Acta Orthopaedica最新文献

{"title":"Associations between hospital characteristics, volume, and reasons for revision: a cohort study of 48,029 unicompartmental knee arthroplasties with 3,397 revisions from the Dutch Arthroplasty Register.","authors":"Hendrik W H De Raadt, Iris Koenraadt-van Oost, Anouk Nijs, Anneke Spekenbrink-Spooren, Leon Elmans, Rutger C I Van Geenen","doi":"10.2340/17453674.2025.44961","DOIUrl":"10.2340/17453674.2025.44961","url":null,"abstract":"<p><strong>Background and purpose: </strong>It remains debated whether high annual hospital volumes for unicompartmental knee arthroplasty (UKA) are associated with a low risk of revision, and what explanations may underlie this relationship. We aimed to analyze the association between specific hospital characteristics defined as volume, type, and referral for revision, and frequency and reasons for UKA revision.</p><p><strong>Methods: </strong>Data from primary UKAs (2007-2022) and their revisions were extracted from the Dutch Arthroplasty Register. Hospitals were categorized by type; academic, top clinical teaching, private, or other general hospitals. Hospitals were grouped by annual UKA volume: ≤24, 25-39, 40-79, and ≥80 procedures. Multiple linear regression assessed the relationship between the number of revisions with hospital volume and type, adjusted for confounders. Chi-squared tests were used to test for differences in revision reasons based on volume and referrals.</p><p><strong>Results: </strong>48,029 primary UKAs and 3,397 revisions were included. High-volume and top clinical teaching hospitals had a significantly lower risk of revision following primary UKA (P < 0.001). Cementless implants had a lower risk compared with cemented implants. Revision reasons varied by hospital volume and whether revision occurred after referral (P < 0.001). Loosening, progression of osteoarthritis, malalignment, and pain were less common in the highest volume hospitals. If revision occurred after referral, malalignment was more frequently registered as the reason for revision.</p><p><strong>Conclusion: </strong>High-volume and top clinical teaching hospitals were associated with lower risk of revision following primary UKA. Differences in revision reasons, with fewer cases of loosening, progression of osteoarthritis, malalignment, and pain, may explain the lower risk of revision at higher volume hospitals.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"164-170"},"PeriodicalIF":3.4,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12963959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative mobility is associated with risk of reoperation and increased mortality after hip fracture: a nationwide cohort study of 33,486 patients.","authors":"Simon Storgaard Jensen, Per Hviid Gundtoft, Jan-Erik Gjertsen, Alma B Pedersen","doi":"10.2340/17453674.2026.45552","DOIUrl":"10.2340/17453674.2026.45552","url":null,"abstract":"<p><strong>Background and purpose: </strong>Postoperative mobilization may influence the outcome following hip fracture. We aimed to examine whether regaining pre-fracture basic mobility on discharge is associated with subsequent risk of reoperation and mortality.</p><p><strong>Methods: </strong>Using nationwide Danish registries, we identified 33,486 patients ≥ 65 years who underwent hip fracture surgery between January 2016 and November 2021. Pre-fracture and discharge mobility were assessed with the Cumulated Ambulation Score (CAS, score 0-6 where 6 is best ambulation). The exposure was regaining pre-fracture CAS at discharge. Adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) for reoperation and mortality up to 365 days were estimated using Cox regression, adjusting for age, sex, surgery year, length of stay, and comorbidities.</p><p><strong>Results: </strong>On discharge, 19,329 patients (65%) had not regained pre-fracture CAS. The 30-day reoperation risk was similar among patients who had not regained CAS (2.9%) and those who had (2.5%; aHR 1.10, CI 0.94-1.29). At 365 days, not regaining CAS was associated with a lower reoperation risk (7.1% vs 8.6%; aHR 0.98, CI 0.89-1.07). A CAS loss of 1-2 points was associated with an increased 30-day reoperation risk (aHR 1.20, CI 1.00-1.44). CAS decline was consistently associated with higher mortality at 30 days (aHR 2.07, CI 1.82-2.35) and 365 days (aHR 1.77, CI 1.66-1.89), with progressively higher rates at greater CAS decline.</p><p><strong>Conclusion: </strong>We found no consistent association between failure to regain pre-fracture mobility on discharge and reoperation, although patients with a 1-2 point CAS loss experienced a modestly higher 30-day reoperation risk. In contrast, failure to regain pre-fracture mobility was strongly associated with increased mortality up to 1 year after hip fracture.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"156-163"},"PeriodicalIF":3.4,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12964105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient satisfaction and patient-reported outcome measures after primary ankle arthrodesis: 2-year results from the Swedish Ankle Registry.","authors":"Alexandra Undén, Lars Jehpsson, Anders Henricson, Magnus K Karlsson, Björn E Rosengren","doi":"10.2340/17453674.2026.45374","DOIUrl":"10.2340/17453674.2026.45374","url":null,"abstract":"<p><strong>Background and purpose: </strong>Ankle arthrodesis (AA) and total ankle replacement are the 2 main surgical treatment options for advanced ankle arthritis but information is scarce on satisfaction and patient-reported outcome measures (PROMs) after surgery. We aimed to evaluate postoperative satisfaction, changes in PROMs from before to 2 years after AA, and factors associated with the outcome.</p><p><strong>Methods: </strong>This is a national registry-based observational study using the Swedish Ankle Registry. We identified 1,145 patients who underwent AA between 2008 and 2020 who answered a question on satisfaction, and between 662 and 702 patients who answered pre- and 2-year postoperative PROMs (SElf reported Foot and Ankle Score [SEFAS], EQ-5D index, and EQ-5D VAS). We analyzed changes in scores and associations between surgical/patient factors (including preoperative PROMs) and the outcomes satisfaction/postoperative PROM score.</p><p><strong>Results: </strong>All mean PROM scores improved from before to 2 years postoperatively (all P < 0.001). 69% of the patients were satisfied with the procedure, 15% uncertain, and 16% dissatisfied. Satisfaction was associated with higher preoperative SEFAS score and dissatisfaction with lower preoperative SEFAS score. Higher SEFAS score was associated with male sex and osteoarthritis (compared with rheumatoid arthritis), while higher EQ-5D index and EQ-5D VAS scores were associated with male sex, posttraumatic arthritis, osteoarthritis (compared with rheumatoid arthritis), and higher age.</p><p><strong>Conclusion: </strong>The majority (69%) of patients treated with AA are satisfied with the procedure and a higher preoperative SEFAS score is associated with postoperative satisfaction. We speculate that preoperative SEFAS score may be useful for predicting postoperative outcomes and will facilitate preoperative patient discussions on expected results.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"171-176"},"PeriodicalIF":3.4,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12963958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of hip reconstruction in ambulatory patients with cerebral palsy and spastic hip displacement: a retrospective study of 73 hips in 55 consecutive patients.","authors":"Kyeong Hyeon Park, Byoung Kyu Park, Isaac Rhee, Kun Bo Park, Hoon Park, Yun Ho Roh, Hyun Woo Kim","doi":"10.2340/17453674.2026.45513","DOIUrl":"10.2340/17453674.2026.45513","url":null,"abstract":"<p><strong>Background and purpose: </strong>Currently, there is no specific surgical treatment strategy established for spastic hip displacement in ambulatory patients with cerebral palsy. We aimed to evaluate the outcomes of our hip reconstructions, specifically designed to address hip displacement within the context of single-event multilevel surgery (SEMLS).</p><p><strong>Methods: </strong>We conducted a retrospective study on patients with Gross Motor Function Classification System (GMFCS) levels II (n = 27) and III (n = 28). Surgical procedures involved various combinations of open or closed reduction, iliac osteotomy, proximal femoral derotational osteotomy, distal femoral derotational and shortening osteotomy, and proximal femoral varus derotational osteotomy. The overall developmental status of the hip was assessed using the Melbourne Cerebral Palsy Hip Classification Scale (MCPHCS) at a mean age of 17.3 years (SD 4.7).</p><p><strong>Results: </strong>73 hips in 55 patients were included. They underwent hip reconstruction at a mean age of 9.7 years (SD 2.6). 69 of 73 hips achieved successful outcomes. Before surgery, 51 hips had a migration percentage (MP) of 30-60%, 21 had 60-100%, and 1 hip > 100%. At the final follow-up, 12 hips were classified as MCPHCS grade 1 (MP < 10%), 36 as grade 2 (10-15%), 21 as grade 3 (15-30%), 3 as grade 4 (30-60%), and 1 as grade 5 (60-100%). 52 patients either maintained or improved their preoperative GMFCS levels.</p><p><strong>Conclusion: </strong>Within the SEMLS framework, our tailored hip reconstruction achieved satisfactory hip outcomes in 69 of 73 hips and resulted in sustained improvement in hip stability at long-term follow-up.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"126-135"},"PeriodicalIF":3.4,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12927440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147269378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inducible displacement CT for implant loosening detection: a scoping review on methods, validation, and challenges.","authors":"Maaike A Ter Wee, Johannes G G Dobbe, Arthur J Kievit, Matthias U Schafroth, Mario Maas, Leendert Blankevoort, Geert J Streekstra","doi":"10.2340/17453674.2026.45512","DOIUrl":"10.2340/17453674.2026.45512","url":null,"abstract":"<p><strong>Background and purpose: </strong>Inducible displacement CT (ID-CT) is an emerging method for diagnosing implant loosening by (i) acquiring CT scans under different joint loading conditions, (ii) analyzing scans via segmentation and registration, and (iii) quantifying and visualizing relative implant-bone displacement. With multiple centers approaching these steps differently, this scoping review aimed to summarize current methodologies and key challenges.</p><p><strong>Methods: </strong>PubMed, Cochrane, and Embase were searched for clinical and experimental ID-CT studies on spinal and arthroplasty implants. Data was extracted using a table based on updated CT-radiostereometric analysis (RSA) guidelines, including study characteristics, CT acquisition parameters, image analysis methods, validation approaches, outcomes, and loading protocols. Diagnostic studies were assessed with QUADAS-2.</p><p><strong>Results: </strong>22 studies were included concerning the hip (10), knee (7), spine (4), and wrist (1), covering clinical and experimental (phantom and cadaveric) designs. Loading protocols varied widely, applying compressive, rotational, and angular forces with external stabilization or loading devices. CT acquisition ranged from µCT to conventional and weight-bearing CT, with variation in kVp, mAs, reconstruction spacing, and metal artefact reduction. Image-analysis workflows were broadly similar, though reporting of algorithms and displacement metrics was often incomplete. Diagnostic validation was limited by variable reference standards, non-prespecified loosening thresholds, and non-blinded assessments, undermining true performance. Technical validation, although often precise, did not cover the full ID-CT pipeline (i.e., complete loading protocol), leaving key sources of measurement variance untested.</p><p><strong>Conclusion: </strong>We showed that ID-CT is used with a wide variation in approach and limited reporting prevents the establishment of its true diagnostic accuracy.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"136-147"},"PeriodicalIF":3.4,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12927442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147269392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bony adaptation signs are predictive of anterior head-neck offset remodeling after internal fixation for slipped capital femoral epiphysis: a multicenter study on 217 patients (228 hips) with follow-up until end of growth.","authors":"Fritz Hefti, Katharina Oder, Renata Pospischill, Bernd Bittersohl, Kathrin Lehnert, Marco Goetze, Danimir Cerkez, Kiril Mladenov, Bjoern Vogt","doi":"10.2340/17453674.2025.45076","DOIUrl":"10.2340/17453674.2025.45076","url":null,"abstract":"<p><strong>Background and purpose: </strong>We aimed to evaluate the prognostic value of radiographic factors in predicting femoral head-neck remodeling, cam deformity, and local growth disturbances in slipped capital femoral epiphysis (SCFE) treated with internal fixation (IF) with or without simultaneous closed reduction.</p><p><strong>Methods: </strong>A retrospective multicenter study on 217 SCFE patients (228 hips) treated with IF in 10 institutions was performed. Hip morphology was assessed using preoperative, postoperative, and end of growth (EG) radiographs and radial MRI scans. Evaluated parameters included: epi-metaphyseal distance, Southwick angle (SA), head-neck offset (HNO), femoral neck varus deformity, and shortening. Depending on the presence of bony adaptation (BA; defined as rounded anterior metaphyseal edge and posterior callus formation, typically indicating slip onset > 4 weeks) at diagnosis hips were divided into Group A (n = 96; without BA) and Group B (n = 132; with BA).</p><p><strong>Results: </strong>At EG, Group A demonstrated better slip correction, more favorable femoral neck remodeling, and lower risk of residual cam deformity than Group B (15% vs 58%, risk difference -43%, 95% confidence interval -54 to -32). Remodeling occurred in most cases in both groups, but normal values were not uniformly reached. Femoral neck varus deformity and shortening were observed in both groups and attributed to disease-specific growth plate damage rather than transphyseal fixation.</p><p><strong>Conclusion: </strong>Radiographic signs of BA at diagnosis can predict the risk of cam deformity at EG. Cases without BA have a favorable prognosis, whereas slips with BA have a higher risk of residual deformity. Signs of BA demonstrated a higher predictive value (0.84) than SA > 40° (0.60) or negative HNO < -5 mm (0.57).</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"96 ","pages":"117-125"},"PeriodicalIF":3.4,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12922479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146256690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Similar incidence and implant survival of multiply revised knee arthroplasties in Norway and Denmark: a register study of the Danish and Norwegian Knee Arthroplasty registries from 1998-2021.","authors":"Julius Tetens Hald, Anne Marie Fenstad, Anders El-Galaly, Anders Odgaard, Ove Nord Furnes","doi":"10.2340/17453674.2026.45411","DOIUrl":"10.2340/17453674.2026.45411","url":null,"abstract":"<p><strong>Background and purpose: </strong>The aim of our study was to identify the absolute incidence and implant survival probability of multiply revised knee arthroplasties in Norway and Denmark from 1998 to 2021.</p><p><strong>Methods: </strong>This was an observational study of primary and revision knee arthroplasties reported prospectively in Norway and Denmark. The nationwide registers in Norway and Denmark were utilized. After identification of all primary procedures reported from 1998 to 2021, revision procedures were identified. Probabilities of implant survival were calculated using Kaplan-Meier methods. A multiply revised knee arthroplasty was defined as at least 3 revisions of a primary knee arthroplasty.</p><p><strong>Results: </strong>The proportion of third revisions was 0.4% in both Denmark (621/159,343) and Norway (404/105,192). The 16-year implant survival of third revisions was 57% (CI 52-62) in Denmark and 54% (CI 48-61) in Norway. No difference in the risk of revision between countries was found for the third revision (HR 1.1, CI 0.7-1.8).</p><p><strong>Conclusion: </strong>The incidence of multiply revised knee arthroplasties was not significantly different between Norway and Denmark. The risk and implant survival probability of multiply revised knee arthroplasties was similar in the 2 countries. The results can be used as a benchmark for incidence and prevalence calculations in other countries.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"110-116"},"PeriodicalIF":3.4,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12922480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146256697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence proportion of complex regional pain syndrome (CRPS) after distal radius fracture: a population-based register study.","authors":"Pernille Melbye, That Minh Pham, Niels-Peter Brøchner Nygaard, Carsten Hanshelge Kock-Jensen, Per Hviid Gundtoft, Bjarke Viberg","doi":"10.2340/17453674.2026.45443","DOIUrl":"10.2340/17453674.2026.45443","url":null,"abstract":"<p><strong>Background and purpose: </strong>One of the most severe complications of distal radius fractures (DRF) is the development of complex regional pain syndrome (CRPS). The incidence proportion (IP) of CRPS following DRF varies widely in the literature. Our aim is to report the incidence proportion of CRPS in DRF patients, subgrouping on age, sex, and treatment choice, and secondarily to assess development over time.</p><p><strong>Methods: </strong>Data was extracted from the Danish National Patient Register on patients > 18 years diagnosed with a DRF (S525) in the period 1998-2017.</p><p><strong>Results: </strong>There were 247,128 DRF in 203,533 patients with a mean age of 61 years. 75% were females. Within 1 year, 493 DRF patients developed CRPS corresponding to a 1-year IP of 0.20% and with an incidence density of 0.57/100,000/year. Median time from DRF to diagnosis was 89 days (SD 73). The IP ranged from 0.01% to 0.39% between age groups with the 30-65-year-olds having the highest incidence proportion. The surgically treated group had an IP of 0.31% and the non-surgical group had an IP of 0.17%. CRPS was slightly more common in women than men (0.21% vs 0.16%). We found a decrease in IP after 2010 from 0.24% to 0.14%.</p><p><strong>Conclusion: </strong>There was a low IP of CRPS diagnosis after DRF treatment with an observed higher IP in the 30-65-year-olds and in surgically treated patients. We consider this to be a minimum IP due to possible undiagnosed cases, but the overall results may be closer to the clinical reality than previous studies.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"105-109"},"PeriodicalIF":3.4,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12922478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146257017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability and reproducibility of classification of distal ulnar fractures using cone beam computed tomography (CBCT).","authors":"Linnéa Wretö, Lotta Fornander, Nina Kämmerling, Erika Nyman, Maria Moloney","doi":"10.2340/17453674.2026.46344","DOIUrl":"10.2340/17453674.2026.46344","url":null,"abstract":"<p><strong>Background and purpose: </strong> Distal ulnar fractures (DUFs) remain under-investigated, primarily due to limited statistical power resulting from the low incidence. The present classification systems are difficult to use and are not validated for new radiological methods such as cone beam computed tomography (CBCT). We aimed to analyze the reliability and reproducibility of the 2 classification systems, Arbeitsgemeinschaft für Osteosynthesefragen foundation/Orthopaedic Trauma Association (AO/OTA) and Biyani, for fractures of the distal ulnar head and neck using CBCT images.</p><p><strong>Methods: </strong> 76 patients with DUF who underwent a CBCT scan during the years 2016-2022 were included retrospectively. The CBCT images were reviewed twice by 6 observers of different medical specialties and levels of experience. All fractures were classified according to AO/OTA and Biyani. The reliability and reproducibility of each classification system were analyzed using kappa value analysis.</p><p><strong>Results: </strong> The reliability was fair to moderate for AO/OTA, Light's ĸ 0.41 (95% confidence interval [CI] 0.38-0.45) and moderate for Biyani, Light's ĸ 0.45 (CI 0.42-0.49), and the reproducibility was substantial for both AO/OTA, mean ĸ 0.65 (CI 0.49-0.80), and Biyani, ĸ 0.69 (CI 0.60-0.79).</p><p><strong>Conclusion: </strong> Both existing classification systems were perceived to be difficult to use and do not match existing fracture patterns. Using CBCT images, they both showed substantial reproducibility but not satisfactory reliability for clinical use.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"517-522"},"PeriodicalIF":3.4,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13444841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Update of guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopedic Association Part 1: preventive measures, diagnostics, and non-surgical treatment of subacromial pain syndrome.","authors":"Frederik O Lambers Heerspink, Egbert J D Veen, Oscar Dorrestijn, Cornelis P J Visser, Maarten J C Leijs, Dennis Van Poppel, Peter A Stroomberg, Ramon P G Ottenheijm, Jan W Kallewaard, Tjerk J W De Ruiter, Henk A Martens, Femke M Janssen, Tessa Geltink, Matthijs S Ruiter, Jos J A M Van Raaij","doi":"10.2340/17453674.2026.45365","DOIUrl":"10.2340/17453674.2026.45365","url":null,"abstract":"<p><strong>Background and purpose: </strong>In 2013, the first clinical practice guideline for subacromial pain syndrome (SAPS) was developed in the Netherlands to support healthcare professionals. SAPS refers to non-traumatic, non-rheumatologic shoulder complaints that are particularly painful during arm elevation. It includes conditions such as supraspinatus tendinosis, calcific tendinitis, and degenerative supraspinatus tears. Over 50,000 patients annually consult orthopedic surgeons for these issues. In response to new evidence and clinical needs, an updated guideline was developed. Part 1 addresses prevention, diagnosis, imaging, and non-surgical treatment. Using a multidisciplinary, evidence-based approach, the guideline aims to answer key clinical questions around SAPS.</p><p><strong>Methods: </strong>Initiated by the Dutch Orthopedic Society, the guideline committee identified knowledge gaps through group sessions. Each module was based on a PICO-formatted key question and reviewed by professionals from different fields. The AGREE and GRADE methods were applied to ensure a systematic evaluation of evidence, leading to conclusions and recommendations.</p><p><strong>Results: </strong>(i) Inform patients about the potential positive effects of a healthy lifestyle and encourage gradual exercise within sport and work. (ii) Perform a cluster of physical diagnostic tests to diagnose SAPS. (iii) Perform ultrasonography in patients with clinical suspicion of (partial thickness) rupture of the supraspinatus tendon. Consider MRI if ultrasound is not available or inconclusive. (iv) Consider barbotage for symptomatic calcific tendinosis, preferably with corticosteroid injection in the bursa, if a previous corticosteroid injection was ineffective. (v) Consider a subacromial corticosteroid injection (with a local anesthetic) to enable exercise therapy in patients with severe complaints that impair their ability to participate in exercise therapy. (vi) Consider suprascapular nerve block for patients with therapy-resistant SAPS when other non-surgical treatment is ineffective.</p><p><strong>Conclusion: </strong>The updated guideline provides multidisciplinary recommendations for physical examination, imaging, and conservative management of SAPS.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"97 ","pages":"91-98"},"PeriodicalIF":3.4,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12908218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146256668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}