Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"Impact of Ayushman Bharat (PM-JAY) on access to spine surgery at a tertiary care centre in North India: A retrospective analysis","authors":"Vishal Kumar ,&nbsp;Tharun Teja Aduri ,&nbsp;Aditya Gupta ,&nbsp;Sarvdeep Singh Dhatt","doi":"10.1016/j.jcot.2026.103352","DOIUrl":"10.1016/j.jcot.2026.103352","url":null,"abstract":"<div><h3>Background</h3><div>Access to complex, resource-intensive procedures such as spine surgery is often limited for economically disadvantaged populations due to high out-of-pocket expenditure. The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) was launched to mitigate these costs, yet data on its specific impact on spine surgery remains limited. This study aims to analyse the impact of PM-JAY on access to spine surgery at a tertiary care centre in North India.</div></div><div><h3>Methods</h3><div>A retrospective, single-centre observational study was conducted analysing all spine surgeries performed from January 2023 to December 2024. Data regarding patient demographics, clinical diagnosis, surgical procedure, and mode of financing were extracted from institutional records. Financing modes were categorised as PM-JAY, self-paid, and other government schemes. Comparative analysis of financing patterns across the study years was performed using the chi-square test.</div></div><div><h3>Results</h3><div>A total of 410 patients underwent spine surgery during the study period (mean age 49.3 ± 4.1 years). Degenerative spinal disorders (46.1 %) and traumatic injuries (33.4 %) constituted the majority of cases. Overall, 276 procedures (67.3 %) were funded under PM-JAY, while 110 (26.8 %) were self-financed. A significant temporal shift was observed: PM-JAY utilisation increased from 58.7 % (101/172) in 2023 to 73.5 % (175/238) in 2024. Correspondingly, self-financed procedures declined from 37.8 % in 2023 to 18.9 % in 2024 (p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>This study demonstrates a substantial and statistically significant increase in the utilisation of PM-JAY for spine surgery, with a concurrent decline in self-financed procedures. The findings suggest that publicly funded insurance is effectively improving financial access to implant-intensive spine care across a broad spectrum of pathologies. However, robust clinical governance remains essential to ensure equitable implementation and prevent overutilisation.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103352"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038348","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":"Global research landscape of artificial intelligence in orthopaedics: A decade of trends from a Scopus-based bibliometric analysis (2015–2025)","authors":"Anil Regmi ,&nbsp;Vivaan Jain ,&nbsp;Surakshya Baral ,&nbsp;Bishwa Bandhu Niraula","doi":"10.1016/j.jcot.2026.103342","DOIUrl":"10.1016/j.jcot.2026.103342","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence (AI) has emerged as a transformative tool in orthopaedics, with its various applications. Despite increasing interest, the global research landscape, collaborative networks, and trends in AI-based orthopaedic research remain incompletely characterized. This research aims to perform a comprehensive bibliometric analysis of AI research in orthopaedics, mapping annual publication trends, document types, leading journals, authors, institutions, countries, funding agencies, and citation impact from 2015 to 2025.</div></div><div><h3>Methods</h3><div>A Scopus-based search was conducted for published documents in AI in Orthoapedics between 2015 and 2025. Bibliographic information including publication year, document type, journal, author names, affiliations, country, funding, and citations was extracted. Descriptive statistics summarized trends, while VOSviewer (v1.6.20) visualized co-authorship, bibliographic coupling, and collaboration networks at author, institution, and country levels.</div></div><div><h3>Results</h3><div>A total of 1629 documents were identified. Publications increased steeply after 2022, peaking in 2025 (n = 544), with original research articles (55.9 %) and reviews (20.7 %) dominating. The United States (34.8 %), China (14.1 %), and India (8.6 %) were the most productive countries. Co-authorship and bibliographic coupling analyses revealed expanding yet fragmented collaborative networks. The National Natural Science Foundation of China and the U.S. National Institutes of Health were the top funding agencies. The dataset accumulated 17,429 citations, with an h-index of 59.</div></div><div><h3>Conclusions</h3><div>AI in orthopaedics has experienced exponential growth over the past decade, driven by high-impact institutions and collaborative networks, yet its clinical translation remains limited, highlighting the need for globally coordinated, methodologically rigorous research to fully realize its transformative potential.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103342"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978610","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":"Validation of a novel knee harness inertial-cum-ultrasound wearable device as a quantitative measure of knee function","authors":"Zachariah Gene Wing Ow ,&nbsp;Edmund Jia Xi Zhang ,&nbsp;Keng Lin Wong","doi":"10.1016/j.jcot.2026.103338","DOIUrl":"10.1016/j.jcot.2026.103338","url":null,"abstract":"<div><h3>Background</h3><div>Accurate assessment of knee function is essential for diagnosis, monitoring, and rehabilitation of musculoskeletal injuries. Patient-reported outcome measures (PROMs) such as the International Knee Documentation Committee (IKDC) score, although validated, are limited by subjectivity and ceiling effects. This study aimed to validate a novel wearable device, the GATOR system, which integrates inertial measurement units (IMUs) and ultrasound to produce an objective composite knee function score, PRIME.</div></div><div><h3>Methods</h3><div>In a prospective cohort of 90 participants (180 knees), PRIME scores were obtained for healthy, injured, and contralateral knees, with concurrent IKDC scores. Descriptive statistics and non-parametric tests compared groups. Spearman correlation and univariate linear regression assessed the relationship between PRIME and IKDC, with the primary correlation analysis restricted to injured knees. Receiver operating characteristic (ROC) analysis evaluated the ability of PRIME to discriminate injured from healthy knees, and the optimal PRIME cut-off was derived using the Youden index. The minimal detectable change (MDC) of PRIME was estimated from the variability in healthy knees.</div></div><div><h3>Results</h3><div>PRIME scores were highest in healthy knees, intermediate in contralateral knees, and lowest in injured knees, with statistically significant differences between all groups (p &lt; 0.001). In injured knees, PRIME showed a moderate-to-strong correlation with IKDC (ρ = 0.54, p &lt; 0.001), whereas no significant correlation was observed in healthy knees, likely reflecting ceiling effects. ROC analysis yielded an AUC of 0.846. A PRIME cut-off of 71.2 points optimally discriminated injured from healthy knees (sensitivity 74.5 %, specificity 82.1 %). The MDC for PRIME was 39.1 points, suggesting that changes exceeding this threshold likely represent true change beyond measurement error.</div></div><div><h3>Conclusion</h3><div>PRIME appears to be a valid, objective measure of knee function that correlates with patient-reported outcomes in pathological knees and demonstrates good discriminatory performance for detecting knee injury.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103338"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978609","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":"Does the treatment of cervicothoracic junction fractures differ from subaxial cervical fractures? A narrative review","authors":"Ratko Yurac ,&nbsp;Gaurav Raj Dhakal ,&nbsp;Andrei Joaquim ,&nbsp;Guillermo Ricciardi ,&nbsp;Cezar Popescu ,&nbsp;Klaus Schnake ,&nbsp;Richard Bransford ,&nbsp;Gregory Schroeder ,&nbsp;Mohammad El-Sharkawi ,&nbsp;Sebastian Bigdon ,&nbsp;Mohamed M. Aly ,&nbsp;AO Spine Knowledge Forum Trauma & Infection","doi":"10.1016/j.jcot.2026.103351","DOIUrl":"10.1016/j.jcot.2026.103351","url":null,"abstract":"<div><div>This narrative review examines whether the cervicothoracic junction (CTJ) should be considered a modifier in the classification of subaxial cervical spine fractures. A comprehensive literature search was conducted in PubMed, Embase, LILACS, and the Cochrane Library to identify studies published between 1990 and May 2025.</div><div>The findings indicate that CTJ fractures display distinct anatomical and biomechanical features compared with injuries affecting more proximal subaxial cervical segments. Key differences include restricted anterior surgical access due to anatomical constraints, higher instability rates, and greater difficulty achieving closed reduction in facet dislocations. Imaging with plain radiographs is frequently unreliable, necessitating CT or MRI for accurate diagnosis. Most studies reported a preference for posterior or combined surgical approaches. Although the evidence base remains heterogeneous and primarily retrospective, emerging patterns suggest that CTJ injuries may merit dedicated consideration in classification systems and treatment guidelines.</div><div>Overall, traumatic CTJ injuries present unique clinical characteristics that differentiate them from other subaxial cervical injuries. These observations support the hypothesis that the CTJ could function as a clinically meaningful modifier. Further prospective research is required to clarify its role and enhance standardization in classification and surgical decision-making.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103351"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146183565","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":"Erratum regarding missing statements in previously published articles","authors":"","doi":"10.1016/j.jcot.2026.103336","DOIUrl":"10.1016/j.jcot.2026.103336","url":null,"abstract":"","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103336"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188525","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":"Geometric optimization of femoral rotational alignment in total knee arthroplasty using minimal surface theory versus anatomical reference axes: a computational simulation study","authors":"Horacio Rivarola ,&nbsp;Cristian Collazo ,&nbsp;Marcos Palanconi ,&nbsp;Marcos Meninato ,&nbsp;Gonzalo Arteaga ,&nbsp;Francisco Endara Urresta","doi":"10.1016/j.jcot.2025.103309","DOIUrl":"10.1016/j.jcot.2025.103309","url":null,"abstract":"<div><h3>Background</h3><div>Femoral rotational alignment is a critical determinant of contact mechanics, kinematics, and long-term survivorship in total knee arthroplasty (TKA). Traditional techniques rely on anatomical landmarks, which exhibit substantial inter-patient variability and may not reliably optimize tibiofemoral load distribution. This study introduces a geometric, anatomy-independent framework using minimal surface theory (MST) to identify an energy-minimizing femoral rotational alignment based on curvature equilibrium rather than fixed bony reference axes.</div></div><div><h3>Methods</h3><div>A three-dimensional finite element model of the tibiofemoral articulation was constructed from computed tomography–derived anatomy. Posterior-stabilized TKA components were virtually implanted, and femoral rotation was varied from 5° internal to 5° external relative to the surgical transepicondylar axis. Simulations were performed at 0°, 45°, and 90° of flexion under a 700-N axial load. Willmore surface energy, mean contact pressure, peak shear stress, and contact area were quantified for each alignment. Sensitivity analyses evaluated robustness to posterior tibial slope (±3°) and insert conformity.</div></div><div><h3>Results</h3><div>Across all flexion angles and model conditions, the MST-derived minimum energy state occurred consistently at <strong>2°–3° of external rotation</strong>. Compared with neutral alignment, this optimized orientation reduced Willmore energy by <strong>38.6 %</strong>, mean contact pressure by <strong>18.7 %</strong>, and peak shear stress by <strong>30.8 %</strong>, while increasing contact area by <strong>13.1 %</strong>. Internal malrotation resulted in abrupt curvature transitions, elevated stress concentrations, and reduced load-sharing capacity. Findings remained stable across sensitivity analyses, indicating that the energy-optimal configuration is reproducible and not dependent on specific anatomical landmarks.</div></div><div><h3>Conclusion</h3><div>Minimal surface theory identifies a narrow and consistent external rotational target that optimizes congruence and reduces mechanical stress in TKA. This framework provides a mathematically grounded, anatomy-independent alternative to conventional landmark-based alignment strategies and may support future computational or robotic applications for patient-specific rotational planning.</div></div><div><h3>Level of evidence</h3><div>Computational simulation study (Level V).</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103309"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839734","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":"Preoperative halo gravity traction (HGT) in severe rigid scoliosis – A single centre study","authors":"Saumyajit Basu ,&nbsp;Ayon Ghosh ,&nbsp;Kushal Gohil ,&nbsp;Vikas Hanasoge","doi":"10.1016/j.jcot.2025.103294","DOIUrl":"10.1016/j.jcot.2025.103294","url":null,"abstract":"<div><h3>Background</h3><div>Managing severe and rigid spinal deformities with limited flexibility and high Cobb angles (≥90°) remains a significant challenge in spine surgery. Halo Gravity Traction (HGT) has been adopted preoperatively to optimize surgical tolerance, facilitate spinal correction, and improve surgical outcomes.</div></div><div><h3>Objective</h3><div>This study aimed to determine the outcomes of severe scoliosis managed by preoperative HGT followed by definitive spinal fusion.</div></div><div><h3>Methods</h3><div>A retrospective analysis of 27 patients was conducted at a single center between 2010 and 2023. The inclusion criteria were patients with severe scoliosis or kyphoscoliosis who underwent HGT before definitive spinal fusion, with a minimum 2-year follow-up. The variables collected included age, HGT duration, sex, deformity etiology, preoperative, post-HGT, and postoperative coronal and sagittal Cobb angles, curve flexibility, and complications. Continuous variables were assessed in Microsoft excel and p value was calculated for categorical variables using Paired T Test (p value &lt; 0.05 was taken as significant)</div></div><div><h3>Results</h3><div>The mean age of the patients was 13.17 years (range, 4–26 years), with an average HGT duration of 40.5 days (SD ± 29.43). The mean preoperative, post-HGT, and postoperative Cobb angles in the 27 patients were 95.18°, 70.46°, and 46.76°, respectively, reflecting a significant postoperative correction rate of 50.87 %. Intraoperative monitoring changes were observed in 18.51 % of the patients. Four (12.5 %) patients had postoperative neuro-deficits, of which three completely recovered. One patient had a neurology of ASIA B in the immediate postoperative period, which improved to AISA D at 2 years of follow-up. The postoperative complications included pin-site infections (14.81 %), wound healing issues (11.11 %), implant prominence (7.40 %), implant failure (14.81 %), and proximal/distal junctional kyphosis (11.11 %).</div></div><div><h3>Conclusion</h3><div>HGT followed by definitive spinal fusion is an effective method for managing severe rigid spinal deformities because HGT can partially correct the deformity and aid in gradual stretching and spinal stress relaxation.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103294"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797113","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":"Pathogen virulence and host response: A systematic review of severe illness in childhood musculoskeletal infection","authors":"Sarah Hunter ,&nbsp;Haemish Crawford ,&nbsp;Jonathan G. Schoenecker","doi":"10.1016/j.jcot.2025.103261","DOIUrl":"10.1016/j.jcot.2025.103261","url":null,"abstract":"<div><h3>Background</h3><div>Severe forms of childhood bone and joint infection (BJI) involve multifocal sepsis, often requiring multiple surgeries and intensive care. Dysregulation of the Acute Phase Response (APR) occurs, as bacterial virulence factors disrupt protective inflammatory and coagulation mechanisms.^1,2 Many algorithms attempt to identify severe cases at diagnosis. Factors driving progression to life-threatening disease remain incompletely understood. This review summarizes risk associations for severe BJI in the context of host-pathogen interactions.</div></div><div><h3>Methods</h3><div>A systematic review of the literature was undertaken from 01/01/2000-1/08/2025. Studies reporting host or pathogen factors associated with BJI severity for children &lt;/ = 18 years were included. Studies focussed on <em>Kingella kingae</em> or atypical organisms were excluded. C-reactive protein (CRP) trends in the context of severe illness were also examined. ROBINS-E was used to assess risk of bias. As it does not consider specific interventions and exposures, this review was not registered with PROSPERO.</div></div><div><h3>Results</h3><div>Literature search of electronic databases returned 1171 articles, of which 38 met full criteria. These comprised 10,084 patients across multiple continents. Pathogen factors associated with severe illness included Methicillin-resistant <em>Staphylococcus aureus</em> (MRSA), Panton-Valentine Leukocidin (PVL), and individual bacterial virulence factors identified genomically. Notably, these virulence factors may be more important than methicillin resistance, with some MSSA strains causing equally severe disease. Very young children, specific ethnic groups, and those with congenital abnormalities were at higher risk. Early genetic studies propose variability in host inflammatory response genes. Sustained CRP elevation was a feature of worse disease, independent of pathogen subtype.</div></div><div><h3>Conclusion</h3><div>These findings indicate that severe pediatric BJI results from complex interactions between bacterial virulence factors and host response capacity. Awareness of these factors should equip clinicians to recognise potentially high-risk cases early in the course of illness. Future research should ascertain how virulence factors dysregulate the host APR, guiding therapeutic interventions targeting the underlying pathophysiology.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103261"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145499919","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":"Intra-articular and extra-articular malunion of proximal tibia: Assessment and management","authors":"Srinivas Kasha ,&nbsp;Ranjith Kumar Yalamanchili ,&nbsp;Rohit GPRK ,&nbsp;Susmith Koneru ,&nbsp;Anurag Gurram ,&nbsp;Venkat Ravi Weera Athili","doi":"10.1016/j.jcot.2025.103279","DOIUrl":"10.1016/j.jcot.2025.103279","url":null,"abstract":"<div><div>Proximal tibial malunions resulting from inappropriate reduction or neglected traumatic sequelae can significantly alter knee biomechanics and predispose the patients to pain, instability, and early post traumatic osteoarthritis (PTOA). Their management requires a detailed analysis of the fracture fragments, location of deformity and status of soft tissue. Accurate preoperative assessment including clinical evaluation, standing radiographs, long-leg scanogram, and 2D/3D CT scans are critical for identifying coronal, sagittal, rotational, and multiplanar deformities. Deformity analysis using malalignment tests and marking of the centre of rotation of angulation (CORA) guides surgical planning. Surgical management focus on correction of limb alignment, restoration of articular congruity and stable fixation. Intra-articular osteotomy is preferred for depression or split-depression injuries, while extra-articular osteotomies address coronal or sagittal plane malalignment. Bicondylar and combined deformities may require dual approaches, and a tibial tubercle (TT) osteotomy might be needed to access and correct deformities, when CORA is close to TT. The biological potential of the osteotomy site, soft tissue condition, and bone quality must be considered when planning fixation. Internal fixation devices including bone graft is only suitable in cases with good soft tissue cover. A circular external fixator is preferred when gradual correction is required and particularly in cases where soft tissues are unsuitable for internal fixation. Mechanical axis should be restored as soon as it is safe to do so to prevent or slow the progression of PTOA. In this article we discuss classification and management strategies for proximal tibial malunions, emphasizing meticulous preoperative planning, surgical approach selection, surgical strategies to optimise functional outcomes and preserve the native joint.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103279"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145694037","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":"Medial patellofemoral ligament reconstruction descends the patella: results from an observational retrospective study with two different surgical techniques","authors":"José Andreu Castelo ,&nbsp;Juan Francisco Londoño ,&nbsp;Jacobo Triviño-Arias ,&nbsp;Gilberto Antonio Herrera ,&nbsp;Paulo José Llinás ,&nbsp;Juan Pablo Martinez-Cano","doi":"10.1016/j.jcot.2025.103263","DOIUrl":"10.1016/j.jcot.2025.103263","url":null,"abstract":"<div><h3>Background</h3><div>Patella alta is a known risk factor in recurrent patellofemoral dislocation. It is recommended to add a tibial tubercle distalization osteotomy for managing patella alta. Medial patellofemoral ligament reconstruction (MPFLr) could alter patellar height. The aim of this study is to quantify the possible decreasing effect of the MPFLr on patellar height in patients with patellofemoral instability treated with two different techniques: the anatomical (Schoettle's point) technique and the adductor's tendon sling technique, in three different indexes.</div></div><div><h3>Methods</h3><div>Retrospective observational study in patients with recurrent patellofemoral dislocation who underwent medial patellofemoral ligament reconstruction with an anatomical technique and an adductor's tendon sling technique between 2011 and 2020, comparing the preoperative and postoperative patellar height.</div></div><div><h3>Results</h3><div>A total of 15 knees and 14 patients were included, with a mean age of 19.2 ± 4.84 years. Eight patients (53.33 %) were treated with the adductor tendon technique and seven (46.67 %) with the anatomic technique. The change between preoperative and postoperative patellar height showed a statistically significant decrease in the three indexes measured, Caton-Deschamps (CD) (p = 0.0017), modified Insall-Salvati (IS) (p = 0.0022), and Blackburne-Peel (BP) (p = 0.0067). No statistically significant difference was found when comparing the delta of patellar descent between anatomic and adductor tendon groups. The mean decrease for the three measurements was 9 %, equivalent to 0.12 for CD, 0.17 for modified IS, and 0.11 for BP.</div></div><div><h3>Conclusion</h3><div>MPFL reconstruction contributes to a mild decrease in patellar height. This effect should be considered in surgical planning. Selected cases of patients with subtle patella alta could avoid the need for additional distalization procedures. Both techniques showed to decrease patellar height, and no differences could be demonstrated between them.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103263"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145529106","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}