Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"Strategies to mitigate complications in arthroscopic rotator cuff repair","authors":"Guido Fierro ,&nbsp;Gabriela Gómez Romero ,&nbsp;Jorge Rojas Lievano ,&nbsp;Juan David Lacouture ,&nbsp;Juan Carlos González","doi":"10.1016/j.jcot.2024.102852","DOIUrl":"10.1016/j.jcot.2024.102852","url":null,"abstract":"<div><div>The rotator cuff, a vital group of tendons and muscles in the shoulder, is essential for stabilizing the joint and enabling a wide range of arm movements. Rotator cuff tears, common across all age groups, often cause significant pain and functional limitations. Rotator cuff repair surgery aims to alleviate pain, restore function, and improve quality of life. Recent advances, particularly in arthroscopic techniques, have enhanced surgical outcomes and shortened recovery times. Nevertheless, risks remain, including surgical site infections, tendon retears, stiffness, severe postoperative pain, and nerve injuries.</div><div>This article explores the complexities of rotator cuff repair, dividing complications into intraoperative and postoperative categories. Key challenges in arthroscopic techniques include ensuring optimal visualization, preventing anchor pullout, and managing chondral damage. Postoperative concerns such as infections, stiffness, and retears are also discussed, with an emphasis on preoperative skin preparation and emerging interventions like benzoyl peroxide application and platelet-rich plasma. By incorporating surgical innovations, evidence-based protocols, and comprehensive patient management, clinicians can enhance outcomes and recovery rates. The ongoing exploration of new treatments and collaborative research efforts are crucial for refining treatment protocols and advancing orthopedic patient care.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"60 ","pages":"Article 102852"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932251","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 influence of the number of postoperative radiological outliers on the survival and clinical outcome of total knee arthroplasty","authors":"D.M.J. Theeuwen ,&nbsp;Y.F.L. Bemelmans ,&nbsp;B. Boonen ,&nbsp;I. Haveman ,&nbsp;W. van der Weegen ,&nbsp;M.G.M. Schotanus","doi":"10.1016/j.jcot.2024.102834","DOIUrl":"10.1016/j.jcot.2024.102834","url":null,"abstract":"<div><h3>Introduction</h3><div>After total knee arthroplasty (TKA), dissatisfaction rates are described up to 30 %. Optimal alignment of the prosthesis in TKA is believed to improve clinical outcome and survival rates. Radiological outliers after TKA are used to define this alignment. Limited evidence is available on the cumulative effect of these outliers on survival or clinical outcome. The purpose of this study is to assess whether the amount of postoperative femoral and/or tibial radiological outliers, measured in different planes, influences the survival and clinical outcome after TKA.</div></div><div><h3>Methods</h3><div>Prospective data were used from a previously published randomized trial, with a mean follow-up of 5-years after surgery. Data of 168 patients who received TKA were assessed. Patients were divided into four groups: 0, 1, 2 or ≥3 postoperative radiological outliers of the femoral and/or tibial component in different planes (e.g. frontal, sagittal). Revision rates were analysed and clinical outcome was assessed using PROMs. The study used a general linear model for repeated measures to compare the difference of each questionnaire over time between the groups.</div></div><div><h3>Results</h3><div>No statistically significant differences were found between patients with 0, 1, 2 or ≥3 outliers regarding improvement of postoperative PROMs. Data was underpowered to detect a possible relationship between the number of outliers and the survival of the prosthesis.</div></div><div><h3>Conclusion</h3><div>The number of postoperative radiological outliers did not influence clinical outcome after TKA. High-powered studies are needed to examine the influence of these outliers on survival rates.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"60 ","pages":"Article 102834"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932529","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":"Reviewer Acknowledgment-2024","authors":"","doi":"10.1016/j.jcot.2024.102896","DOIUrl":"10.1016/j.jcot.2024.102896","url":null,"abstract":"","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"60 ","pages":"Article 102896"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143098540","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":"Complications following shoulder arthroplasty: A review of the recent literature","authors":"Giles Faria ,&nbsp;Zaid Ali ,&nbsp;Muhammed Rasheed ,&nbsp;Ali Abdelwahab ,&nbsp;Hariharan Mohan ,&nbsp;Nik Bakti ,&nbsp;Bijayendra Singh","doi":"10.1016/j.jcot.2024.102850","DOIUrl":"10.1016/j.jcot.2024.102850","url":null,"abstract":"","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"60 ","pages":"Article 102850"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933610","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":"Osteoporosis Knowledge Assessment Tool – Tamil (OKAT-T) in postmenopausal women: A validity and reliability study","authors":"Lalithambigai Chellamuthu ,&nbsp;J Jenifer Florence Mary ,&nbsp;Suvathi Palanichamy","doi":"10.1016/j.jcot.2024.102845","DOIUrl":"10.1016/j.jcot.2024.102845","url":null,"abstract":"<div><h3>Introduction</h3><div>Osteoporosis is a silent disease that is more prevalent among postmenopausal women (PMW) due to hormonal transition. Various toolkits, including the Osteoporosis Knowledge Assessment Tool (OKAT), were available for the knowledge assessment. The Osteoporosis-related knowledge is crucial for preventing osteoporosis, but there is no validated, reliable questionnaire in Tamil to measure this knowledge.</div></div><div><h3>Aim</h3><div>To validate the Tamil version of the OKAT (OKAT-T) and its psychometric properties to measure the knowledge of osteoporosis for use in postmenopausal women.</div></div><div><h3>Methodology</h3><div>This cross-sectional study was done in two phases, as translation of OKAT in Tamil and validation of OKAT-T among 430 postmenopausal women in both rural and urban regions. Reliability was examined by the Flesch reading ease (FKRE&amp;G) and McNemar's test, along with difficulty index, item discrimination and item-total correlations, inter-item consistency (Cronbach's alpha coefficient).</div></div><div><h3>Result</h3><div>The overall mean age of the 430 PMW was 59.53 ± 9.83 years. The results showed a good and satisfactory face validity and FKRE&amp;G score (55.9). The Cronbach's alpha for the overall scale was calculated as 0.85 and considered to be good and satisfactory. As per the difficulty index, 19 items had a 0.3 to 0.7, implying that the questionnaire was easy to understand and satisfactory. Similarly, a test-retest was assessed, which was statistically significant for only six items out of 26, showing that the tool has stable reliability.</div></div><div><h3>Conclusion</h3><div>The management of chronic disorders such as osteoporosis has become more challenging for patients especially among PMW and healthcare professionals due to the increasing life expectancy and urbanization. The use of an Osteoporosis Knowledge Assessment tool that has been tailored to people's understanding and developed in the local language can raise awareness levels about osteoporosis, encourage the adoption of osteoprotective strategies, and provide guidance on treatment options.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"60 ","pages":"Article 102845"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933556","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":"Femoral tunnel enlargement after medial patellofemoral ligament reconstruction is common and can be monitored using plain radiographs","authors":"Tobias Roberts ,&nbsp;Laura Casey ,&nbsp;Diego Agustín Abelleyra Lastoria ,&nbsp;Samuel Walters ,&nbsp;Toby Smith ,&nbsp;Caroline Hing","doi":"10.1016/j.jcot.2024.102835","DOIUrl":"10.1016/j.jcot.2024.102835","url":null,"abstract":"<div><h3>Introduction</h3><div>medial patellofemoral ligament reconstruction (MPFLr) is a common surgical procedure for treating patellar instability. Grafts can be fixed to the femur using a bone-tunnel technique with an interference screw. However, this may lead to femoral tunnel enlargement (FTE) post-operatively. The aim of this study was to assess the correlation between time after MPFLr and FTE, to evaluate factors that might influence FTE and to determine if FTE can be reliably evaluated with plain radiographs.</div></div><div><h3>Methods</h3><div>we conducted a single-surgeon series, retrospective review of 70 MPFLr (52 female; 18 male) between 2014 and 2022. We assessed change in femoral tunnel area compared with original tunnel area (TP0), on lateral radiographs at two time points. Time point one (TP1): mean 34 days (standard deviation (SD): 25); and Time Point 2 (TP2): mean 490 days (SD: 333). We analysed the relationship between surgical characteristics to FTE, and assessed inter- and intra-rater reliability of FTE.</div></div><div><h3>Results</h3><div>tunnel area significantly increased from TP0 to TP1 and TP2 (p &lt; 0.001). Mean percentage increase in cross-sectional tunnel area (CTA) between TP0 and TP1 was 113 % (SD: 49 %). Mean percentage increase in CTA between TP0 and TP2 was 139 % (SD: 64 %). There were 25 cases (36 %) of tunnel malposition. There was no significant correlation between distance from the isometric point and FTE at TP1 (r = 0.05; 95 % confidence intervals (CI): −0.19 to 0.29) or TP2 (r = 0.17: 95 % CI: −0.068 to 0.39). There were no other significant correlations with FTE. Inter-rater reliability for FTE at TP1 was moderate (Inter-Class Coefficient (ICC): 0.67; 95 % CI: 0.47 to 0.80; p &lt; 0.001), with intra-rater reliability being excellent (ICC: 0.94; 95 % CI: 0.90 to 0.96; p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>FTE after MPFLr is common. Plain radiographs can be used reliably to monitor tunnel enlargement in clinical practice.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"60 ","pages":"Article 102835"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886297","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 radiological insights into fibrodysplasia ossificans progressiva: A report on two cases","authors":"Sanika Rapole ,&nbsp;Bhavika Mehta ,&nbsp;Vivek Sodhai","doi":"10.1016/j.jcot.2024.102846","DOIUrl":"10.1016/j.jcot.2024.102846","url":null,"abstract":"<div><div>Fibrodysplasia ossificans progressiva (FOP) is a rare genetic illness marked by progressive heterotopic ossification of tendons, ligaments, fascia, and skeletal muscle, leading to immobility and reduced quality of life. Early recognition is critical to avoiding flare-ups often triggered by trivial trauma or medical interventions. This report presents two early-diagnosed FOP cases—one at 6 months, the other at 18 months—both with typical features and congenital great toe abnormalities. Early detection enables preventive strategies that enhance the quality and longevity of affected children's lives. Increased awareness among healthcare professionals about the unique presentation of FOP is vital for prompt diagnosis.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"60 ","pages":"Article 102846"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886293","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":"Integrative surgical approach for complex transverse-posterior wall fractures of the acetabulum: A case series of 21 patients evaluating mid-term outcomes","authors":"Ramesh Perumal ,&nbsp;Owais Ahmed ,&nbsp;Asif Imran ,&nbsp;Mohamed Zackariya ,&nbsp;Dheenadhayalan Jayaramaraju ,&nbsp;Rajasekaran Shanmuganathan","doi":"10.1016/j.jcot.2024.102851","DOIUrl":"10.1016/j.jcot.2024.102851","url":null,"abstract":"<div><h3>Introduction</h3><div>Complex-fractures-of-acetabulum represent a significant challenge due to their complicated nature and their crucial role in the function and stability of hip joint. Associated-transverse-posterior-wall(TPW) fractures of acetabulum have been categorized as partial-articular-fractures by the AO/ATO-classification. The cornerstone for a good-to-excellent outcome is anatomical reduction and rigid-internal-fixation. The management of TPW-fractures has shown significant advancements, but there is still debate regarding the best surgical approach.</div></div><div><h3>Methods</h3><div>The study was conducted in a level-1-tertiary-trauma-care-centre, involving patients with an TPW- fractures-of-the-acetabulum. During Jan-2015 to Jan-2023, 512-acetabulum-fractures were managed-surgically. Out-of-which, 87-patients had TPWfracture. 21-patients who-underwent surgical-fixation using a combined-approach: Kocher-Langenbeck(KL) and iliofemoral(IF)-approaches were included in this study. Post-operative-radiological results were graded according to Matta-score. Functionaloutcome-analysis was done using EuroQOL-5D-score. The occurrence and rate-ofcomplications were evaluated.</div></div><div><h3>Results</h3><div>TPW-fractures had incidence of 17% among acetabulum-fractures. The Meanage: 39-years and male-to-female ratio was 19:2. Mean-follow-up: 30.5 (months). 47.6% had multiple-fractures and 38.1% were-polytraumatized. On arrival, 71.5% had hip-dislocation,19% had sciatic-nerve-injury. Excellent-to-good anatomic-reduction in 85.7%. Excellent-to-good functional-outcomes in 86%. An iatrogenic-sciatic-nerveinjury was seen in two-patients. Avascular-necrosis (AVN),heterotrophicossification (HO),and post-traumatic-osteoarthritis (OA) were seen in 14.3%, 33.3%, and 9.5% respectively. The rate-of-conversion to THR was 4.7%.</div></div><div><h3>Conclusion</h3><div>In cases of complex TPW-fractures-of-the-acetabulum with complete displacement and/or comminution, the integrative use of the KL and IF-approach provides comprehensive and controlled exposure for the reduction and fixation of both columns and walls, thereby facilitating excellent-reduction and stable-fixation. For-those presenting with comminution at posterior-wall or column and simple anteriorcolumn-fracture, the IF-approach should be employed first to stabilize the anteriorcolumn, followed-by of posterior-wall &amp; column using KL-approach. Contrarily, in cases without posterior-wall or column-comminution, initial-fixation and stabilization of posterior aspect can be performed using KL-approach. Subsequently, if intra-operative assessment reveals an anterior-column displacement greater-than-2mm and intraoperative roof-arc-angle less than 45degrees, iliofemoral-approach should be utilized to address anterior-column if indirect reduction from the posterior-approach proves insufficient.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"60 ","pages":"Article 102851"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933611","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 following functionally aligned total knee arthroplasty in severe varus deformity","authors":"Richard Hogan ,&nbsp;Baha John Tadros ,&nbsp;Serene Lee ,&nbsp;Dermot Collopy ,&nbsp;Gavin Clark","doi":"10.1016/j.jcot.2024.102836","DOIUrl":"10.1016/j.jcot.2024.102836","url":null,"abstract":"<div><h3>Introduction</h3><div>Total knee arthroplasty (TKA) in severe varus deformity still remains a challenge. Alternative alignment TKA aims to improve outcomes and satisfaction. The purpose of this study is to report on the outcomes of a functionally aligned TKA in severe varus deformity.</div></div><div><h3>Methods</h3><div>This is a retrospective review of single surgeon series. 92 patients with a varus deformity of &gt;15⁰ on varus stress underwent a functionally aligned, TKA (Stryker Triathlon, Mahwah, New Jersey, USA) between 2016 and 2022. A control group, matched for age, gender and body mass index (BMI) from the same period was also identified with mild varus deformity (&lt;10⁰). Intra-operative robotic data collected included gap measurements, bone resection depths, alignment, and rate of soft tissue releases. Clinical outcome data was collected as part of the prospective registry which included patient reported outcome measures (Forgotten Joint Score 12, Oxford Knee Score and Knee Injury and Osteoarthritis Outcome Score Joint Replacement), pain Visual analogue score (VAS), patient satisfaction and range of motion. We reported a minimum follow-up of 12 months.</div></div><div><h3>Results</h3><div>Medial soft tissue release was performed in 7.6 % of patients in the severe varus group. No soft tissue release was required in the control group. 96.7 % of TKAs achieved coronal balance in extension within 1 mm in the severe varus group. The varus stressed Hip knee ankle angle (HKA) was corrected by 8.5⁰ (95 % CI -9.4 to −7.6, p &lt; 0.001). Patients in both group achieved excellent clinical outcomes scores and satisfaction (Severe varus: 91.9 % vs control: 92.7 %) at the final follow-up.</div></div><div><h3>Conclusion</h3><div>Patient with severe varus deformity (&gt;15⁰) undergoing a functionally aligned TKA achieve a well-balanced TKA with excellent clinical outcomes and small rates of soft tissue release.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"60 ","pages":"Article 102836"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886305","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 size of local recurrence influences outcomes in chondrosarcoma: Significant impact observed in grade 2 tumours","authors":"G. Kask,&nbsp;M.K. Laitinen,&nbsp;M.C. Parry,&nbsp;V.J. Kurisunkal,&nbsp;G.V. Morris,&nbsp;J.D. Stevenson,&nbsp;L.M. Jeys","doi":"10.1016/j.jcot.2024.102866","DOIUrl":"10.1016/j.jcot.2024.102866","url":null,"abstract":"<div><h3>Background</h3><div>Chondrosarcoma is the second most common bone malignancy. Chondrosarcoma is considered a surgical disease, and the role of surgical margin is important since local recurrence is known to decrease survival. The aim of this study was to investigate the timing of local recurrence and the size of local recurrence in post local recurrence survival in chondrosarcoma.</div></div><div><h3>Methods</h3><div>We reviewed data from one international tertiary sarcoma hospital. Between 1990 and 2022, 911 patients with chondrosarcoma of the pelvis and extremities were identified and 161 (18 %) had a local recurrence. Competing risk analysis was used to identify the timing and size of local recurrence in post local recurrence survival in different grades.</div></div><div><h3>Results</h3><div>Increasing size of local recurrence was a statistically significant negative factor in grade 2 chondrosarcoma patients. The timing of local recurrence was not significant for post local recurrence survival. Only 7 % of the local recurrences in high grade tumours were detected after five years after index surgery.</div></div><div><h3>Conclusion</h3><div>In this study we have shown that the size of local recurrence emerges as a significant factor in grade 2 tumours. Timing of local recurrence does not significantly predict the post local recurrence survival. Moreover, only 7 % of local recurrences are detected after five years in high grade tumours. Therefore, we recommend that active surveillance efforts be particularly focused on grade 2 chondrosarcomas during the initial five years after index surgery.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"60 ","pages":"Article 102866"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143098538","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}