Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"Performance of the GeneXpert® MRSA/SA SSTI test in periprosthetic joint infections: rate of failure, outcomes and risk factors","authors":"Jean-Thomas Leclerc ,&nbsp;Marie Titécat ,&nbsp;Theo Martin ,&nbsp;Julien Dartus ,&nbsp;Sophie Putman ,&nbsp;Pierre Martinot ,&nbsp;François Demaeght ,&nbsp;Caroline Loïez ,&nbsp;Philippe-Alexandre Faure ,&nbsp;Gilles Pasquier ,&nbsp;Julien Girard ,&nbsp;Alain Duhamel ,&nbsp;Eric Senneville ,&nbsp;Henri Migaud","doi":"10.1016/j.otsr.2024.104032","DOIUrl":"10.1016/j.otsr.2024.104032","url":null,"abstract":"<div><h3>Background</h3><div>The GeneXpert® MRSA/SA SSTI test allows early detection of methicillin-resistant staphylococci in intraoperative samples of prosthetic joint infections (PJI) in order to stop early broad-spectrum antibiotics.</div></div><div><h3>Questions/Purpose</h3><div>(1) What is the rate of false-negative GeneXpert® MRSA/SA SSTI test results? (2) Does a false-negative GeneXpert® MRSA/SA SSTI test result increase the risk of treatment failure for the patient with a PJI? (3) What are the risk factors of a false-negative result?</div></div><div><h3>Method</h3><div>A retrospective study was carried out to compare all GeneXpert® assays to conventional cultures in prosthetic joint infections from April 1st, 2012 to October 1st, 2016. False-negative (FN) results (absence of methicillin-resistant staphylococci (MRS) with GeneXpert® test, but presence in the culture) were identified. We compared the rate of treatment failure between FN results and other test results and we established the risk factors of having a FN result.</div></div><div><h3>Results</h3><div>Among the 612 GeneXpert® results, the rate of FN results was 3.6 % (22/612). We found a significant increase in treatment failures for prosthetic joint infection with a FN result with 14 treatment failures (14/22) compared to 198 treatment failures (198/590) in the other test results (OR, 2.1; 95 % CI, 1.3−3.4, p = 0.0019). Not considering suppressive antibiotics as a treatment failure, we found no significant difference in the rate of treatment failures between the false-negative tests and the other tests (OR, 1.36; 95 % CI, 0.66–2.81, p = 0.41). Tobacco use (OR, 3.8; 95 % CI, 1.4−10.3, p = 0.004), ASA classification (OR, 2,4; 95 % CI, 0.9−6.9, p = 0.064), history of infection in the joint (OR, 3.2; 95 % CI, 1.2−9.6, p = 0.007), chronic infections (OR, 3.2; 95 % CI, 0.8−17.5, p = 0.01) and polymicrobial infections (OR, 3.2; 95 % CI, 1.1−9.2, p &lt; 0.0001) were risk factors for a FN result.</div></div><div><h3>Conclusion</h3><div>GeneXpert® tests in prosthetic joint infections showed a low rate of FN results. An increased risk of treatment failures was observed in FN results only when long-term use of suppressive antibiotics was considered as treatment failure.</div></div><div><h3>Level of evidence</h3><div>III; Diagnostic retrospective case control study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 6","pages":"Article 104032"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559470","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":"Anterior tibial tubercle internal torsion osteotomy (ATTITO) in patient with patellar instability","authors":"Glauco Loddo ,&nbsp;Mathias Donnez ,&nbsp;Jean-Louis Blin ,&nbsp;Frédéric Khiami ,&nbsp;Jean-Marc Zeitoun ,&nbsp;Matthieu Ollivier ,&nbsp;Vincent Chassaing","doi":"10.1016/j.otsr.2025.104170","DOIUrl":"10.1016/j.otsr.2025.104170","url":null,"abstract":"<div><div><span>Anterior tibial tuberosity </span>osteotomy<span> is a well-described therapeutic option for the treatment of patellar instability. External torsion of the anterior tibial tuberosity can be one of several factors that adversely affect the patellofemoral joint and its stability. The Anterior Tibial Tubercle Internal Torsion Osteotomy (ATTITO) allows the correction of excessive external torsion of the tibial tuberosity in a safe and reproducible manner.</span></div></div><div><h3>Level of evidence</h3><div>V.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 6","pages":"Article 104170"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016550","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":"Assessment of Return To Driving After Anterior Cruciate reconstruction","authors":"Aurore Emery,&nbsp;Grégoire Duval,&nbsp;Gaëlle Maroteau,&nbsp;Alexandre Ferreira,&nbsp;Guillaume Mergenthaler,&nbsp;Marianne Wiklund,&nbsp;Christophe Hulet","doi":"10.1016/j.otsr.2025.104308","DOIUrl":"10.1016/j.otsr.2025.104308","url":null,"abstract":"<div><h3>Background</h3><div>Anterior cruciate ligament (ACL) reconstruction is widely performed in France in young active patients. The delay in resuming driving after the operation is a frequent issue in this population. There is no clear recommendation on this subject. The main purpose of this study was to determine the average time taken to resume driving postoperatively in patients undergoing anterior cruciate ligament reconstruction.</div></div><div><h3>Material and methods</h3><div><span>In total, 54 ACL were included in a prospective, single centre, multioperator observational study. The mean age of the patients at the time of surgery was 28.9 ± 8.3 years old (18, 55). Data on behavior and functional scores were collected prospectively at the time of inclusion. Patients were asked to complete a standardized questionnaire concerning their driving habits preoperatively, at 6 weeks and at 3 months, the ACL-RSI questionnaire and the IKDC score preoperatively and at 3 months. Factors that could influence the return to driving included sex, age, </span>BMI, operated side, surgical technique, association with anterolateral ligament reconstruction or meniscal suture, time of tourniquet, number of years driving license, frequency of vehicle use pre-operatively, manual or automatic gearbox, and pre-operative sporting ability.</div></div><div><h3>Results</h3><div>The mean time to return to driving was 4.4 weeks ± 2.33 (1, 11) for the 50 patients (93%) who returned to driving. No road accidents were reported. Four out of 54 patients had not returned to driving at 3 months. Mean knee flexion was 125.7 ° ± 9.48 (100, 140. The ACL-RSI score was 56.5 ± 19.6 (10.6, 94.1) and the IKDC score was 65.1 ± 14.3 (43.7, 93.1). There was no difference between the ACL groups with or without meniscal suture. Among the factors studied, only sport level favored an earlier resumption of driving.</div></div><div><h3>Conclusion</h3><div>Resumption of driving after ACL reconstruction surgery varies and must be discussed with the patient. In clinical practice, a period of 4 weeks may be adopted.</div></div><div><h3>Level of evidence</h3><div>IV; prospective cohort study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 6","pages":"Article 104308"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210255","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":"MRI analysis of the chondral surface following deepening trochleoplasty for patellofemoral instability","authors":"Tobias Roberts,&nbsp;Diego Abelleyra Lastoria,&nbsp;Vivian Ejindu,&nbsp;Caroline B. Hing","doi":"10.1016/j.otsr.2025.104322","DOIUrl":"10.1016/j.otsr.2025.104322","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;&lt;span&gt;The incidence of patellofemoral instability is 5.8 per 100,000 in the general population, rising to 29–43 per 100,000 in adolescents. Up to 85% of recurrent instability is associated with trochlea dysplasia. The Dejour sulcus deepening trochleoplasty can be used to effectively treat patellofemoral instability, however the effect on patellofemoral cartilage and survival of the osteochondral flap is not known. The aim of the study was to determine changes in the patellofemoral &lt;/span&gt;articular surface&lt;span&gt; in the early postoperative period with MRI analysis.&lt;/span&gt;&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients and methods&lt;/h3&gt;&lt;div&gt;&lt;span&gt;MRI analysis of a single-surgeon series, retrospective review of 61 sulcus deepening trochleoplasties between 2014 and 2022, of which 40 had a postoperative MRI and were assessed – including 26 women (65%) and 22 (55%) right knees. Trochleoplasty was performed in conjunction with medial reefing and lateral release in 26 patients (65%), in conjunction with MPFL reconstruction alone in 12 (30%), and in conjunction with MPFL reconstruction and tibial tubercle &lt;/span&gt;osteotomy&lt;span&gt; in 2 (5%). Preoperative and postoperative MRIs were assessed for articular cartilage&lt;span&gt; loss, percentage of full thickness cartilage loss as well as volume and number of bone marrow lesions using a modified version of the MRI osteoarthritis knee score (MOAKS).&lt;/span&gt;&lt;/span&gt;&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;&lt;span&gt;Mean age at operation was 25.3 years (SD: 7.3). The modal number of comorbidities was zero, and no patient had diabetes or was taking immunosuppressive medication. Mean time between preoperative MRI and trochleoplasty was 8.7 months (SD: 6.9). Mean time between trochleoplasty and postoperative MRI was 19.9 months (SD 14.9). There were further episodes of symptomatic instability in 8 (20%) of patients. In all anatomical subregions (medial and lateral patellar, medial and lateral trochlear groove) there was a significant increase in articular cartilage loss between pre- and post-operative MRIs (p &lt; 0.001). There was a significant decrease in the volume and number of bone marrow lesions (BMLs) in the medial &lt;/span&gt;patella only, with static or nonsignificant increases in the lateral patella and medial trochlear groove, and significant increases in the number and volume of BMLs in the lateral trochlea (p &lt; 0.001). MOAK grade 1 was seen in at least one anatomical subregion in every patient post-operatively and there was progression in MOAK grade in all subregions. Progression in MOAK grade was seen in the medial patella in 20 patients (50%), lateral patella in 18 patients (45%), medial trochlea in 22 patients (45%) and lateral trochlea in 31 patients (78%).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion and conclusion&lt;/h3&gt;&lt;div&gt;Whilst patellofemoral osteoarthritis is common post trochleoplasty, the history of its development is not clear. Few studies report cartilage condition post-surgery. Authors in the only other MRI stud","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 6","pages":"Article 104322"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340595","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":"Outcomes following anterior cruciate ligament injury with concomitant damage to the medial collateral ligament: an analysis from the registry of the francophone arthroscopic society","authors":"Charles Kajetanek ,&nbsp;Etienne Cavaignac ,&nbsp;Emilie Bérard ,&nbsp;Benjamin Freychet ,&nbsp;Alexandre Hardy ,&nbsp;Corentin Hercé ,&nbsp;Christian Lutz ,&nbsp;Thomas Neri ,&nbsp;Matthieu Ollivier ,&nbsp;Nicolas Bouguennec","doi":"10.1016/j.otsr.2025.104194","DOIUrl":"10.1016/j.otsr.2025.104194","url":null,"abstract":"<div><h3>Introduction</h3><div>Anterior cruciate ligament (ACL) rupture with concomitant damage to the medial collateral ligament<span> (MCL) is frequently seen following knee trauma. Non-surgical treatment of the MCL lesion generally results in good internal healing, but surgery may be necessary depending on the location of the lesion, the severity, and the laxity.</span></div></div><div><h3>Objectives</h3><div>To determine outcomes following ACL<span> reconstruction surgery<span> when there is concomitant damage to the MCL compared to isolated ACL lesions, as assessed through a prospective, multi-center cohort study in France.</span></span></div></div><div><h3>Materials and methods</h3><div><span>In this prospective, multi-center cohort study, patients who had a primary ACL lesion with or without concomitant damage to the MCL, and who had undergone ACL reconstruction surgery were included. Complications related to the surgery were evaluated prospectively (ACL re-rupture, </span>contralateral rupture, reoperation), and functional scores were obtained until the last follow-up (subjective IKDC, Tegner, ACL-RSI, and SKV).</div></div><div><h3>Results</h3><div>A total of 722 patients were included in the study: 314 (43.5%) with an isolated ACL lesion and 408 (56.5%) with a combined ACL + MCL lesion. The ACL + MCL group had a significantly higher reoperation<span> rate than the ACL group (7.4% versus 3.2%, p = 0.015). The ACL + MCL group also had mean IKDC and SKV scores at the last follow-up that were significantly poorer than the ACL group (p &lt; 0.0001). High-grade MCL lesions (grade II or III) were identified in 18.2% of cases, and this was found to be predictive of poorer functional scores at the last follow-up. The mean IKDC score was significantly better when non-surgical MCL treatment was possible (p = 0.005). When MCL surgery was indicated, all of the functional scores were significantly better for ligament reinsertion surgery compared to ligament reconstruction.</span></div></div><div><h3>Conclusion</h3><div>For combined ACL + MCL lesions, the outcomes are poorer, with a higher reoperation rate and lower functional scores. For high-grade MCL lesions, the functional recovery is poorer, particularly when there are chronic lesions that require multi-ligament reconstruction.</div></div><div><h3>Level of evidence</h3><div>II; prospective cohort study</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 6","pages":"Article 104194"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484600","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":"No secondary osteoarthritis after recession wedge trochleoplasty associated with tibial tubercle osteotomy for treating recurrent patellar dislocation in high-grade dysplasia","authors":"Florian Barbotte,&nbsp;Charles Landon,&nbsp;AzEddine Djebara,&nbsp;Nicolas Pujol","doi":"10.1016/j.otsr.2024.104116","DOIUrl":"10.1016/j.otsr.2024.104116","url":null,"abstract":"<div><h3>Purpose</h3><div><span><span>To determine in the long-term the rate of osteoarthritis of recession wedge trochleoplasty performed in patients with high-grade trochlear </span>dysplasia and recurrent </span>patellar dislocations. The hypothesis was that the rate of secondary osteoarthritis was low.</div></div><div><h3>Methods</h3><div>Fifteen consecutive patients (17 knees) undergoing a recession wedge trochleoplasty surgery for recurrent patellar dislocation were retrospectively included. Recurrence of dislocation and functional scores of Lille and Kujala were collected. A complete radiological assessment was carried out to assess secondary patella-femoral and femoro-tibial osteoarthritis.</div></div><div><h3>Results</h3><div>No recurrence of dislocation was observed. Mean Lille and Kujala scores were respectively 84 ± 9/100 and 78 ± 12/100 at an average follow-up of 11.2 ± 1.8 years (132 ± 22 months, range 96–165).</div><div>No significant radiological changes in osteoarthritis were observed.</div><div>Of the 15 knees without any radiological signs of patellofemoral osteoarthritis at time of surgery, 7 presented a bone remodeling (Iwano1) and 8 had no signs of osteoarthritis at the latest follow-up. Among the 2 knees with a preoperative Iwano stage 1, one evolved to Iwano stage 2.</div></div><div><h3>Conclusion</h3><div>Recession wedge trochleoplasty is an effective treatment for recurrent patellar instability in patients with a high-grade trochlear dysplasia. In the long term, the patellofemoral joint is stable, the functional scores are good, and there is no significant arthritic degeneration.</div></div><div><h3>Level of evidence</h3><div>IV, retrospective series.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 6","pages":"Article 104116"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878533","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":"Improving Robustness and Interpretability of Models — Including Machine Learning — in Orthopedics through Data Preprocessing","authors":"Baptiste Boukebous ,&nbsp;Jacques-Emmanuel Galimard ,&nbsp;David Biau","doi":"10.1016/j.otsr.2025.104390","DOIUrl":"10.1016/j.otsr.2025.104390","url":null,"abstract":"","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 6","pages":"Article 104390"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979072","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":"Comparative performance analysis of Synovasure™ and Leukocyte Esterase assays for the diagnosis of periprosthetic infections in complex microbiological situations","authors":"Adrien Pascal ,&nbsp;Pierre-Jean Lambrey ,&nbsp;Benjamin Valentin ,&nbsp;Henri Migaud ,&nbsp;Sophie Putman ,&nbsp;Philippe-Alexandre Faure ,&nbsp;Julien Dartus ,&nbsp;Caroline Loiez ,&nbsp;Benoîtde Saint Vincent ,&nbsp;Eric Senneville","doi":"10.1016/j.otsr.2024.104046","DOIUrl":"10.1016/j.otsr.2024.104046","url":null,"abstract":"<div><h3>Introduction</h3><div>Osteoarticular infections (OAI) after prosthetic surgery have serious functional and economic consequences. Rapid tests for alpha-defensin (TAD) and leukocyte esterase (TLE) are two intra-articular markers involved in the diagnosis of OAIs. TLE cannot be applied in the presence of blood unless centrifugation is used, but the rate of \"non-application\" of the test for this reason is unknown in complex microbiological situations (discordant or negative puncture, ongoing antibiotic treatment). We therefore conducted a prospective study to determine: 1) the performance of the TAD and TLE rapid tests in diagnosing complex OAI, 2) the rate of non-application of the TLE due to hemarthrosis, and 3) the concordance between the two tests.</div></div><div><h3>Assumption</h3><div>These two diagnostic tests had a negative predictive value (NPV) ≥ 90% for the diagnosis of complex OAI.</div></div><div><h3>Materials and methods</h3><div>A total of 79 suspected OAI patients with complex microbiological diagnoses were included between 2018 and 2023. They were 52 men (66%) for 27 women (34%), with a mean age of 66 ± 13.5 years. The hip (<em>n</em> = 41, 52%) and knee (<em>n</em> = 36, 46%) were the most represented, followed by the elbow (<em>n</em> = 1, 1%) and shoulder (<em>n</em> = 1, 1%). These patients were suspected of having an OAI that required joint puncture, but with a complex microbiological diagnosis due to discordant punctures (<em>n</em> = 21, 27%) or sterile punctures despite strong suspicion of infection (<em>n</em> = 50, 63%), or in case of ongoing antibiotic treatment (<em>n</em> = 8, 10%). All patients underwent joint fluid puncture followed by TAD (Synovasure™, Zimmer, Warsaw, IN, USA) and, when the macroscopic appearance of the sample allowed (clear fluid group), TLE (Multistix 8SG, Siemens Healthcare GmbH, Erlangen, Germany). The results of both tests were compared with Musculoskeletal Infection Society (MSIS) criteria.</div></div><div><h3>Results</h3><div>Of the 79 patients included, 27 (34%) were considered infected according to the MSIS. In 30% of cases (<em>n</em> = 24), TLE was not feasible due to the presence of blood in the joint fluid. In the \"clear fluid\" group, the NPV was equal to 90% for both TAD (sensitivity 87%, specificity 88%) and TLE (sensitivity 87%, specificity 81%). The two parameters showed almost perfect agreement (<em>κ</em> = 0.927).</div></div><div><h3>Conclusion</h3><div>TAD and TLE are two rapid, reliable tests with near-perfect concordance and high NPV, even in situations of complex microbiological diagnosis. They are particularly useful for deciding on a therapeutic strategy for patients with complex OAI. The TLE cannot be used in 30% of cases due to hemarthrosis, but centrifugation can correct this defect.</div></div><div><h3>Level of evidence</h3><div>III; Prospective comparative diagnostic accuracy study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 6","pages":"Article 104046"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632137","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":"Anterior cruciate ligament reconstruction using hamstring graft: Functional and laximetric results of a pedicled semi tendinosus technique compared to a pedicled semi tendinosus technique combined with anterolateral ligament reconstruction","authors":"Grégoire Vaz ,&nbsp;Guillaume André","doi":"10.1016/j.otsr.2025.104311","DOIUrl":"10.1016/j.otsr.2025.104311","url":null,"abstract":"<div><h3>Introduction</h3><div>The anterolateral ligament plays a key role in knee biomechanics. Its reconstruction, combined with anterior cruciate ligament (ACL) reconstruction, is not systematic but offers numerous advantages (reduced iterative ACL graft rupture rates, internal rotation control, and protection following internal meniscus repair) without increasing the risk of perioperative morbidity.</div></div><div><h3>Hypothesis</h3><div>ACL reconstruction using a semitendinosus graft combined with anterolateral ligament reconstruction using a gracilis graft (Group 2: ST + ALL) provides better functional and laxity outcomes on Dyneelax® Genourob than isolated ACL reconstruction using a semitendinosus graft does (Group 1: ST).</div></div><div><h3>Methods</h3><div>This was a retrospective, single-center study of 91 patients. Pre- and postoperative functional scores (KOOS 12, Lysholm scale score, ACL-RSI score, and Tegner scale score) were collected, along with automated laxity measurements (Genourob® Dyneelax) at the last follow-up. The minimum follow-up period was 18 months, with patients reviewed between 18 and 24 months.</div></div><div><h3>Results</h3><div>Clinical functional outcomes and laxity measurements at the last follow-up were significantly better in Group 2 (ST + ALL). ACL-RSI, Tegner scale score and its difference in pre- and postoperative, KOOS 12 postoperative score improvement, Lysholm score and its postoperative score improvement showed significant results in favor of group 2. The automated Genourob® Dyneelax measurement of residual laxity during anterior translation of the operated knee was 0.677 mm (±1.59) for Group 2 and 1.44 mm (±2.13) for Group 1 (<em>p</em> = NS). The internal rotation measurements were −0.671 (±2.3) for Group 2 and 1.64 (±2.98) for Group 1 (<em>p</em> &lt; 0.001). The ligament reconstruction failure rate was 6.98% in Group and 18.75% in Group 1.</div></div><div><h3>Conclusion</h3><div>ACL reconstruction using a semitendinosus graft combined with anterolateral ligament reconstruction using a gracilis graft provides better functional and objective laxity results than isolated ACL reconstruction with a semitendinosus graft does.</div></div><div><h3>Level of evidence</h3><div>III; retrospective comparative study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 6","pages":"Article 104311"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227659","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":"Risk Factors for Venous Thromboembolism (VTE) Following Anterior Cruciate Ligament (ACL) reconstruction: A systematic review and meta-analysis","authors":"Yao-Tung Tsai,&nbsp;Chia-Chun Wu,&nbsp;Ru-Yu Pan,&nbsp;Pei-Hung Shen","doi":"10.1016/j.otsr.2025.104184","DOIUrl":"10.1016/j.otsr.2025.104184","url":null,"abstract":"<div><h3>Background</h3><div>Thromboembolism (VTE) is an uncommon, but potentially serious complication in patients who undergo anterior cruciate ligament (ACL) reconstruction.</div></div><div><h3>Patients and methods</h3><div><span>PubMed, EMBASE, and Cochrane databases were searched for relevant studies published until July 16, 2023. Eligible studies were those investigating patients who were undergoing ACL reconstruction, with the primary focus on factors associated with VTE including age, sex, </span>body mass index (BMI), hypertension, smoking, type of surgical setting (outpatient vs. inpatient), and tourniquet time.</div></div><div><h3>Results</h3><div><span>Six studies consisted of a total of 47,886 patients underwent ACL reconstruction were included. The VTE rate ranged between 0.4% and 11.0%, and the mean patient age ranged from 26.8 to 33.25 years. The meta-analysis revealed no significant association between VTE risk and sex (pooled adjusted odds ratio [aOR] = 1.28, 95% confidence interval [CI]: 0.88–1.85). Furthermore, the meta-analysis showed a significantly higher risk of VTE in smokers compared to non-smokers, favoring non-smokers (pooled aOR = 1.71, 95% CI: 1.16–2.54). The </span>systematic review identified several other potential factors, including older age, BMI, hypertension, smoking, surgical setting, and tourniquet time, which were documented in at least 2 included studies. However, while some of these factors showed reported significance, the number of studies was insufficient to generate a pooled result.</div></div><div><h3>Discussion</h3><div>According to our meta-analysis, sex does not appear to be a significant risk factor for VTE in patients undergoing ACL reconstruction. However, more evidence is needed to determine whether factors such as older age, BMI, hypertension, outpatient vs. inpatient surgery, and tourniquet time are associated with increased VTE risk. Caution is still advised when managing patients with these risk factors in the context of ACL reconstruction. A future meta-analysis is warranted once a sufficient number of studies are available to draw more definitive conclusions.</div></div><div><h3>Level of evidence</h3><div>IV</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 6","pages":"Article 104184"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374954","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}