Clinics in Orthopedic Surgery最新文献

{"title":"Impact of In-Hospital Osteoporosis Treatment on Post-discharge Medication Continuity in Osteoporotic Fracture Patients: Implications for Care Continuity.","authors":"Seung Hoon Kim, Seoyeong Choi, Yonghan Cha, Eunjeong Choi, Suk-Yong Jang","doi":"10.4055/cios25226","DOIUrl":"10.4055/cios25226","url":null,"abstract":"<p><strong>Background: </strong>Despite the well-established benefits of osteoporosis medication in reducing the risk of secondary fractures and mortality, post-fracture treatment rates remain suboptimal. The hospitalization period represents a critical opportunity to initiate therapy, yet the impact of in-hospital osteoporosis treatment on long-term adherence has not been fully evaluated in the Korean population.</p><p><strong>Methods: </strong>This retrospective cohort study used data from the National Health Insurance Service sample cohort in South Korea. Patients aged ≥ 50 years who were hospitalized for osteoporotic fractures, including surgically and conservatively managed cases, between 2007 and 2019, were included. The primary exposure was receipt of osteoporosis medication during hospitalization, and the primary outcome was medication continuation within 1 year post-discharge. Log-binomial regression models were used to estimate adjusted risk ratios (aRRs) for post-discharge medication continuation, adjusted for demographic, socioeconomic, and clinical variables. Subgroup analyses were conducted by age, sex, fracture site, income level, and residential region.</p><p><strong>Results: </strong>Of 19,021 patients with osteoporotic fractures, 25.9% received osteoporosis treatment during hospitalization. The 1-year post-discharge medication rate was 75.8% in the treatment group, compared to 25.4% in the non-treatment group. The aRR for post-discharge medication continuation was 2.23 (95% CI, 2.14-2.32). Similar effects were observed for both oral (aRR, 2.26) and injectable (aRR, 2.13) medications. Subgroup analysis revealed stronger associations in males (aRR, 5.01), younger patients (50-70 years; aRR, 2.93), and those with minor fractures (aRR, 3.22). Although the overall continuation rate was lower in older adults and patients with major fractures, in-hospital treatment was still positively associated with improved adherence.</p><p><strong>Conclusions: </strong>In-hospital initiation of osteoporosis medication was associated with improved post-discharge treatment continuity in patients with osteoporotic fractures. Incorporating structured osteoporosis management into inpatient orthopedic care pathways may help enhance long-term adherence and support secondary fracture prevention.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 3","pages":"571-580"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144995","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":"Proximal Tibial Resection Alone Leads to a Significant Increase in Flexion Gap Size in Tibia-First Robotic-Assisted Posterior-Stabilized Total Knee Arthroplasty.","authors":"Khairul Anwar Ayob, David W Liu","doi":"10.4055/cios25302","DOIUrl":"10.4055/cios25302","url":null,"abstract":"<p><strong>Background: </strong>Alignment philosophies in total knee arthroplasty (TKA) have shifted from universal mechanical alignment to patient-specific strategies aiming to optimize soft-tissue balance and improve satisfaction. Robotic-assisted TKAs have enhanced preoperative planning and intraoperative assessments, but the effects of sequential bone cuts on joint gaps remain unclear. This study evaluates whether flexion and extension gaps change after the tibial resection in tibia-first (TF) robotic-assisted posterior-stabilized (PS) TKA.</p><p><strong>Methods: </strong>A prospective observational study included 82 knees (78 patients) undergoing robotic-assisted TKA with a TF workflow. Gap assessments were recorded pre- and post-proximal tibial bone resection, both after posterior cruciate ligament (PCL) excision, using the Velys robotic system software. Changes in medial and lateral flexion and extension gaps were analyzed as paired measurements and correlated with femoral component modifications.</p><p><strong>Results: </strong>Removal of the proximal tibial bone cut in isolation led to significant changes in the measured gaps, disproportionately more for the flexion than extension space. Medial and lateral flexion gaps increased by a mean of 2.57 mm and 2.30 mm, respectively, compared to minor changes in mean extension gaps (0.26 mm medially and -0.31 mm laterally) (<i>p</i> < 0.001). These changes influenced component sizing and positioning, with femoral component upsizing or component flexion performed in 70% of cases to balance the flexion and extension gaps.</p><p><strong>Conclusions: </strong>Proximal tibial bone resection, independent of PCL excision, significantly affects flexion gap size in PS-TKA, often necessitating intraoperative adjustments to femoral component size and position. The TF approach allows surgeons a second chance to optimize ligament balance through femoral component positioning, to achieve their desired balance target. While the clinical benefits of this intraoperative flexibility are intuitive, further research is warranted to establish whether this improves patient clinical outcome and satisfaction.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 3","pages":"449-460"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144959","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":"Clinical Outcomes and Complications of Superior Capsular Reconstruction Versus Reverse Shoulder Arthroplasty for Massive Rotator Cuff Tears: A Meta-Analysis.","authors":"Napatpong Thamrongskulsiri, Danaithep Limskul, Thanathep Tanpowpong, Somsak Kuptniratsaikul, Thun Itthipanichpong","doi":"10.4055/cios25259","DOIUrl":"10.4055/cios25259","url":null,"abstract":"<p><strong>Background: </strong>Irreparable rotator cuff tears without advanced arthritis are difficult to manage. Superior capsular reconstruction (SCR) preserves the native joint, while reverse total shoulder arthroplasty (rTSA) offers reliable function but with higher implant-related risks, especially in younger patients. This study compared outcomes and complications between SCR and rTSA.</p><p><strong>Methods: </strong>This study was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. PubMed, Scopus, and Ovid Medline were searched from inception to May 2, 2025, for studies directly comparing SCR and rTSA in patients with irreparable rotator cuff tears without advanced arthritis. Eligible studies were required to report at least 1 of the following outcomes: patient-reported outcome scores, shoulder range of motion, or postoperative complications. Outcomes of interest included patient-reported outcomes, shoulder range of motion, and postoperative complications.</p><p><strong>Results: </strong>Seven level III studies involving 257 patients in the SCR group (age, 54.2-73.6 years; follow-up, 2.1-51.6 months) and 173 in the rTSA group (age, 63-77 years; follow-up, 24-48.3 months) met inclusion criteria. Meta-analysis showed no statistically significant differences between SCR and rTSA in American Shoulder and Elbow Surgeons scores (mean difference [MD] = 1.66; 95% CI, -3.44 to 6.77; <i>p</i> = 0.520), pain visual analog scale (MD = 0.16; 95% CI, -0.63 to 0.95; <i>p</i> = 0.690), or any range of motion parameters, including abduction, forward flexion, external rotation, and internal rotation. However, SCR demonstrated a statistically significantly lower overall complication rate compared to rTSA (3.5% vs. 10.8%; odds ratio, 0.32; <i>p</i> = 0.020). Complications following SCR were mainly graft- or tendon-related, whereas those after rTSA were typically mechanical or bone-related, including scapular notching, acromial fracture, and implant loosening.</p><p><strong>Conclusions: </strong>At short- to midterm follow-up, SCR provides similar clinical outcomes to rTSA in patients with irreparable rotator cuff tears without advanced arthritis. However, the complication rate was higher in the rTSA group. Complications following SCR were primarily graft- or tendon-related, whereas rTSA complications were more often mechanical or bone-related.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 3","pages":"485-497"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144926","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 Postoperative Outcomes of Rotational Acetabular Osteotomy Using Autografts and Allografts.","authors":"Tsuguaki Hosoyama, Nobuhiro Kaku, Yutaro Shibuta","doi":"10.4055/cios25092","DOIUrl":"10.4055/cios25092","url":null,"abstract":"<p><strong>Background: </strong>Developmental dysplasia of the hip (DDH) contributes to the progression of hip osteoarthritis (OA), particularly in younger individuals. To delay OA development, joint-preserving procedures such as rotational acetabular osteotomy (RAO) improve hip stability by repositioning the acetabulum. Originally introduced by Ninomiya and Tagawa, RAO involves filling the osteotomy gap with autografts or allografts. Since 2013, our institution has transitioned from autografts to allografts. This study compares postoperative outcomes between these graft materials, as no prior studies have directly examined their efficacy.</p><p><strong>Methods: </strong>A retrospective analysis of 59 patients (62 hips) who underwent RAO for DDH between June 2006 and June 2022 was conducted. Patients with advanced OA, prior acetabular osteotomy, or inadequate follow-up were excluded. The cohort included 1 male and 58 female patients (mean age, 40.8 years). Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) hip score, while radiographic evaluations included center-edge (CE) angle, Sharp angle, acetabular roof obliquity (ARO), acetabular head index, joint space width, and graft thickness. Bone fusion was assessed using Knight's classification, and statistical comparisons were performed between autograft and allograft groups.</p><p><strong>Results: </strong>Preoperative JOA hip scores were comparable (autograft: 69 ± 14, allograft: 61.9 ± 15.5). At 1 year, both groups demonstrated significant improvement (autograft: 92.3 ± 6.2, allograft: 90.8 ± 6.0). Radiographic evaluations showed improved CE, Sharp angles, and ARO values in both groups, with no significant intergroup differences. Bone fusion progressed similarly, with trabecular reorientation occurring around 25 months. Joint survival rates were 93% at 15 years (autograft) and 100% at 10 years (allograft).</p><p><strong>Conclusions: </strong>RAO with autografts and allografts yielded similar favorable outcomes in early-stage hip OA. Both approaches improved hip function and morphology, with high survival rates. The allograft group maintained greater gluteus medius integrity and showed no OA progression after 10 years, suggesting that allografts are a viable, less invasive option. Further research is necessary to assess long-term outcomes and muscle preservation.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 3","pages":"430-438"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144909","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":"Recent Updates on Allograft Selection for Reconstruction of Massive Rotator Cuff Tears.","authors":"Jong Pil Yoon, Sung-Jin Park, Dong-Hyun Kim, Hyun Joo Lee, Jun-Young Kim, Seok Won Chung","doi":"10.4055/cios25159","DOIUrl":"10.4055/cios25159","url":null,"abstract":"<p><p>Massive rotator cuff (RC) tears often require advanced reconstructive procedures, with graft selection playing a critical role in determining surgical success. Autografts offer excellent biocompatibility but are limited by donor site morbidity and inconsistent mechanical strength. Acellular dermal matrix grafts support host integration but are prone to elongation and variable resorption. Tendon allografts provide superior tensile strength but may integrate slowly depending on processing methods. Synthetic and xenografts offer alternative options, yet long-term durability and immune response remain concerns. Recent improvements in graft processing, including decellularization and ready-to-use technologies, have enhanced clinical efficiency but introduced new questions about long-term performance. Given the lack of standardized guidelines, graft selection should be tailored to patient-specific factors such as age, activity level, and tissue quality. This review evaluates current graft options for reconstruction of massive RC tears, providing evidence-based insights to support personalized surgical decision-making.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 3","pages":"381-392"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145040","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 Human-Derived Collagen Injection on Clinical and Structural Outcomes after Arthroscopic Rotator Cuff Repair: A Prospective Randomized Controlled Trial.","authors":"Jin Hyeok Lee, Kyosun Hwang, Woong Kyo Jeong","doi":"10.4055/cios25235","DOIUrl":"10.4055/cios25235","url":null,"abstract":"<p><strong>Background: </strong>Arthroscopic rotator cuff repair is widely performed; yet tendon healing failure still occurs in some cases and remains a challenge. To address this issue, several studies have investigated intraoperative injection or patch augmentation using porcine-derived collagen; however, no randomized controlled trials have evaluated the efficacy of human-derived collagen.</p><p><strong>Methods: </strong>This prospective, single-center, single-blind, randomized controlled trial included 60 adult patients with full-thickness rotator cuff tears who underwent arthroscopic repair between November 2022 and October 2023. Patients were randomly assigned to either the collagen group (n = 30) or the control group (n = 30). In the collagen group, following tendon repair, human-derived collagen was injected between the tendon and the footprint, as well as into the tendon matrix. Clinical outcomes were assessed using functional scores including the Constant score, University of California, Los Angeles score, American Shoulder and Elbow Surgeons score, and Simple Shoulder Test, as well as range of motion and the visual analog scale (VAS). Structural outcomes were evaluated using magnetic resonance imaging (MRI)-based Sugaya classification and shear wave elastography.</p><p><strong>Results: </strong>A total of 45 patients completed the study and were included in the final analysis: 23 in the collagen group and 22 in the control group. At the final follow-up, there were no significant differences in VAS or functional scores between the collagen and control groups; however, external rotation was significantly reduced in the collagen group compared to the control group (47.39° ± 13.22° vs. 56.19° ± 14.40°, <i>p</i> = 0.015). Retear occurred in 1 patient (4.3%) in the collagen group and in 2 patients (9.1%) in the control group, with no significant difference (<i>p</i> = 0.483). The collagen group showed a significantly lower mean Sugaya grade (1.944 ± 0.639 vs. 2.789 ± 0.976, <i>p</i> = 0.003) and greater tendon elasticity at the greater tuberosity footprint on shear wave elastography (9.23 ± 6.06 vs. 6.87 ± 4.96, <i>p</i> = 0.001).</p><p><strong>Conclusions: </strong>Human-derived collagen injections during rotator cuff repair did not result in superior clinical outcomes. However, postoperative MRI showed significantly lower Sugaya grades, and shear wave elastography demonstrated significantly greater tendon elasticity.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 3","pages":"507-518"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144880","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":"Wrist Arthroscopy in South Korea: Utilization, Disparities, and Complications from an 11-Year Nationwide Cohort.","authors":"Hyunsun Lim, Chi-Hoon Oh, Joo Youn Kim, Haeyong Pak, SeongJu Choi, Hyun Tak Kang, Jun-Ku Lee","doi":"10.4055/cios25394","DOIUrl":"10.4055/cios25394","url":null,"abstract":"<p><strong>Background: </strong>Wrist arthroscopy has evolved significantly as a minimally invasive technique for both diagnostic and therapeutic purposes. However, epidemiologic data on its nationwide use remain scarce, particularly for small joints like the wrist. Given its increasing adoption and technical complexity, understanding population-level trends in wrist arthroscopy is essential to inform clinical practice, policy planning, and surgical education.</p><p><strong>Methods: </strong>We conducted a retrospective nationwide analysis of wrist arthroscopic procedures performed in South Korea between 2013 and 2023, using National Health Insurance claims data. Procedures were categorized into diagnostic arthroscopy (P1), partial joint debridement or synovectomy (P2), and ligament or tendon reconstruction (P3) based on administrative billing codes. Trends were analyzed by year, age group, sex, income ventile, and region, with incidence rates calculated per 100,000 persons. In addition, postoperative complications such as nerve injury, extensor tendon injury, infection, and complex regional pain syndrome were identified using diagnosis codes within specified postoperative periods.</p><p><strong>Results: </strong>A total of 48,962 wrist arthroscopic procedures were identified between 2013 and 2023. The incidence increased from 6.43 to 10.98 per 100,000 persons, with a temporary decline during the coronavirus disease 2019 (COVID-19) pandemic. P2 remained most common, but the share of P3 rose markedly. The 50-59-year age group consistently accounted for the highest total number of procedures across the study period. The 30-39-year group showed the most prominent relative increase in P2 and P3 cases. The 20-29-year group recorded the highest rate of P3 procedures in 2023. Women consistently underwent more procedures, though men showed greater growth in P3. Regional variation was observed; however, contrary to expectation, Seoul and the metropolitan areas were not among the highest-incidence regions. No income-based disparity was identified, and complications were uncommon overall.</p><p><strong>Conclusions: </strong>This nationwide 11-year analysis demonstrates that wrist arthroscopy in South Korea has steadily increased, with a growing trend toward complex reconstructive procedures. Despite regional variation, no income-based disparity was observed, and overall complication rates remained low, although postoperative infection was observed somewhat more frequently than reported after larger-joint arthroscopy, supporting both the accessibility and safety of wrist arthroscopy in routine clinical practice.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 3","pages":"529-542"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144998","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":"Broken Transverse Force Coupling as a Predictor of Poor Prognosis after Lower Trapezius Tendon Transfer.","authors":"Hsien-Hao Chang, Yong-Min Chun, Sung-Jae Kim, Tae-Hwan Yoon","doi":"10.4055/cios25317","DOIUrl":"10.4055/cios25317","url":null,"abstract":"<p><strong>Backgroud: </strong>Lower trapezius transfer (LTT) has emerged as a promising surgical option for irreparable posterosuperior massive rotator cuff tears (PSMRCTs), particularly for restoring external rotation and improving shoulder function. The transverse force couple, formed by the balanced action of the subscapularis anteriorly and the infraspinatus and teres minor posteriorly, is essential for maintaining shoulder stability and kinematics. However, outcomes remain variable, and predictors of suboptimal recovery are not fully understood. The objective of this study was to evaluate clinical and radiologic outcomes following LTT in patients with irreparable PSMRCTs and to identify prognostic factors associated with achieving clinically meaningful improvement.</p><p><strong>Methods: </strong>This retrospective study included 44 patients who underwent LTT between June 2022 and February 2024. Functional outcomes were assessed at 12 months using visual analog scale, American Shoulder and Elbow Surgeons, Subjective Shoulder Value, University of California at Los Angeles scores, and active range of motion (ROM). Postoperative magnetic resonance imaging was performed at 6 months following surgery to evaluate repair integrity. The primary outcome was Patient Acceptable Symptom State (PASS). Patients were categorized into PASS-Y (yes) or PASS-N (no) groups. Multivariate logistic regression identified independent predictors of PASS failure.</p><p><strong>Results: </strong>Of 44 patients, 32 (72.7%) achieved PASS. The PASS-Y group demonstrated significantly superior improvements in pain, functional scores, and ROM compared with the PASS-N group. Tear of the transferred tendon was observed in 13.6% (6 / 44) and was significantly more common in the PASS-N group than in the PASS-Y group (33.3% [4 / 12] and 6.3% [2 / 32], respectively; <i>p</i> = 0.039). Subscapularis retear was identified in 18.2% overall and was significantly associated with PASS failure (41.7% vs. 9.4%, <i>p</i> = 0.025). Logistic regression identified tear of the transferred tendon (odds ratio [OR], 2.863; <i>p</i> = 0.017), subscapularis fatty infiltration (OR, 2.751; <i>p</i> = 0.009), and smoking status (OR, 2.501; <i>p</i> = 0.046) as independent risk factors for not achieving PASS.</p><p><strong>Conclusions: </strong>The most significant finding of this study is that disruption of transverse force coupling-whether due to tear of the transferred graft or failure of the repaired subscapularis tendon-negatively impacts clinical outcomes of LTT. Therefore, careful consideration is warranted in cases with a high risk of subscapularis tendon retear.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 3","pages":"519-528"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144667","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 General Personality Traits with Outcomes in Total Hip Arthroplasty: A Multicenter, Cross-Sectional, Prospective Trial.","authors":"Felix Wunderlich, Philipp Schippers, Thomas Klonschinski, Yama Afghanyar, Frank Traub, Philipp Drees, Lukas Eckhard","doi":"10.4055/cios25047","DOIUrl":"10.4055/cios25047","url":null,"abstract":"<p><strong>Background: </strong>The influence of psychological traits such as depression on postoperative outcomes after total hip arthroplasty (THA) is known, but data on general personality traits, such as optimism and pessimism, remain scarce. Understanding the impact of optimism and pessimism on postoperative outcomes in THA patients could provide valuable insights for preoperative patient assessments and postoperative care strategies. We hypothesized that patients with higher levels of optimism would demonstrate superior functional outcomes and that the opposite applies to pessimistic patients.</p><p><strong>Methods: </strong>A prospective, multicenter, cross-sectoral study assessed the association of personality traits with preoperative and 3, 6, and 12-month postoperative functional scores (12-item Hip Disability and Osteoarthritis Outcome Score [HOOS-12]). Optimism and pessimism were measured preoperatively via the revised Life Orientation Test (LOT-R). Linear regression models were fitted, and coefficients of determination (R²) and <i>t</i>-tests were obtained to reveal the correlation and statistical significance of the associations. The study was recorded in the German Clinical Trials Register (DRKS00013972).</p><p><strong>Results: </strong>Eight hundred forty-six patients were analyzed. Optimism was significantly associated with HOOS-12 scores over the first postoperative year, whereas pessimism was significantly associated for 6- and 12-month follow-up (preoperative: optimistic <i>r</i> = 0.11, <i>p</i> = 0.018; pessimistic <i>r</i> = 0.07, <i>p</i> = 0.099; postoperative optimistic: 3 months <i>r</i> = 0.143, <i>p</i> = 0.005; 6 months <i>r</i> = 0.148, <i>p</i> = 0.013; 12 months <i>r</i> = 0.121, <i>p</i> = 0.049; postoperative pessimistic: 3 months <i>r</i> = 0.090, <i>p</i> = 0.070; 6 months <i>r</i> = 0.155, <i>p</i> = 0.010; 12 months <i>r</i> = 0.165, <i>p</i> = 0.008).</p><p><strong>Conclusions: </strong>Optimism and pessimism are opposing and significantly associated with postoperative outcomes after THA, although not reaching the minimal clinically important change of the HOOS-12 score. If patients scheduled for THA seem prone to pessimistic behavior, further screening of the patient's personality traits and other risk factors should be conducted. The outcomes of these patients could be improved through psychoeducation or cognitive behavioral interventions.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 3","pages":"439-448"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144672","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":"Early Structural Healing and 12-Month Clinical Outcomes of Atelocollagen Patch Augmentation for Achilles Tendon Repair: A Prospective Cohort Comparison.","authors":"Young Hwan Park, Woon Kim, Jeong Ho Son, Hak Jun Kim","doi":"10.4055/cios25338","DOIUrl":"10.4055/cios25338","url":null,"abstract":"<p><strong>Background: </strong>Achilles tendon rupture (ATR) is a common injury, yet achieving optimal biological healing remains a challenge despite various surgical techniques. This study aimed to investigate the effect of atelocollagen patch augmentation on ATR repair. We hypothesized that atelocollagen patch augmentation would show superior structural and clinical outcomes compared with the standard repair group.</p><p><strong>Methods: </strong>In this prospective cohort comparison, 17 patients were enrolled to undergo Achilles tendon repair with atelocollagen patch augmentation, while 18 patients receiving standard open ATR repair served as the control group. A comparison of outcomes between the 2 groups was performed. Outcomes were assessed at 1, 3, 6, and 12 months postoperatively via ultrasonography and clinical measures, including the Achilles Tendon Total Rupture Score (ATRS), visual analog scale (VAS) for pain, and isokinetic muscle strength. Ultrasonographic evaluation focused on the cross-sectional area (CSA) and intratendinous morphology of the repaired tendon.</p><p><strong>Results: </strong>Ultrasonographic evaluation revealed that the atelocollagen patch group had a significantly higher CSA ratio at 1 and 3 months postoperatively (<i>p</i> = 0.026 and <i>p</i> = 0.043, respectively), though this difference was not significant at 6 and 12 months. Morphology scores were also higher in the patch group at 3 and 6 months (<i>p</i> = 0.009 and <i>p</i> = 0.027, respectively). Clinical outcomes, including ATRS, VAS pain scores, and isokinetic muscle strength, showed no significant differences between groups at all follow-up points. No complications, such as rerupture, infection, or allergic reactions, were observed in either group.</p><p><strong>Conclusions: </strong>Atelocollagen patch augmentation provides early structural benefits in tendon healing after ATR repair; however, these benefits did not translate into superior clinical functional outcomes within the 12-month follow-up period. Further large-scale studies are warranted to confirm the long-term clinical efficacy and safety of this technique.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 3","pages":"548-557"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144930","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}