared between OA and normal tissues, and receiver operating characteristic curves were used to validate their diagnostic performance, yielding final hub genes. An <i>in vitro</i> OA model was established, and the expression of key genes was validated using quantitative reverse transcription-polymerase chain reaction (qRT-PCR) and Western blot analysis. Immune infiltration in OA was assessed, and hub genes' functional analogs, microRNAs (miRNAs), transcription factors (TFs), and potential drugs were predicted.</p><p><strong>Results: </strong>Two hub genes, CDH11 and MSX2, were identified. Both genes were up-regulated in OA and demonstrated promising diagnostic efficacy. qRT-PCR and Western blot validation revealed that mRNA and protein levels of CDH11 and MSX2 were significantly higher in OA cell models than in normal cells. Based on transcriptomic data, the single-sample gene set enrichment analysis algorithm inferred that significantly higher levels of B cells, macrophages, mast cells, neutrophils, T helper cells, and tumor-infiltrating lymphocytes were found in OA samples than in controls. Twenty functional analogs of the 2 hub genes were predicted, mainly enriched in skeletal system development and bone development functional pathways. Additionally, 34 miRNAs (e.g., hsa-miR-568, hsa-miR-548d-5p, hsa-miR-144) and 17 TFs (e.g., CEBPA, NFATC1, SP1, EGR1, FOXO1) were predicted based on CDH11 and MSX2. Entinostat, estradiol, cobaltous chloride, and valproic acid were identified as potential OA therapeutics.</p><p><strong>Conclusions: </strong>CDH11 and MSX2 may serve as candidate diagnostic biomarkers for OA, identified from a predefined MDRG set, but requiring further mechanistic and clinical validation.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 5","pages":"957-972"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197112","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":"Radiologic Progression of Early-Stage Ankle Osteoarthritis: A Mean 12-Year Follow-up Observational Study.","authors":"Myoung Yeol Shin, Jae Hyeon Seo, Young Kwan Moon, Jin Kyung Kim, Young Rak Choi, Ho Seong Lee","doi":"10.4055/cios26067","DOIUrl":"10.4055/cios26067","url":null,"abstract":"<p><strong>Background: </strong>The natural history of early-stage ankle osteoarthritis (OA) remains poorly defined, and the long-term outcomes of nonoperative management are unclear. This study investigated long-term Takakura stage progression and associated risk factors in early-stage ankle OA managed nonoperatively.</p><p><strong>Methods: </strong>In this study, 57 patients (89 ankles) with Takakura stage I-IIIA ankle OA who were followed up for a mean of 12.1 years were retrospectively reviewed. At the first and final visits, radiographic parameters including Takakura stage, mechanical axis deviation (MAD), hindfoot alignment angle (HAA), hindfoot moment arm (HMA), tibial articular surface angle (TAS), tibial lateral surface angle (TLS), and talar tilt angle (TT) were measured. Clinical outcomes were assessed using the Foot Function Index (FFI) and visual analog scale (VAS). Risk factors for stage progression were evaluated using multivariable logistic regression.</p><p><strong>Results: </strong>Of the 89 ankles, 50 (56.2%) showed no Takakura stage progression, 35 (39.3%) progressed by 1 stage, and 4 (4.5%) progressed by 2 stages. Among ankles classified as stage IIIA at baseline, progression to stage IIIB occurred more frequently in those with hindfoot varus deformity (<i>p</i> = 0.023). In the progression group, HMA, HAA, and TT increased (all <i>p</i> < 0.001), whereas TAS and TLS decreased (<i>p</i> < 0.001 and <i>p</i> = 0.045, respectively). In multivariable analysis, HAA (odds ratio [OR], 2.49; <i>p</i> = 0.076), HMA (OR, 2.09; <i>p</i> = 0.085), and TT (OR, 1.38; <i>p</i> = 0.064) showed statistical trends toward association with progression, whereas TAS, TLS, MAD, initial stage, sex, age, and body mass index (BMI) were not significant predictors. The VAS score improved in the no-progression group (<i>p</i> = 0.008) and worsened in the progression group (<i>p</i> = 0.006), while changes in FFI were not significant.</p><p><strong>Conclusions: </strong>In this 12.1-year follow-up observational study of early-stage ankle OA, no radiographic progression was observed in 56.2% of ankles, 1-stage progression in 39.3%, and 2-stage progression in 4.5%. Progression from stage IIIA to stage IIIB occurred more frequently in ankles with hindfoot varus. Lower limb alignment and clinical factors (sex, age, and BMI) were not significantly associated with OA progression.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 5","pages":"924-933"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197151","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":"Lateral Ulnar Collateral Ligament Reconstruction with Tibialis Anterior Allograft and Internal Brace after Septic Elbow Defects.","authors":"Ki Youn Kwon, Jin Rok Oh, Jisu Park","doi":"10.4055/cios25396","DOIUrl":"10.4055/cios25396","url":null,"abstract":"<p><p>Chronic lateral ulnar collateral ligament (LUCL) insufficiency of the elbow can develop after trauma or infection, resulting in instability and loss of motion. Although internal bracing has demonstrated promising biomechanical strength, clinical evidence combining it with allograft reconstruction remains scarce. We describe a reproducible technique for LUCL reconstruction using a tibialis anterior allograft augmented with an internal brace in patients with post-infectious lateral elbow defects. Both patients underwent staged management with infection control, cement spacer placement, and definitive ligament reconstruction using FiberTape-SwiveLock fixation. At 6 months postoperatively, both elbows achieved stability and near-normal forearm rotation. Case 1 regained almost full motion with a Mayo Elbow Performance Score (MEPS) of 95, while case 2 showed functional improvement despite mild stiffness (MEPS 85). This technique demonstrated robust fixation and clinically meaningful recovery despite compromised tissue conditions, suggesting it may be a viable option for complex post-infectious elbows.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 5","pages":"973-978"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185205","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":"Development and Validation of a Perioperative Risk Update Model for Postoperative Delirium in Patients Aged ≥ 80 Years Undergoing Hip Fracture Surgery: A Retrospective Cohort Study.","authors":"Feifei Zhao, Huan Sai, Shan Peng, Jing Wu, Lingling Wang, Tao Zhang, Xuebin Zhang","doi":"10.4055/cios26062","DOIUrl":"https://doi.org/10.4055/cios26062","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium (POD) remains a frequent and serious complication after hip fracture surgery in very old patients. A clinically usable risk model could facilitate perioperative risk updating and targeted prevention in this vulnerable population.</p><p><strong>Methods: </strong>We retrospectively included consecutive patients aged ≥ 80 years undergoing hip fracture surgery between January 2021 and December 2023 (n = 666). POD during hospitalization was the primary outcome. Candidate predictors covering demographics, comorbidities, perioperative variables, and routine laboratory tests were prespecified. Predictors were selected using least absolute shrinkage and selection operator with 10-fold cross-validation and entered into multivariable logistic regression to develop a nomogram. Discrimination, calibration, and clinical utility were assessed. External validation was conducted in an institutionally related cohort (January 2024 to December 2025) using identical eligibility criteria. Two sensitivity analyses were conducted to assess the robustness.</p><p><strong>Results: </strong>POD occurred in 99 patients (14.9%). The final nomogram included 14 predictors and showed excellent discrimination in the derivation cohort, with an area under the receiver operating characteristic curve (AUC) of 0.913 (95% CI, 0.877-0.948). At the optimal predicted-probability threshold of 0.274, the sensitivity and specificity were 0.788 and 0.922, respectively. Bootstrap calibration demonstrated close agreement between predicted and observed risks, with a bias-corrected mean absolute error of 0.009. In the external validation cohort, the model retained good discrimination, with an AUC of 0.884. In addition, the preoperative-only sensitivity model also retained good predictive performance.</p><p><strong>Conclusions: </strong>This nomogram provides individualized perioperative POD risk estimation for octogenarian patients undergoing hip fracture surgery. Additionally, clinically meaningful risk estimation may also be feasible before surgery.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 5","pages":"788-799"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197128","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":"Short- and Medium-Term Outcomes of Hip Arthroscopy in Patients under 18 Years.","authors":"Roberto Seijas, Luis Pérez-Carro, Jorge Guadilla, Nicolás Fiz, Marc Tey, Jesús Mas, Javier Sanz, Fabián Urraza, Juan Ribera, David Serrano, Oliver Marín","doi":"10.4055/cios26022","DOIUrl":"10.4055/cios26022","url":null,"abstract":"<p><strong>Background: </strong>Femoroacetabular impingement (FAI) is a common cause of hip pain in adolescents and may lead to osteoarthritis. While conservative treatments are the first-line option, arthroscopy offers a minimally invasive approach to repairing labral tears and correcting bone deformities. This study analyzes the outcomes of patients under 18 years old who underwent hip arthroscopy for FAI in a multicenter retrospective cohort with a minimum 5-year follow-up.</p><p><strong>Methods: </strong>This was a retrospective multicenter study. Patients under 18 with a confirmed FAI diagnosis and a minimum follow-up of 5 years were included. Clinical and radiological findings, demographics, and functional outcomes (Tegner, modified Harris Hip Score [mHHS], Hip Outcome Score [HOS], and International Hip Outcome Tool-33 [iHOT-33]) were analyzed pre- and postoperatively. The percentage of patients who achieved improvements exceeding the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) thresholds was also calculated.</p><p><strong>Results: </strong>A total of 90 hips were included (mean age, 16.1 ± 1.5 years). At 5 years, all functional scores improved significantly: mHHS (68.1 ± 16.3 to 96.6 ± 8.7, <i>p</i> < 0.001), iHOT-33 (51.7 ± 20.3 to 85.6 ± 10.8), HOS activities of daily living (71.2 ± 16.6 to 96.1 ± 4.9), and HOS sports subscale (50.3 ± 21.1 to 92.7 ± 8.5). Cam-type deformities were the most prevalent (68.8%), followed by mixed morphologies (22.2%). Labral lesions were repaired in 96.3% of cases, with a mean of 2.9 anchors per repair. The alpha angle significantly decreased postoperatively (62.3° ± 11.8° to 45.6° ± 8.4°, <i>p</i> < 0.001). At 5 years, 85%-94% of patients surpassed the MCID thresholds and 33%-77% reached the SCB thresholds depending on the outcome measure.</p><p><strong>Conclusions: </strong>Hip arthroscopy was associated with significant functional improvement and symptom relief in adolescents with FAI at a minimum 5-year follow-up. Further studies with longer follow-up are necessary to determine its long-term role in joint preservation. Notably, systematic radiological assessment of osteoarthritis progression (e.g., joint space width, Tönnis grade) was not available across all participating centers and could therefore not be analyzed, which constitutes an important limitation of this study.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 5","pages":"950-956"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197156","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":"Association of Intraoperative Ketorolac Administration with Pediatric Anterior Cruciate Ligament Reconstruction Outcomes: A Retrospective Cohort Study.","authors":"Muaaz Wajahath, Ahmad Hassan, Amir Mahdi Ghafarian, Malik Al-Jamal, Abdul-Lateef Shafu, Haytham Al-Qasmi, Walid Yasir","doi":"10.4055/cios25488","DOIUrl":"https://doi.org/10.4055/cios25488","url":null,"abstract":"<p><strong>Background: </strong>Pediatric anterior cruciate ligament reconstruction (ACLR) is increasingly common. Optimizing pain management while minimizing opioid exposure is a priority. Intraoperative ketorolac, a nonsteroidal anti-inflammatory drug (NSAID), is used for analgesia, but its impact on healing and surgical outcomes remains controversial. This study evaluates the effects of intraoperative ketorolac on postoperative outcomes in pediatric ACLR patients (< 18 years).</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the TriNetX national clinical database (102 healthcare organizations). We identified pediatric patients who underwent arthroscopic ACLR (Current Procedural Terminology [CPT] 29888) between 2005 and 2025. Two groups were defined: those who received intraoperative ketorolac (15 or 30 mg intravenous [IV]) and those who did not. Propensity score matching (1 : 1) was performed on baseline covariates (age, sex, race/ethnicity, and comorbidities) to balance the cohorts. Outcomes were assessed at 90 days (opioid utilization and complications) and at 2 years (ACL revision surgery, knee stiffness, and mechanical complications).</p><p><strong>Results: </strong>A total of 3,409 patients met inclusion criteria; 1,443 pairs were successfully matched. At 90 days, the ketorolac group had a slightly lower mean number of opioid prescriptions (1.20 ± 0.44 vs. 1.43 ± 1.26, <i>p</i> = 0.039). Rates of muscle atrophy, wound disruption, and infection were similar (~0.8% in both groups, <i>p</i> = 1.0). The incidence of an opioid dependence diagnosis was low but significantly higher in the ketorolac group (1.0% vs. 0.3%; risk ratio [RR], 4.0; <i>p</i> < 0.001). At 2-year follow-up, most complication rates were similar between groups (e.g., mechanical complications 0.7% each; knee stiffness 12.5% vs. 10.9%, <i>p</i> = 0.18). However, the ketorolac cohort had a significantly higher rate of repeat ACLR (6.0% vs. 2.6%; RR, 2.29; 95% CI, 1.58-3.33; <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Intraoperative ketorolac administration was associated with reduced postoperative opioid requirements and no increase in short-term complications. However, a higher incidence of ACL revision surgery was observed at 2 years, representing an association that does not establish causation.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 5","pages":"837-847"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197175","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":"Effect of Hand Grip Exercise on Rotator Cuff Strength and Shoulder Function Recovery after Arthroscopic Rotator Cuff Repair: A Prospective Randomized Controlled Trial.","authors":"Byeong Sun Park, Seung Ik Cho, Da Hui Jeong, Hailey Nam, Ji Seung Yoo, Dong Hwan Lee, Seok Won Chung","doi":"10.4055/cios25284","DOIUrl":"10.4055/cios25284","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the effect of hand grip exercise on rotator cuff strength and shoulder function after arthroscopic rotator cuff repair.</p><p><strong>Methods: </strong>Ninety patients who underwent arthroscopic rotator cuff repair were randomly allocated into the grip exercise group (n = 45) and control group (n = 45). The hand grip strengthening exercise (3 sets of 15 repetitions, twice daily) was applied only to the grip exercise group immediately after surgery up to 3 months. From 3 months postoperatively, the same rotator cuff and periscapular muscle strengthening exercises were applied to both groups. The isometric strength of the shoulder joint (abductor, external rotator, and internal rotator) and periscapular muscles, tone and stiffness of the upper trapezius muscle, range of motion (ROM), pain visual analog scale (VAS) score, American Shoulder and Elbow Surgeons score, Constant score, and University of California, Los Angeles score were measured preoperatively and at 3, 6, and 12 months postoperatively. Changes in the supraspinatus muscle atrophy and repair integrity were assessed via magnetic resonance imaging at 6 months postoperatively.</p><p><strong>Results: </strong>At 3 months, abductor, external rotator, and internal rotator muscle strengths were not significantly different between groups, but at 6 months, the grip exercise group showed significantly higher external rotator and internal rotator strengths (all <i>p</i> < 0.05). Similarly, the periscapular muscle strengths were not different at 3 months, but the serratus anterior muscle strength was higher in the grip exercise group at 6 months (<i>p</i> = 0.034). At 12 months postoperatively, the differences in the external rotator and internal rotator muscle strengths, and serratus anterior muscle strength disappeared. There were no significant differences in the tone and stiffness of the upper trapezius muscle, ROM, pain VAS, and functional scores. In addition, changes in the supraspinatus muscle atrophy and the repair integrity were not different between groups.</p><p><strong>Conclusions: </strong>Hand grip exercise affected the rotator cuff and periscapular muscle strengths at 6 months after rotator cuff repair. The grip exercises can effectively and safely promote a faster recovery of shoulder muscle strength and function, without compromising rotator cuff healing.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 5","pages":"880-892"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197148","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}