Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"The role of machine learning in high tibial osteotomy: A systematic review of predictive modeling, planning, and outcome analysis","authors":"Ankush Mohabey ,&nbsp;Vivaan Jain ,&nbsp;Sitanshu Barik ,&nbsp;Vikash Raj ,&nbsp;Mukund Madhav Ojha ,&nbsp;Vishal Kumar","doi":"10.1016/j.jcot.2025.103290","DOIUrl":"10.1016/j.jcot.2025.103290","url":null,"abstract":"<div><h3>Background</h3><div>High tibial osteotomy (HTO) is a key joint-preserving procedure for medial compartment osteoarthritis and varus deformity, but conventional planning is operator-dependent. Machine learning (ML) offers potential to automate radiographic assessment and predict surgical outcomes. This systematic review evaluated the accuracy, efficiency, and generalizability of ML models applied to HTO planning and prediction.</div></div><div><h3>Methods</h3><div>Following PRISMA 2020 guidelines (PROSPERO CRD420251122187), PubMed, EMBASE, and Web of Science were searched to August 2025. Studies using ML for HTO planning, alignment measurement, or outcome prediction were included. Two reviewers independently extracted data and assessed risk of bias using the PROBAST tool across four domains: participants, predictors, outcomes, and analysis.</div></div><div><h3>Results</h3><div>From 43 retrieved records, 11 studies met inclusion criteria. Most were retrospective, single-center analyses with heterogeneous datasets. Convolutional neural networks and deep learning systems achieved sub-2° mean absolute error for alignment parameters such as hip–knee–ankle, medial proximal tibial and lateral distal femoral angles. Ensemble ML models predicted lateral hinge-fracture risk and postoperative alignment with area-under-curve values exceeding 0.80. Intraclass correlation coefficients for AI-derived measures were consistently &gt;0.90. Automated analysis was markedly faster than manual measurement—0.2 s versus 1–2 min per radiograph. Only a single study performed multicenter external validation; others remained internally tested.</div></div><div><h3>Conclusion</h3><div>ML demonstrates excellent precision and efficiency in radiographic analysis and complication prediction for HTO. Nonetheless, evidence is constrained by single-center data, small cohorts, and lack of functional validation. Future multicentric, prospective, and explainable AI studies are required to confirm clinical applicability and patient-reported benefit.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103290"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747385","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":"Revisiting the ACL reconstruction rehabilitation algorithm: A gait analysis study","authors":"Champak Roy,&nbsp;Vineet Kumar,&nbsp;Devashish Chhutani,&nbsp;Prabhat Kumar,&nbsp;Pankaj Aggarwal,&nbsp;Mohd Ammar Aslam","doi":"10.1016/j.jcot.2025.103291","DOIUrl":"10.1016/j.jcot.2025.103291","url":null,"abstract":"<div><h3>Background</h3><div>Anterior cruciate ligament (ACL) injuries are common among young adults, often resulting in knee instability and impacting quality of life. Despite advances in surgical techniques and rehabilitation, patients experience persistent quadriceps weakness, altered gait patterns, and increased risk of osteoarthritis.</div></div><div><h3>Methods</h3><div>This 1-year prospective cohort study investigated knee joint stability and gait patterns in 45 patients within one-year post-ACL reconstruction. Gait analysis was performed using a six-infrared camera system and two force plates. Lysholm knee scoring scale was used to evaluate knee function.</div></div><div><h3>Results</h3><div>The study's results showed that among 45 ACL reconstruction patients, majority were males (97.78 %) aged 25–29 (33.33 %), with high knee function (average Lysholm score: 95.33 ± 3.47). Gait analysis revealed altered patterns with reduced trunk movement, deviations from normal stride parameters in both limbs. Trunk obliquity and tilt were lower than normal, knee valgus-varus alignment was lower in both limbs, with the operated limb having slightly higher alignment. Knee flexion-extension was lower in the operated limb. The study highlighted altered gait patterns and reduced trunk movement in ACL reconstruction patients.</div></div><div><h3>Conclusion</h3><div>This study emphasizes the importance of comprehensive rehabilitation programs for ACL reconstruction patients, focusing on hip strengthening exercises to restore optimal gait patterns. Tailored rehabilitation plans with hip physiotherapy can improve hip muscle strength and symmetry, enhancing patient care and long-term success. By integrating these insights, healthcare professionals can provide more effective care, improving patients' quality of life and functional abilities.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103291"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839741","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":"Open vs. closed patella Fractures: Difference in incidence, treatment and outcomes","authors":"Ellen Lutnick ,&nbsp;Ryan Riley ,&nbsp;Emilie Harley ,&nbsp;Idem Essien ,&nbsp;Nicholas Frappa ,&nbsp;Christopher Mutty","doi":"10.1016/j.jcot.2025.103315","DOIUrl":"10.1016/j.jcot.2025.103315","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to describe the incidence and compare treatment and outcomes of open versus closed patella fractures at one institution.</div></div><div><h3>Methods</h3><div>Adult patients presenting to one American College of Surgeons Level 1 trauma hospital from 01/01/2001-12/31/2020 with patella fracture(s), screened by ICD codes were retrospectively reviewed. The primary outcome was the incidence of peri-injury or perioperative complications, including nonunion, superficial or deep infection, contracture/arthrofibrosis, deep venous thrombosis (DVT), hardware failure, patellar tendon rupture, painful hardware, wound healing complications, or return to the operating room (RTOR). Rates of postoperative complications were compared between fracture types (open vs closed) and treatment strategies (operative vs non-operative). All analyses were performed in R version 4.5.0. P-value &lt;0.05 was significant.</div></div><div><h3>Results</h3><div>Of 451 patients, (median age 52 years), 35.3 % were open fractures, and 62.3 % underwent operative treatment. Patients with open fractures were younger (mean age 38.84 ± 15.67 vs. 58.27 ± 19.45 years; p &lt; 0.001) and more commonly smokers (37.1 % vs. 27.4 %; p = 0.043). Open fractures had higher Injury Severity Scores (ISS) (12.81 ± 8.41 vs. 10.30 ± 8.28; p = 0.003) and were treated operatively more frequently than closed fractures (84.9 % vs. 50.0 %; p &lt; 0.001). Open fractures demonstrated a higher rate of any complication (38 [23.9 %] vs 42 [14.2 %], p = 0.014), as did patients treated operatively (78 [27.8 %] vs 2 [1.2 %], p &lt; 0.001). Patients who underwent RTOR were younger than those who did not (median 42.9 vs 53.7 years; p &lt; 0.001). Open fracture and postoperative complications were significantly associated with RTOR.</div></div><div><h3>Conclusion</h3><div>In this cohort, open patella fractures occurred at a higher rate than previously described in the literature at 35.3 %. Open fracture was significantly associated with increased risk of complications and unplanned RTOR.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103315"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839739","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":"Radiation exposure in orthopaedic trauma surgery: A systematic review and meta-analysis","authors":"Wasif Kawsar Qadri,&nbsp;Altaf Ahmad Kawoosa,&nbsp;Junaid Ali,&nbsp;Ishtiyaq Ahmad Lone","doi":"10.1016/j.jcot.2025.103304","DOIUrl":"10.1016/j.jcot.2025.103304","url":null,"abstract":"<div><h3>Background</h3><div>Fluoroscopic imaging is a cornerstone of modern orthopaedic trauma surgery, providing real-time guidance for fracture reduction and implant positioning. However, repeated intraoperative exposure poses significant radiation risks to patients and operating room personnel. Despite its routine use, there is limited consolidated evidence quantifying radiation exposure in common orthopaedic trauma procedures, and standardized diagnostic reference levels (DRLs) have yet to be established.</div></div><div><h3>Methods</h3><div>This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Comprehensive searches of PubMed, EMBASE, Cochrane CENTRAL, Web of Science, Scopus, and Ovid were performed up to May 2023. Studies reporting intraoperative radiation exposure using dose–area product (DAP, mGy·cm²) and/or fluoroscopy screening time (minutes:seconds) were included. Data were pooled using a random-effects model (DerSimonian–Laird). Study quality and risk of bias were assessed using the Joanna Briggs Institute (JBI) and ROBINS-I tools. The review could not be registered with PROSPERO, as retrospective registration is not permitted; however, the methodology fully adhered to PRISMA standards.</div></div><div><h3>Results</h3><div>Seven studies comprising 4159 patients met inclusion criteria. Proximal femoral nailing (PFN) showed the highest mean DAP (3168.8 ± 382.5 mGy cm²), followed by dynamic hip screw fixation (1606.5 ± 79 mGy cm²) and femoral intramedullary nailing (1251.6 ± 76.5 mGy cm²). The longest fluoroscopy times occurred during femoral and tibial nailing. Substantial heterogeneity (I² &gt; 99 %) reflected procedural and operator variability, with surgeon experience identified as a major determinant of exposure.</div></div><div><h3>Conclusion</h3><div>Femoral fixation procedures pose the highest radiation risk in orthopaedic trauma surgery. Structured radiation-safety education, adherence to ALARA principles, and establishment of standardized DRLs are essential. Future studies should report variance data and evaluate navigation-assisted and robotic techniques to minimize exposure.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103304"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839736","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":"Comment on “Changes in sagittal spinopelvic parameters following S2-alar-iliac screw fixation in adult degenerative scoliosis: A one-year radiographic analysis of 80 patients”","authors":"Bhumesh Tyagi ,&nbsp;Aishwarya Biradar","doi":"10.1016/j.jcot.2025.103310","DOIUrl":"10.1016/j.jcot.2025.103310","url":null,"abstract":"","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103310"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839738","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":"Multicenter reliability study of the universal long bone nonunion classification","authors":"Anton A. Semenistyy ,&nbsp;Leonid N. Solomin ,&nbsp;Artem V. Komarov ,&nbsp;Roman Y. Mitsikov ,&nbsp;Borislav G. Tasev ,&nbsp;Andrey N. Mironov","doi":"10.1016/j.jcot.2025.103302","DOIUrl":"10.1016/j.jcot.2025.103302","url":null,"abstract":"<div><h3>Background</h3><div>A universal classification providing a clinically relevant and anatomically comprehensive framework for long bone nonunions has been recently introduced. This study aimed to evaluate its inter- and intra-observer reliability and compare its performance with the widely used Weber–Cech classification.</div></div><div><h3>Methods</h3><div>This multicenter, three-stage validation study included 191 cases meeting the FDA definition of nonunion. Four expert raters participated. In Stage 1, cases were classified using existing systems: AO/OTA for anatomical location and Weber–Cech for biological type. In Stage 2, 133 eligible cases were independently classified using the Universal Long Bone Nonunion Classification (ULBNC) in two rounds, two weeks apart. Stage 3 involved refinement of classification criteria based on feedback and statistical analysis, followed by re-assessment of 90 cases. Inter-observer reliability was assessed using free-marginal Fleiss' kappa; intra-observer reliability using Cohen's kappa with linear weighting.</div></div><div><h3>Results</h3><div>Substantial to almost perfect inter-observer agreement was observed for type classification (κ = 0.85), with the highest reliability in diaphyseal nonunions (κ = 0.90). Incorporating pathological mobility significantly improved agreement compared to Weber–Cech (κ = 0.38, p &lt; 0.05). Periarticular nonunions showed substantial agreement (κ = 0.72). Group-level agreement improved from moderate (κ = 0.42–0.57) to substantial (κ = 0.79–0.82) after refining criteria. Subgroup agreement was excellent (κ = 0.89–1.00). Intra-observer reliability ranged from substantial to almost perfect across all levels.</div></div><div><h3>Conclusion</h3><div>ULBNC is a reliable and reproducible classification system for long bone nonunions. Incorporation of clinical features—such as pathological mobility, alignment, and correction strategy—enhances its clinical utility and supports standardization in treatment and research.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103302"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839810","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":"Clinical and functional outcomes of neo-adjuvant zoledronic acid therapy and valgus osteotomy in proximal femoral fibrous dysplasia","authors":"Nitish Jagdish Jyoti ,&nbsp;Pon Aravindhan,&nbsp;Ritvik Janardhanan,&nbsp;Dyuti Deepta Rano,&nbsp;Love Kapoor,&nbsp;Shah Alam Khan","doi":"10.1016/j.jcot.2025.103277","DOIUrl":"10.1016/j.jcot.2025.103277","url":null,"abstract":"<div><h3>Background</h3><div>Fibrous dysplasia (FD) is characterised by structurally weak bone due to disorganized fibro-osseous matrix, leading to pain, deformities and pathological fractures. While traditional treatments like curettage and bone grafting are ineffective due to graft resorption and lesion persistence, intramedullary fixation is currently preferred method to prevent recurrent deformities and fractures. This study aimed to evaluate the clinical and functional outcomes of neo-adjuvant zoledronic acid (ZA) therapy combined with valgus osteotomy in proximal femoral FD, and to assess changes in neck-shaft angle (NSA) and limb length discrepancy (LLD).</div></div><div><h3>Methods</h3><div>This single centre, retrospective study included eight patients with proximal femoral monostotic/polyostotic FD treated between January 2021 and December 2023. All patients received three doses of intravenous ZA at 4-week intervals, followed by valgus osteotomy performed 8 weeks after the final ZA dose. Pre- and post-operative NSA and LLD were recorded and compared. Functional outcomes were assessed using the modified Guille criteria.</div></div><div><h3>Results</h3><div>The mean age was 21.8 ± 6.68 years. Three patients had monostotic and 5 had polyostotic FD. Mean follow-up was 24.5 ± 6.4 months. All patients experienced pain relief post-ZA without serious adverse events, although only 2 showed radiological improvement. The mean modified Guille score improved from 3.5 ± 1.51 to 8.25 ± 1.48 (p = 0.01). The mean NSA improved from 100.75 ± 17.05° to 125.75 ± 8.31° (p = 0.044) and LLD reduced from 1.93 ± 0.72 cm to 0.93 ± 0.49 cm (p &lt; 0.001). Union was achieved in all cases with a mean healing time of 6.25 ± 1.66 months.</div></div><div><h3>Conclusion</h3><div>Combining neo-adjuvant ZA therapy and valgus osteotomy offers significant functional improvement and deformity correction in proximal femoral FD. While ZA offers consistent pain relief, its radiological impact remains variable. Valgus osteotomy, stabilized with intra- or extramedullary fixation remains a valuable technique for managing FD-associated deformities. Further prospective studies are warranted to refine treatment protocols and validate long-term outcomes.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103277"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624596","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":"Different treatment modalities and their impact on outcomes in severe rigid scoliosis: a systematic review and pooled data meta-analysis","authors":"Syed Ifthekar ,&nbsp;Deepankar Satapathy ,&nbsp;Kaustubh Ahuja ,&nbsp;Samarth Mittal ,&nbsp;Siddharth Sekhar Sethy ,&nbsp;Pankaj Kandwal","doi":"10.1016/j.jcot.2025.103295","DOIUrl":"10.1016/j.jcot.2025.103295","url":null,"abstract":"<div><h3>Background</h3><div>Severe rigid scoliosis is a stiff and complex three-dimensional deformity. The children presenting with severe scoliosis need to be timely treated to prevent further deterioration of the curves and physiological function. The goals of treatment include to stop the progression of the curve, restore the spinal alignment, prevent neurological deterioration or improve the neurology if it is already deteriorated, improvement of pulmonary function and improve cosmetic outcomes. The various surgical options are one stage correction with osteotomies, posterior only approach, staged anterior release and posterior approach, pre-operative optimization by halo traction followed by posterior fusion and temporary internal distraction.</div></div><div><h3>Method</h3><div>The study protocol was published in PROSPERO with the ID CRD420251046131.Studies with participants diagnosed with severe rigid scoliosis who were operated and reporting the baseline values and correction of the scoliosis at follow-up were included. Studies mentioning the type of procedure and complications associated with the procedure were also included. Studies dealing with exclusive kyphosis, infective deformities, porcine models, adult degenerative lumbar scoliosis and those that did not give details about the scoliosis correction were excluded.</div></div><div><h3>Results</h3><div>A total of Seventy-Five studies were included with 2314 patients. Both neurological and non-neurological complications were significantly more likely in osteotomy compared to halo traction followed by definitive surgery. The difference was very significant in neurological complications (RR∼3.76, 95 % CI = 2.52–5.60).</div></div><div><h3>Conclusion</h3><div>Among the various strategies employed to treat severe rigid scoliosis, Spinal Osteotomy techniques had the highest rates of neurological and non-neurological complications. All the techniques described like halo traction, osteotomy and staged procedures gave a good curve correction in severe rigid scoliosis.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103295"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797115","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":"Computed tomography versus plain radiography in the Mitsuzawa classification for severe proximal humeral fractures: Comparative agreement analysis and clinical implications","authors":"Sadaki Mitsuzawa ,&nbsp;Hisataka Takeuchi ,&nbsp;Tadashi Yasuda ,&nbsp;Shuichi Matsuda","doi":"10.1016/j.jcot.2025.103276","DOIUrl":"10.1016/j.jcot.2025.103276","url":null,"abstract":"<div><h3>Background</h3><div>In a prior investigation, we demonstrated that the Mitsuzawa classification for dislocated and severely displaced proximal humeral fractures (PHFs) provided substantially higher reliability than the Neer or AO/OTA systems when applied to plain radiographs. The present study builds on that work by determining whether computed tomography (CT) alters classification outcomes or improves observer agreement.</div></div><div><h3>Methods</h3><div>Four independent reviewers—two shoulder specialists and two orthopedic residents—classified 70 PHFs according to the Neer, AO/OTA, and Mitsuzawa systems. Each fracture fulfilled criteria for dislocation or severe displacement requiring arthroplasty. Evaluations were performed at two separate timepoints: first with radiographs and then with CT scans, including three-dimensional reconstructions. Changes between modalities were recorded. Intraobserver consistency was assessed with the Cohen κ statistic, while interobserver reliability was evaluated with the Fleiss κ statistic.</div></div><div><h3>Results</h3><div>The incidence of axillary artery injury was 7.1 %. After CT review, classification changes occurred in 31 % of Neer, 29 % of AO/OTA, and 11 % of Mitsuzawa assessments. With radiographs alone, intraobserver reliability was moderate for Neer (κ = 0.52), substantial for AO/OTA (κ = 0.63), and substantial for Mitsuzawa (κ = 0.73). With CT imaging, the corresponding values were 0.55, 0.59, and 0.73. Interobserver agreement ranged from 0.43 to 0.45 (Neer), 0.49–0.52 (AO/OTA), and 0.68–0.68 (Mitsuzawa) with radiographs, and from 0.47 to 0.50, 0.57–0.57, and 0.67–0.69, respectively, after CT. Significant pairwise differences (<em>p</em> &lt; 0.05) in interobserver agreement were observed among all combinations of the three systems for both modalities.</div></div><div><h3>Conclusions</h3><div>The Mitsuzawa classification was minimally influenced by imaging modality and consistently provided substantial agreement. For dislocated and displaced PHFs, CT appears to have only a minor influence on Mitsuzawa-based categorization, indicating that well-performed radiographs remain sufficient for reproducible classification. These findings have direct implications for clinical decision-making, imaging selection, and anticipating risks such as neurovascular compromise.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103276"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624597","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":"“Rotator cuff arthropathy: Insights into this under-recognized entity”","authors":"Soham Banerjee,&nbsp;Stanzin Spalkit,&nbsp;Ankur Goyal,&nbsp;Shivanand Gamanagatti","doi":"10.1016/j.jcot.2025.103307","DOIUrl":"10.1016/j.jcot.2025.103307","url":null,"abstract":"<div><div>Rotator cuff tears are commonly seen in athletes and older adults. Rotator cuff arthropathy (RCA), the end stage of untreated or neglected massive rotator cuff tears, leads to debilitating restriction of shoulder movements. The condition typically occurs in the seventh decade of life. While the entity can be suspected clinically, imaging clinches the diagnosis and guides the appropriate management. However, it may be missed by the radiologist on a radiograph, and sometimes on magnetic resonance imaging as well, where the findings of cuff tears take apparent priority in the impression over those of arthropathy. The inexperienced radiologist may also fail to mention findings important for surgical decision-making, such as muscle atrophy, fatty infiltration of muscles, and the location of the retracted end of the cuff tendons. This review article aims to provide teaching points on the correct diagnosis, and the importance of relevant and comprehensive reporting of such cases for timely management.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103307"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839737","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}