Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"What is the optimal shape and size of a cortical window that least affects bone strength? A biomechanical study.","authors":"Muhammed Şakir Çalta, Muhammed Furkan Tosun, Ethem Burak Oklaz, Fatma Kübra Erbay Elibol, Yunus Uslan, Teyfik Demir, Şefik Murat Arıkan","doi":"10.1016/j.otsr.2025.104452","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104452","url":null,"abstract":"<p><strong>Background: </strong>Biopsy and curettage are frequently used in orthopaedic oncology surgeries. However, these procedures reduce bone strength and result in pathological fractures. Therefore, meticulous planning of the size and shape of the cortical window is paramount to preserve bone strength. However, few studies have examined the shape and size of the windows created for biopsy and curettage procedures. The purpose of this study was to evaluate the effect of cortical window shape (rectangular versus elliptical) on bone strength and to evaluate the effect of ellipses with different dimensions on bone strength.</p><p><strong>Hypothesis: </strong>The hypothesis of this study was that an elliptical cortical window would have a lesser impact on bone strength than a rectangular window, particularly in cases where the length of the ellipse increases while its width decreases.</p><p><strong>Materials and methods: </strong>Sixty-four synthetic femur models were divided into four groups (n = 8) for compression and torsional tests. Four equal-area cortical windows were created. G1 (rectangular), G2 (elliptical, 1/1.5 ratio), G3 (elliptical, 1/3 ratio), and G4 (elliptical, 1/6 ratio). Compression tests (10 mm/min) were used to assess the maximum load, stiffness, yield load, and fracture energy. Torsion tests (50º/min) were used to measure the maximum torque, stiffness, and work done. Biomechanical performance was compared using load-displacement and torque-angular displacement data.</p><p><strong>Results: </strong>All bone models were fractured along the cortical window. G3 (elliptical, 511.09 ± 55.07 N) had higher maximum load than G1 (rectangular, 389.18 ± 88.46 N, p = 0.003). The elliptical groups (G2:71.21 N/mm, G3:71.04 N/mm, G4:84.10 N/mm) showed greater compression stiffness than G1 (52.60 N/mm, p ≤ 0.05). G3 had higher yield load (458.72 ± 43.42 N) and work done (2.6 J) than G1 (352.43 ± 91.24 N, 1.78 J, p ≤ 0.05). No significant difference in torsion test results was observed between G3 and G1 (p > 0.05). G2 exhibited lower maximum load, yield load, and work than G3 and G4 (p ≤ 0.003). G4 exhibited higher torque (17.08 Nm) than G2 (11.73 Nm, p = 0.02) and G3 (12.62 Nm, p = 0.018). The torsional stiffness was similar across the elliptical groups.</p><p><strong>Discussion: </strong>This biomechanical study demonstrated that elliptical cortical windows, especially those with higher length-to-width ratios, outperform rectangular windows in terms of strength under compression and torsional loads. These findings suggest that elliptical cortical windows may provide biomechanical advantages in terms of preserving bone strength and reducing fracture risk. However, as these results are based on an experimental model, further in vivo studies are needed to confirm their clinical applicability.</p><p><strong>Level of evidence: </strong>V; Comparative laboratory study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104452"},"PeriodicalIF":2.2,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How does surgeon's experience impacts revision rates after nononcologic lower extremity total joint arthroplasty with a megaprosthesis?","authors":"Corentin Bertout, Emilie Renoud-Grappin, Guillaume Tran, Denis Waast, Christophe Nich, François Lataste, François Gouin, Vincent Crenn","doi":"10.1016/j.otsr.2025.104454","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104454","url":null,"abstract":"<p><strong>Background: </strong>Megaprostheses, initially developed for oncological indications, have increasingly found application in traumatology and hip and knee revision surgery. However, their frequent complications highlight the importance of learning the procedure. This study aims to provide original data on the impact of a surgeon's learning curve on key perioperative outcomes of these surgeries.</p><p><strong>Question/purpose: </strong>The experience of surgeons performing massive arthroplasties influences key perioperative outcomes.</p><p><strong>Patients and methods: </strong>We conducted a monocentric retrospective study between January 2005 and August 2022, involving 93 megaprostheses surgeries performed for non-oncological indications. Learning curves were constructed using the LOESS (Locally Estimated Scatterplot Smoothing) method, based on intraoperative data such as total blood loss (TBL) and blood volume transfused (BVT). These curves were used to categorize surgeons into the learning phase (SLP) and mastery phase (SMP). We also compared the cumulative incidence of reinterventions for complications between the two groups.</p><p><strong>Results: </strong>Linear regression analysis revealed a learning effect for the TBL with thresholds of five procedures (R² = 0.139; p = 0.008), and five procedures for BVT (R² = 0.079; p = 0.002). Based on these findings, we defined the threshold for the learning phase as up to four procedures, and the mastery phase from the fifth procedure onwards. Multivariate analysis showed a slightly higher cumulative incidence of re-interventions for complications in the SLP group (33%; n = 14) compared to the SMP group (22%; n = 11), with a Hazard Ratio of 2.07 (CI 95% [0.94-4.59]; p = 0.071) without reaching statistical significance.</p><p><strong>Conclusion: </strong>This study describes a learning curve for performing proximal and distal femur replacement with megaprostheses in non-oncological indications. Despite it is well established that all surgical procedures benefit from supervision during the early learning phase, we did not find a learning effect on the risk of reoperation for complications. Nevertheless, there is an improvement on variables such as bleeding along the learning curve, leading to suggest that these interventions should be performed by experienced surgeons or under supervision.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104454"},"PeriodicalIF":2.2,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes Following Medial Patellofemoral Ligament Reconstruction Using Ultra High-Strength 2-mm-Wide Tape In Non-elite Athletes.","authors":"Tunay Erden, Muzaffer Agir, Jotyar Ali, Malik Celik, Suat Batar, Ali Toprak, Berkin Toker, Ömer Taser","doi":"10.1016/j.otsr.2025.104450","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104450","url":null,"abstract":"<p><strong>Background: </strong>The medial patellofemoral ligament (MPFL) reconstruction is commonly conducted using gracilis, semitendinosus, quadriceps or tensor fascia lata tendon autografts or allografts. This approach, however, can sometimes lead to complications or morbidity at the site from which the graft is harvested. This study reports the clinical outcomes of non-elite competitive athletes who undergone MPFL reconstruction using an ultrahigh-strength 2-mm-wide tape.</p><p><strong>Patients and methods: </strong>This retrospective cohort study included 67 non-elite athletes with acute or recurrent lateral patellar instability who underwent surgical treatment between December 2015 and December 2020. Athletes who underwent tibial tubercle osteotomy due to severe patellofemoral arthritis or severe osteochondral damage (kissing lesions or >2.5cm²) (1), trochlear dysplasia (Dejour type D dysplasia) (5), open physis (19) and revison MPFL reconstruction (8), were excluded. The remaining 34 athletes were followed postoperatively for a minimum of 48 months.</p><p><strong>Results: </strong>During the follow-up period, there was only one case and which was revised by adding Fulkerson Osteotomy. Two patients had limited range of motion and joint mobilization was performed under general anesthesia at the end of the second month. The International Knee documentation Committee (IKDC), Kujala, and visual analog scale (VAS) scores showed improvement postoperatively (p < 0.001). Moreover, the mean improvements in IKDC (≈+41), Kujala (≈+33), and VAS (≈-3.8) scores exceeded the established minimal clinically important difference (MCID) thresholds, indicating that the outcomes were not only statistically significant but also clinically meaningful for patients. When comparing the pre- and postoperative radiological measurements, the mean tilt angle and mean congruence angle showed a significant decrease (p < 0.001) CONCLUSION: Suture tape may be a good alternative to autograft, as it does not cause donor site morbidity. However, its most important disadvantage is its higher cost.</p><p><strong>Level of evidence: </strong>IV; Retrospective case series.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104450"},"PeriodicalIF":2.2,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impacts of surgically treated acetabular and pelvic fractures on return to work and to sports.","authors":"Juliette Tremblay, Alexis Dufour, Rami Ayoubi, Étienne L Belzile, Julien Dartus, Stéphane Pelet","doi":"10.1016/j.otsr.2025.104449","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104449","url":null,"abstract":"<p><strong>Background: </strong>Literature exploring impacts and quality of life limitations of pelvic ring and acetabular fracture is limited. The aim of the study is to evaluate the impact of pelvic ring and acetabular fracture on the return to work (RTW) and sports (RTS) and identify factors associated with difficulties to resume their previous activities.</p><p><strong>Hypothesis: </strong>Patients with pelvic ring and acetabular fractures will experience difficulties to return to their previous occupation and physical activities.</p><p><strong>Patients and methods: </strong>This is a retrospective cohort study reviewing the medical and radiological charts under IRB approbation. The patients were contacted for a final questionnaire assessing the RTW and the RTS at a minimum of two years follow-up. All patients admitted for a surgically treated pelvic ring and/or acetabulum fracture between 2009 and 2022 at a level 1 trauma center were included. For RTW, collected information covered an overview of the patients' employment situation and classifying it by level of occupational activity. Global physical activity level was assessed with the UCLA Hip Activity Scale. Other variables of interest included: concomitant injury, trauma type, pelvic ring fracture type, delay for final fracture stabilization, and complications. Initial analysis was carried out based on the ability to resume activities at the level before the trauma (success or failure). Uni- and multivariate analyzes were conducted to identify factors associated with a failed return to their activities.</p><p><strong>Results: </strong>One hundred and thirteen patients completed the final questionnaire (73% men, average age 51 ± 16.7 years). Among 88 patients still employed at the time of the trauma, 57 patients had a difficult RTW (65%). Forty-eight patients had a difficult RTS (43%). Thirty-four patients (39%) never returned to work and 30 patients (27%) did not return to sports. The presence of other fractures within the initial trauma (OR 3.17; 95%CI 1.24-8.10; p = 0.014) and a concomitant traumatic brain injury (OR 3.78; 95%CI 1.27-11.27; p = 0.013) are significantly associated with a difficult RTW. The presence of marginal impaction on the acetabulum (OR = 7.3; p = 0.014, CI95% 1.44-37.16) is associated with a difficult RTS.</p><p><strong>Discussion: </strong>Most patients with a surgically treated pelvic and acetabular fracture have a difficult RTW and RTS. Among the factors identified, few are modifiable. The study does not show influence of quality reduction on RTW and RTS.</p><p><strong>Level of evidence: </strong>III; Retrospective cohort study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104449"},"PeriodicalIF":2.2,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of intramedullary platelet-rich plasma on fracture healing in elderly intertrochanteric fractures: A randomized controlled trial.","authors":"Saran Tantavisut, Sanzhar Artykbay, Chavarin Amarase, Siripong Tantanarat, Sinsuda Dechsupa, Sittisak Honsawek","doi":"10.1016/j.otsr.2025.104457","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104457","url":null,"abstract":"<p><strong>Background: </strong>Intertrochanteric fractures in the elderly present challenges due to poor bone healing and high complication rates. Platelet-rich plasma (PRP) may promote early bone regeneration, but clinical evidence, especially for osteoporotic fractures, is limited. Unlike extramedullary injections, intramedullary PRP specifically targets the vascular marrow at the fracture site. This randomized controlled trial aimed to evaluate the effect of intramedullary PRP application on fracture healing and clinical outcomes in elderly patients undergoing surgical fixation for intertrochanteric fractures.</p><p><strong>Hypothesis: </strong>We hypothesized that intramedullary PRP would accelerate early bone healing and improve postoperative functional recovery compared to placebo.</p><p><strong>Patients and methods: </strong>This single-center, double-blind, parallel-group trial was conducted from November 2020 to December 2024. Patients aged ≥60 years with isolated low-energy intertrochanteric femoral fractures were randomized to receive either 5 mL of autologous PRP or 5 mL of normal saline intraoperatively. All patients underwent fixation with a short cephalomedullary nail. Follow-up assessments were performed at 2 weeks, 6 weeks, 3 months, and 6 months postoperatively.</p><p><strong>Results: </strong>Eighty-four patients were randomized (40 to the PRP group, 44 to the control group), with no significant differences in baseline characteristics. At 2 weeks, the PRP group showed a significantly higher Radiographic Union Score for Hip (RUSH) than the control group (12.0 vs. 10.5; P <  0.001); however, no significant differences were observed at 6 weeks, 3 months, or 6 months. Postoperative bone turnover markers (P1NP, osteocalcin, ALP, Beta-Crosslaps, and bone-specific ALP) were comparable between groups. Functional outcomes, assessed by the Harris Hip Score, Barthel Index, and De Morton Mobility Index at 6 weeks and 6 months, did not differ significantly.</p><p><strong>Discussion: </strong>Intramedullary PRP did not improve mid- to long-term fracture healing or functional outcomes in elderly patients with intertrochanteric fractures. Although early radiographic healing was enhanced at 2 weeks, this benefit was not sustained over time. Functional recovery also showed no significant difference. PRP may offer limited clinical benefit in this population, and further research is needed to assess its role in selected subgroups or with modified protocols.</p><p><strong>Level of evidence: </strong>I.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104457"},"PeriodicalIF":2.2,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional results of septic arthritis after anterior cruciate ligament reconstruction treated by arthroscopic lavage with preservation of the graft: case-control study at 7 years follow-up.","authors":"Martin Tripon, Maxime Bougard, Arthur Gras, Guillaume Mergenthaler, Gaelle Maroteau, Christophe Hulet","doi":"10.1016/j.otsr.2025.104455","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104455","url":null,"abstract":"<p><strong>Introduction: </strong>Septic arthritis is a rare but serious complication following anterior cruciate ligament reconstruction (ACLR). Arthroscopic lavage with graft retention and antibiotic therapy is considered to be the gold standard for the initial treatment of surgical site infections. The aim of this study was to compare long-term clinical and functional outcomes between patients with septic ACL reconstructions and those without septic complications.</p><p><strong>Methods: </strong>This was a retrospective, single-center, multi-surgeon study. ACLR complicated by surgical site infection between 2010 and 2022 were matched 1:1 with ACLR without septic complications performed during the same period. Matching criteria included age, sex, body mass index, existence of meniscal and chondral lesions, graft type used, postoperative follow-up duration, and smoking status. At final follow-up, functional outcomes were assessed using IKDC, Lysholm, KOOS, and Tegner scores. Return to sport and level of return were also evaluated in each group.</p><p><strong>Results: </strong>17 septic ACLR were matched with non-septic ACLR. At a mean follow-up of 7 ± 3 years, no recurrent infections were observed; only one patient required a second lavage. There were no significant differences in the Lysholm, International Knee Documentation Committee (IKDC), or the Knee injury of Osteoarthritis Outcomes (KOOS) scores between septic and non-septic groups (Lysholm: 89.1 ± 10.4 vs 92.1 ± 8.5, p = 0.32; IKDC: 82.9 ± 12.6 vs 88.5 ± 11.2, p = 0.10; KOOS: 89.9 ± 9.9 vs 91.7 ± 9.7, p = 0.80). No significant difference was observed in activity level at final follow-up (Tegner: 4.9 ± 1.2 vs 5.5 ± 1.8, p = 0.18). However, time to return to sport was significantly longer in the septic ACLR group (10.2 ± 1.1 months vs 8.1 ± 2.1 months, p = 0.01). There was no significant difference in the level of return to sport (53% returned to the same level in the septic group vs 65% in the non-septic group, p = 0.49).</p><p><strong>Conclusion: </strong>When treated early with arthroscopic lavage and antibiotic therapy without graft removal, septic arthritis following ACLR yields comparable functional outcomes to uncomplicated ACLR at 7-year follow-up. This approach allows good clinical recovery and limits long-term functional impact, but with a longer rehabilitation period before returning to sport. Arthroscopic lavage remains the first-line treatment in cases of septic arthritis after ACLR.</p><p><strong>Level of evidence: </strong>IV Keywords: Anterior cruciate ligament, septic arthritis, arthroscopic lavage, clinical outcomes.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104455"},"PeriodicalIF":2.2,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of the level of evidence and impact factor for the journal OTSR (Orthopaedics & Traumatology: Surgery & Research), is it correlated?","authors":"Rose Ducarouge, Claude Alain Roullet, Guillaume Vilatte, Stéphane Descamps, Stéphane Boisgard, Roger Erivan","doi":"10.1016/j.otsr.2025.104456","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104456","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Orthopedics, traumatology, and surgery are constantly evolving disciplines that require high-quality scientific evidence to drive improvements. Two indicators can be used to assess the quality and impact of scientific publications: the level of evidence and the impact factor. However, the impact factor is an indicator that is widely criticized because it can be influenced and not be in agreement with the quality of the published article. The aim of this study were: 1) to evaluate, between 2010 and 2023, the evolution of the level of evidence of articles published in Orthopaedics & Traumatology: Surgery & Research (OTSR) journal, 2) to determine whether there is a correlation between this evolution and that of the journal's impact factor.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Hypotheses: &lt;/strong&gt;The increase in the impact factor of OTSR in recent years was associated with an improvement in the level of evidence of the studies published, signifying a gain in scientific quality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Retrospective study of articles published in OTSR between 2010 and 2023. The articles were extracted from the PubMed and Google Scholar databases. The papers included were separated in four subgroups according to following years: 2010-2011, 2015-2016, 2019-2020, and 2022-2023. For each article included, were collected: the number of authors and number of citations, the types of article and the methodological design and the level of evidence. The total number of articles published each year and the corresponding impact factor were also recorded. Letters, tributes, editorials, errors, and retractions of publication were excluded, as were articles published outside the target years. This study compared these data with the journal Impact Factor.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The results show a significant increase in the number of articles (171 articles published in 2010 against 324 in 2023), an improvement in the average level of evidence (0.63% = 1/158 of level 1 or 2 articles published in 2010 compared to 1.98% = 6/303 of level 1 and 7.26% = 22/303 of level 2 published in 2023), as well as an increase in the impact factor of OTSR (0.5 in 2010 against 2.3 in 2023). A strong correlation between the two targeted indicators was identified (Rs= -0.98; p &lt; 0.00)1, suggesting that improving the scientific quality of published articles contributes to enhancing the visibility and reputation of OTSR, suggesting that the improvement in the level of evidence of articles published in OTSR was associated with an increase in its impact factor.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The results obtained show a trend toward an improvement in the methodological quality of articles published in OTSR, as well as an increase in its impact factor, with a strong correlation between these two elements. In addition, the increase in the number of annual publications reflects a growing editorial dynamic in the field of orthopedics, which is essential for progres","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104456"},"PeriodicalIF":2.2,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two-Year Outcomes of Non-Conservative Treatment of the Long Head of the Biceps Tendon in the Repair of Small Supraspinatus Tears: A Multicenter Prospective Study.","authors":"Aimery Sabelle, Benjamin Sallé, Christophe Charousset, Adrien Jacquot, François Gadéa, Jacques Guery, Thierry Joudet, Nicolas Bonnevialle, Xavier Ohl, Lionel Neyton, Nicolas Gasse, Ramy Samargandi, Johannes Barth, Maxime Antoni, Franck Dordain, David Gallinet, Julien Berhouet","doi":"10.1016/j.otsr.2025.104451","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104451","url":null,"abstract":"<p><strong>Introduction: </strong>The management of the long head of the biceps tendon (LHBT) is well established in case of massive, irreparable rotator cuff tears (RCTs). However, its treatment in the context of small RCTs, especially those involving the supraspinatus tendon remain controversial, with ongoing debate over whether tenotomy, tenodesis, or simple preservation is the most appropriate approach. This study hypothesized that a non-conservative treatment (either isolated tenotomy or tenodesis) would yield equivalent functional outcomes, regardless of the macroscopic intraoperative appearance of the biceps tendon.</p><p><strong>Materials and methods: </strong>In this prospective multicenter study, 210 patients underwent rotator cuff repair for a tear primarily affecting the supraspinatus tendon. A tenotomy or a tenodesis of the LHBT was systematically performed, regardless of its intraoperative appearance (normal or pathologic). Functional outcomes at two years (VAS, Constant score, SSV, ASES score) were collected and compared according to the macroscopic aspect of the tendon. To account for potential confounding factors, a 1:1 propensity score matching was performed. Outcomes were also compared between tenotomy and tenodesis groups. Cuff healing was assessed by ultrasound at the last follow-up.</p><p><strong>Results: </strong>At the two-year follow-up, after propensity-score matching, no statistically significant differences were found between groups in any of the tested score (Constant score, p =  0.96; VAS, p =  0.33; ASES score, p =  0.50). Before matching, functional scores were significantly better in patients who underwent tenotomy or tenodesis in combination with cuff repair when the LHBT appeared macroscopically normal during surgery: Constant score (87 ± 8 vs. 83 ± 11, p = 0.003), ASES score (91 ± 19 vs. 85 ± 22, p = 0.002), and SSV (95 ± 9 vs. 79 ± 31, p < 0.001). No statistically significant difference was found in Constant score improvement. Tenodesis was associated with better flexion strength, but no statistical differences were observed for other outcomes, including the Popeye deformity. At two years, cuff healing rates were similar between the two groups.</p><p><strong>Conclusion: </strong>After controlling for confounding factors, the macroscopic appearance of the LHBT did not significantly influence clinical outcomes at two years after rotator cuff repair and tenotomy or tenodesis.</p><p><strong>Level of evidence: </strong>III; Prospective non-randomized study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104451"},"PeriodicalIF":2.2,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of platelet count on the clinical effectiveness of platelet-rich plasma in the treatment of knee osteoarthritis: a systematic review and meta-analysis.","authors":"Mario Simental-Mendía, Carlos A Acosta-Olivo, Daniela Ortega-Mata, Héctor Javier Salazar-Domínguez, Gabriela Cecilia Carrizales-Hernández, Ximena Fernanda Sierra-Morales, Luis Alejandro Rodríguez-Corpus, Víctor M Peña-Martínez, Félix Vilchez-Cavazos","doi":"10.1016/j.otsr.2025.104453","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104453","url":null,"abstract":"<p><strong>Background: </strong>Clinical effectiveness of platelet-rich plasma (PRP) for knee osteoarthritis (OA) continues to be debated, largely due to inconsistencies in PRP preparation methods and the variability in platelet concentrations. The optimal therapeutic range for platelet concentration remains unclear, leading to inconsistent treatment protocols and outcomes across studies. This systematic review and meta-analysis aimed to evaluate whether platelet count in PRP influences clinical outcomes in patients with knee OA.</p><p><strong>Materials and methods: </strong>A systematic search was conducted in MEDLINE, Scopus, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials through February 2024. Randomized controlled trials evaluating PRP injections in knee OA were included. Studies reporting platelet counts in whole blood and PRP, as well as baseline and follow-up pain and functional scores, were analyzed. Standardized mean differences (SMD) were computed, and subgroup analyses were conducted based on platelet fold increase in PRP preparation.</p><p><strong>Results: </strong>Forty studies met the inclusion criteria. PRP improved both pain and function across all platelet concentration categories. However, lower platelet fold increases (0-2× and >2-4×) demonstrated greater clinical benefits (SMD 1.84, 95% CI [1.05, 2.04], p = 0.0004 and SMD 1.36, 95% CI [0.94, 1.79], p < 0.0001, respectively) compared to higher concentrations (>4-6× and >6-9×). Effect sizes for lower concentrations exceeded established minimal clinically important differences.</p><p><strong>Discussion: </strong>Moderate platelet count increases (2-4×) in PRP appear optimal for knee OA treatment. Higher platelet concentrations may not provide additional benefit and could attenuate therapeutic effects. These findings highlight the importance of standardizing PRP formulations to optimize efficacy while minimizing variability.</p><p><strong>Level of evidence: </strong>I.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104453"},"PeriodicalIF":2.2,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The throwing shoulder.","authors":"Jean Grimberg, Emmanuel Dahan","doi":"10.1016/j.otsr.2025.104448","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104448","url":null,"abstract":"<p><p>The shoulder is affected by numerous pathological conditions related to the high speeds and intra-articular stresses during the throwing movement. The most common are SLAP lesions and internal impingement. The treatment is preventive and conservative initially, starting in athletes at a young age and continuing throughout their entire sports career It includes posterior capsule stretching, strengthening of the external rotators and scapular stabilizers, correcting any scapular dyskinesia and optimizing the static and dynamic balance of the thorax, pelvis and legs. Surgical treatment is considered after failure of conservative treatment. For SLAP lesions: repair may be proposed to high-level athletes younger than 35 years; biceps tenodesis is advised in other cases. For internal impingement: posterior glenoidoplasty with posterosuperior labral debridement, sometimes combined with posterosuperior capsulotomy is usually successful. However, an associated rotator cuff tear that needs repair will compromise the outcomes. In the throwing shoulder, one must keep in mind the possibility of other rare lesions, including capsular, musculotendinous, neurologic, and bone lesions. The objective of any treatment is to allow return to the previous level of sport, which can be evaluated by subjective scores specific to throwing sports (KJOC score). LEVEL OF EVIDENCE: > V; expert opinion.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104448"},"PeriodicalIF":2.2,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}