European Journal of Orthopaedic Surgery and Traumatology最新文献

{"title":"Comparison of near- and midterm outcomes of two unilateral percutaneous translaminar vertebral kyphoplasty procedures for the treatment of single-segment OVCF: a single-center randomized controlled study.","authors":"Yang Fuguo, Chen Kang, Luo Yuanchao, He Renjian","doi":"10.1007/s00590-025-04241-4","DOIUrl":"10.1007/s00590-025-04241-4","url":null,"abstract":"<p><strong>Background: </strong>Osteoporotic vertebral compression fractures (OVCFs) have become a significant public health concern due to the high morbidity and limited efficacy of conservative treatment. Conventional unilateral percutaneous vertebral kyphoplasty (UPKP) is beset by technical limitations, including the uneven distribution of cement and the inherent risk of leakage. Conversely, percutaneous curved kyphoplasty (PCKP) involves the creation of an accessible contralateral bone tunnel through a curved bone auger, a technique that, in theory, optimizes cement distribution. However, the clinical benefits of PCKP remain a subject of debate.</p><p><strong>Objective: </strong>To prospectively compare the difference in near- and midterm efficacy between PCKP and UPKP for the treatment of single-segment OVCFs, and to clarify the clinical value of PCKP.</p><p><strong>Methodology: </strong>A total of 89 patients with single-segment OVCFs were selected from October 2021 to March 2024 and divided into two groups: the PCKP group (n = 43) and the UPKP group (n = 46). At the 12-month follow-up, pain visual analog scores (VAS, Oswestry Dysfunction Index (ODI)) and cement distribution were assessed preoperatively, at 2 days, 3 months, and 12 months postoperatively. The duration of surgery was recorded, as were the number of fluoroscopy, bone cement dose, and complications. Compare the two sets of parameters.</p><p><strong>Results: </strong>(1) Functional improvement: the VAS score and ODI of patients in PCKP group was better than that of UPKP group at 2 days postoperatively (P < 0.05), and there was no statistically significant difference between the VAS score and ODI of the two groups at the rest of the follow-up points (P > 0.05). (2) Bone cement: the amount of cement used in the PCKP group was significantly more than that in the UPKP group (P < 0.05), and the rate of excellent distribution and leakage rate were better (P < 0.05). (3) Vertebral recovery: the degree of recovery of the height of the anterior margin of the vertebral body was similar between the two groups (P > 0.05). (4) Complications: there was no difference in the rate of re-fracture (P > 0.05), and the risk of leakage was lower in the PCKP.</p><p><strong>Conclusion: </strong>Both PCKP and UPKP can effectively treat single-segment OVCFs, but PCKP achieves better control of spatial distribution of cement through curved bone drilling technique and significantly reduces the risk of leakage, especially for patients with moderate and severe fractures, and PCKP has more advantages in early pain relief, but near- and intermediate-term follow-up shows that the efficacy of the two converge.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"142"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extension patterns of giant lipomas arising from the brachial plexus: giant lipomas from brachial plexus.","authors":"Keiichi Muramatsu, Yasuhiro Tani, Masaya Ueda, Daniela Kristina D Carolino, Mary Rose Casas Gonzales","doi":"10.1007/s00590-025-04205-8","DOIUrl":"https://doi.org/10.1007/s00590-025-04205-8","url":null,"abstract":"<p><strong>Purpose: </strong>Benign adipose tumors in close proximity to the major nerves are termed troublesome lipomas and are indicated for resection because of neurological impairment. Until now, however, limited cases of giant lipoma arising from the brachial plexus region have been reported. We discussed our experience with cases of giant lipomas arising from the brachial plexus region.</p><p><strong>Methods: </strong>We reviewed six cases treated in our hospital. There were four males and two females with the mean age of 55 years. On its greatest dimension, the size of the giant tumor ranged from 14 to 30 cm with an average of 21.6 cm. Based on MRI findings, the tumor extension patterns were divided, (1) lateral type, (2) posterior type and (3) inferior type. The symptoms were characteristic according to extension patterns of the tumor.</p><p><strong>Results: </strong>Five patients who underwent tumor resection showed improvement in subjective symptoms early after surgery. An asymptomatic case with inferior type underwent only open biopsy. The histopathology in all cases confirmed ordinary lipomas. There was no local recurrence postoperatively.</p><p><strong>Conclusion: </strong>Brachial plexus lipoma has potential to grow unexpectedly large due to repetitive microtrauma. The indication for tumor resection surgery should be considered in each type of tumor extension. The lateral type, which directly causes neurological symptoms, is the most indicative for tumor resection, while the posterior type is more suitable for surgery due to stubborn shoulder stiffness and symptom with thoracic outlet syndrome. In the case with inferior extension type, the patient was asymptomatic and the operative indication should be less.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"140"},"PeriodicalIF":1.4,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic evaluation of articular laxity (REAL) classification: a new intraoperative knee soft-tissue laxity classification using ROSA robotic software.","authors":"Eustathios Kenanidis, Nikolaos Milonakis, Alexandros Maslaris, Eleftherios Tsiridis","doi":"10.1007/s00590-025-04265-w","DOIUrl":"10.1007/s00590-025-04265-w","url":null,"abstract":"<p><strong>Purpose: </strong>Currently, there is no widely accepted method for measuring soft-tissue laxity and defining a balanced total knee arthroplasty (TKA). We aim to evaluate whether robotic technology can facilitate the categorization of intraoperative knee laxity.</p><p><strong>Methods: </strong>Our study was conducted in two phases. A senior surgeon performed imageless robotically assisted TKAs (ra-TKAs) using functional alignment. The first phase included 120 patients. Following the surgical approach, the medial and lateral soft-tissue laxity was recorded in extension and 90° flexion. The distribution of the difference and sum of laxities in extension and 90° flexion was assessed to classify laxity phenotypes. The second phase validated the classification in 102 additional ra-TKAs. Laxity phenotypes were evaluated at the start and end of the procedure.</p><p><strong>Results: </strong>Laxity difference followed a normal distribution, facilitating categorization into three groups, with a standard deviation of 2.5 mm. Three categories of mediolateral laxity severity difference were established: < 2.5 mm, 2.5-5 mm, and > 5 mm. These laxity groups were coded in extension as 1, 2, and 3 and in flexion as A, B, and C, respectively. Nine laxity phenotypes emerged from the combination of the extension and flexion categories (1A-C, 2A-C, and 3A-C). Phenotypes 1A and 1B were the most common at the operation' beginning, while phenotypes 3B and 1C were the rarest. At the end of the operation, 93% were categorized as class 1A and 1B, defining the \"balanced area\".</p><p><strong>Conclusion: </strong>Our study recognized nine intraoperative soft-tissue knee laxity phenotypes, potentially laying the groundwork for a surgical consensus on knee balancing.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"139"},"PeriodicalIF":1.4,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The intricate link between anterior cruciate ligament rupture and lower limb muscle fatigue: a case study.","authors":"Zeynab Saghaeinooshabadi, Mohammad Reza Zakerzadeh, Mohmmad Ali Nazari","doi":"10.1007/s00590-025-04256-x","DOIUrl":"https://doi.org/10.1007/s00590-025-04256-x","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to explore the impact of Anterior Cruciate Ligament (ACL) injuries on the fatigue behavior of selected lower limb muscles during high-intensity physical activity.</p><p><strong>Methods: </strong>The study involves assessing the surface electromyographic activity of key muscle groups, including the hamstrings, quadriceps, and triceps surae (Biceps Femoris (BF), Semitendinosus (ST), Rectus Femoris (RF), Vastus Lateralis (VL), Vastus Medialis (VM), GastroCnemius Lateralis (GCL), GastroCnemius Medialis (GCM), and Soleus (S)), in an individual with a left leg ACL rupture. Muscle activity has been monitored during a fatigue protocol, and metrics such as Root Mean Square (RMS), Median Frequency (MDF), and Integrated Electromyography (IEMG) have been calculated to evaluate muscle function.</p><p><strong>Results: </strong>Significant reductions in electromyographic parameters are observed in the BF, ST, VM, and VL of the injured leg and in the GCL of the contralateral leg during the fatigue protocol.</p><p><strong>Conclusions: </strong>These findings enhance the understanding of how ACL injuries influence the neuromuscular function of both the affected and unaffected legs during prolonged activity. This knowledge provides valuable insights into knee joint loading mechanics and may inform strategies for addressing muscle fatigue and optimizing rehabilitation protocols.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"137"},"PeriodicalIF":1.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous C1C2 transarticular screw fixation for atlantoaxial osteoarthritis with 3D navigation: technical note and functional outcomes.","authors":"Paul-Emile Borge, Camille Damade, William Gerbeaux, Gaelle Kerdiles, Ibrahim Obeid, Benjamin Bouyer, Olivier Gille, Louis Boissiere","doi":"10.1007/s00590-025-04254-z","DOIUrl":"https://doi.org/10.1007/s00590-025-04254-z","url":null,"abstract":"<p><strong>Purpose: </strong>Atlantoaxial osteoarthritis is a debilitating condition often resistant to conservative management. In refractory cases, C1-C2 fusion becomes a surgical option. Recent advancements, particularly in 3D navigation, have allowed for more precise and minimally invasive approaches, though there are limited reports on isolated percutaneous C1-C2 arthrodesis for osteoarthritis. This study aims to evaluate the feasibility, accuracy, and clinical outcomes of percutaneous C1-C2 transarticular screw fixation using 3D navigation in patients with disabling atlantoaxial osteoarthritis.</p><p><strong>Methods: </strong>Ten patients (median age: 75.5 years), all female, underwent percutaneous C1-C2 screw fixation using the Magerl technique, guided by 3D navigation. Preoperative assessment included CT and contrast-enhanced imaging to ensure safe screw placement. Postoperative evaluations included pain assessment, radiographic analysis, and patient satisfaction.</p><p><strong>Results: </strong>Transarticular screws were inserted in all of patients, with no significant intraoperative complications. Median operative time was 65 min with blood loss under 100 mL. Postoperative pain improved with the median VAS decreasing from 10 preoperatively to 1 at one year. Screw backout was observed in one patient without clinical repercussions. All patients expressed satisfaction and would undergo the procedure again.</p><p><strong>Conclusion: </strong>Percutaneous C1-C2 transarticular screw fixation with 3D navigation is a safe and effective treatment for severe atlantoaxial osteoarthritis. It offers significant pain relief, accurate screw placement, and reduced postoperative morbidity. Preoperative anatomical evaluation remains critical to minimize risks. Level of Evidence Level III, Retrospective Cohort.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"138"},"PeriodicalIF":1.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The cranial unstable transverse acetabulum fracture: an important variant.","authors":"Lauren Luther, Ridge Maxson, R Brandon Ponce, Cade A Morris, Andres F Moreno-Diaz, Phillip M Mitchell","doi":"10.1007/s00590-025-04263-y","DOIUrl":"10.1007/s00590-025-04263-y","url":null,"abstract":"<p><strong>Purpose: </strong>Achieving anatomic reduction in combined injuries of the pelvic ring and acetabulum is critical to optimizing outcome. One of the most common combined patterns is a transverse-type acetabular fracture with associated ipsilateral sacroiliac joint instability. The optimal order of fixation (pelvis-first versus acetabulum-first) in these patients remains unclear. The present study aimed to analyze the impact of operative sequence on outcomes when treating transverse variant acetabulum fractures with concomitant posterior pelvic ring disruption.</p><p><strong>Methods: </strong>Across a 12-year period, 24 patients with transverse variant (e.g., transverse, transverse posterior wall, or T-type) acetabulum fractures with unstable cranial segments were identified. This cohort included 17 patients treated with a pelvis-first approach and 7 patients treated with an acetabulum-first approach. Data regarding demographics, mechanism, associated injuries, operative details, post-operative reduction quality, and clinical outcomes were collected.</p><p><strong>Results: </strong>The average age in this series was 37 years, and 63% of patients were male. All injuries involved a high-energy mechanism, most commonly motor vehicle collision (63%). There were no significant differences in demographic or injury characteristics between cohorts. A pelvis-first approach was associated with a significantly lower rate of poor reduction quality (12% vs. 57%, P = 0.038) and lower blood loss on average (500 mL vs. 1000 mL, P = 0.009) when compared to an acetabulum-first approach.</p><p><strong>Conclusion: </strong>In this series, a pelvis-first approach was associated with improved reduction quality and decreased blood loss among patients with operatively managed transverse acetabulum fractures with a cranial unstable fracture fragment.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"135"},"PeriodicalIF":1.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of ambulatory versus outpatient hospital-based surgical center shoulder arthroplasty: complications, readmissions, and charges.","authors":"Paul G Mastrokostas, Joshua Harounian, Ameer Tabbaa, Lucas Voyvodic, Andrew Horn, Mitchell K Ng, Ramin Sadeghpour, Afshin E Razi, Jack Choueka","doi":"10.1007/s00590-025-04253-0","DOIUrl":"10.1007/s00590-025-04253-0","url":null,"abstract":"<p><strong>Purpose: </strong>The rising demand for primary total shoulder arthroplasty (TSA) has spurred interest in comparing the safety and cost-effectiveness of outpatient TSA in ambulatory surgical centers (ASCs) versus hospital-based centers (HSCs). This study evaluates ASCs and HSCs for medical complications, readmission rates, implant complications, and costs.</p><p><strong>Methods: </strong>This retrospective cohort study used the PearlDiver Mariner Database to identify patients undergoing primary TSA in ASCs or HSCs, assessing medical complications, readmissions, implant issues, and costs. ASC patients were matched in a 1:5 ratio to HSC patients by age, sex, region, and Elixhauser Comorbidity Index (ECI). Logistic regression analyzed the impact of ASC versus HSC settings on complications and readmissions, while Welch's t-tests compared costs. Statistical significance was determined by a P value less than or equal to 0.05.</p><p><strong>Results: </strong>ASCs showed lower odds of pulmonary embolism (OR = 0.69; P = 0.04), total medical complications (OR = 0.89; P = 0.01), prosthetic joint dislocation (OR = 0.43; P = 0.05), and total implant-related complications (OR = 0.85; P = 0.03), but a higher 90-day readmission rate (OR = 1.22; P < 0.01). ASCs also offered significant cost savings on the day of surgery ($4600 vs. $11,100; P < 0.01) and for 90-day total costs ($6600 vs. $13,500; P < 0.01) compared to HSCs.</p><p><strong>Conclusion: </strong>Outpatient primary TSA in ASCs offers comparable safety with substantially lower costs than HSCs. Despite higher readmission rates, ASCs represent a viable, cost-effective alternative.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"136"},"PeriodicalIF":1.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic review of radiocarpal dislocations: epidemiology, treatment modalities, and outcomes.","authors":"Arvin Eslami, Ali Torkaman, Shaya Alimoghadam, Karim Pisoudeh, Amir Ebrahimzadeh Babaki, Moein Ghaeini, Parsa Torkaman, Omid Elahifar, Hamidreza Dehghani Nazhvani","doi":"10.1007/s00590-025-04252-1","DOIUrl":"https://doi.org/10.1007/s00590-025-04252-1","url":null,"abstract":"<p><strong>Purpose: </strong>Radiocarpal dislocation (RCD) is a rare but severe injury, often resulting from high-energy trauma such as motor vehicle accidents and falls. This study aims to synthesize existing case reports and series to provide insights into the epidemiology, associated injuries, and management strategies for RCD.</p><p><strong>Methods: </strong>A systematic search of PubMed, Scopus, and Web of Science was conducted, including English-language case reports and series up to August 5, 2023. Data extraction followed PRISMA guidelines, with bias assessment using Joanna Briggs Institute criteria. Descriptive statistics and t tests were applied to analyze demographics, treatments, and outcomes.</p><p><strong>Results: </strong>Among 343 articles, 57 met inclusion criteria, covering 303 patients. The mean age was 36.52 years, with males comprising 78.9%. Dorsal dislocations were the most common type. Fractures, particularly of the radial styloid, were present in most cases. Common soft tissue injuries included median nerve compression, TFCC/DRUJ injuries, and scapholunate ligament tears. Ligament repair, performed in 24.7% of cases, improved flexion-extension outcomes (p = 0.048) but showed no significant effects on ulnar or radial deviation. Spanning plates demonstrated acceptable outcomes in one study.</p><p><strong>Conclusions: </strong>RCDs are complex injuries requiring comprehensive diagnostic assessment and tailored treatment strategies, particularly addressing associated fractures and soft tissue damage. While ligament repair may enhance flexion-extension, its role in overall joint stability remains uncertain. Further prospective, multicenter studies are needed to better evaluate treatment approaches, including the effectiveness of ligament repair, and to refine management protocols for improved long-term patient outcomes.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"132"},"PeriodicalIF":1.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research progress and prospect of MAPK signaling pathway in knee osteoarthritis.","authors":"Qiao Fan, MingYu Zhao, Xiang-Dong Zhang, Tian-Yun Chu, Zhao-Xi Kou, Qi Zhao","doi":"10.1007/s00590-025-04261-0","DOIUrl":"10.1007/s00590-025-04261-0","url":null,"abstract":"<p><p>The knee joint, one of the most vulnerable joints in the human body, is susceptible to degenerative changes due to factors such as aging, obesity, trauma, inflammation, and genetic predisposition. These factors contribute to primary or secondary degeneration of knee joint cartilage and bone hyperplasia. Knee osteoarthritis (KOA), a prevalent condition particularly among the elderly, significantly impacts patients' quality of life. Aberrant activation of cellular signaling pathways, namely the NF-κB, MAPK, and Wnt pathways, has been identified as a key factor in the pathogenesis of KOA. These pathways contribute to inflammation, cartilage degradation, and disruption of the anabolic-catabolic balance within articular cartilage. Understanding the precise roles of these pathways is crucial for developing targeted therapies to prevent and treat knee OA. Therefore, further exploration of the pathogenesis of knee osteoarthritis is essential to develop more effective therapeutic strategies.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"134"},"PeriodicalIF":1.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11947053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of radiographic malpositioning on patellar height measurements: implications for diagnosis and surgical planning. A retrospective observational study.","authors":"Jorge García Cabrera, Sergio Barroso Rosa, Carmen Nieves Hernández Flores","doi":"10.1007/s00590-025-04236-1","DOIUrl":"10.1007/s00590-025-04236-1","url":null,"abstract":"<p><strong>Purpose: </strong>Patella alta stands as a significant predisposing factor for patellofemoral instability. Patellar heights indexes (PHI) require precise lateral knee radiographic projections for accurate computation. However, within clinical contexts, a notable proportion of radiographic images are taken with certain degrees of excessive rotation and/or tilting. The primary aim of this investigation was to assess the impact of suboptimal radiographic positioning on the determination of patellar height, utilizing the Blackburne-Peel (BP), Caton-Deschamps (CD) and Insall-Salvati (IS) indexes. Secondarily, it was evaluated whether any index is more sensible to suboptimal radiographic positioning, and how inter and intra observer reproducibility are affected.</p><p><strong>Methods: </strong>Thirty-three patients with strictly lateral radiographs and another one demonstrating a noticeable degree of tilt and/or rotation were included in the study. Four orthopaedic surgeons specialized in knee surgery and four Orthopaedics residents conducted measurements on each radiograph in a randomized sequence at two different time points. A linear mixed-effects model was applied, with the quality of the radiograph (adequate projection vs malrotation, tilt, or both), observer expertise (consultant or resident), and observation time regarded as fixed effects, while consultant and patient were treated as random effects.</p><p><strong>Results: </strong>Statistically significant differences were obtained between strict lateral and tilted radiographs in the BPI, with an overestimation of up to 0.0937; between strict lateral and malrotated radiographs in the ISI, showing an overestimation of up to 0.0696 and between tilted and/or rotated radiographs in the CDI, with overestimation reaching up to 0.0813. No significant differences were observed between resident and consultant observers in any of the indexes. Good inter-observer consistency was achieved.</p><p><strong>Conclusion: </strong>This study showed statistically significant differences in the determination of the three PHIs. Although these differences were small, they may predispose to diagnostic errors and inaccurate surgical planning in cases requiring surgical correction. Future studies quantifying the degrees of malrotation and/or inclination may further clarify these findings.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"133"},"PeriodicalIF":1.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11946984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}