Archives of Orthopaedic and Trauma Surgery最新文献

{"title":"Evaluating the Risk of Postoperative Infection and Complications in Lumbar Spine Surgery Patients with Preoperative Methicillin-resistant Staphylococcus aureus (MRSA) Colonization","authors":"Sri Tummala,&nbsp;Drew Haslam,&nbsp;David Gibbs,&nbsp;Jason Alder,&nbsp;Joseph Chavarria,&nbsp;Ioannis Avramis,&nbsp;James Rizkalla","doi":"10.1007/s00402-025-06036-y","DOIUrl":"10.1007/s00402-025-06036-y","url":null,"abstract":"<div><h3>Introduction</h3><p>Preoperative methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) colonization is a known risk factor for surgical site infections (SSIs) in orthopaedic procedures. However, its impact on a comprehensive range of postoperative complications, particularly in elective lumbar spine surgery (LSS), remains unexplored. This study evaluated the association between preoperative MRSA colonization and a comprehensive set of 30-day postoperative outcomes in patients undergoing LSS.</p><h3>Materials and methods</h3><p>A retrospective cohort study was conducted using the TriNetX multi-institutional database, including 440,336 patients undergoing elective LSS. Patients were stratified into MRSA-colonized (<i>n</i> = 3,711; 0.84%) and non-colonized controls (<i>n</i> = 436,625). Propensity score matching (1:1) adjusted for demographics and comorbidities (age, race, sex, obesity, diabetes, tobacco use, malnutrition, chronic kidney disease), yielding balanced cohorts of 3,706 patients each. Primary outcomes included 30-day mortality, SSIs, systemic infections (sepsis, pneumonia), hematologic complications (anemia, transfusions), renal failure, and thromboembolic events. Risk ratios (RR) with 95% confidence intervals were calculated.</p><h3>Results</h3><p>MRSA-colonized patients exhibited significantly higher complication risks versus matched controls: Wound complications: superficial SSI (RR = 2.291, <i>p</i> &lt; 0.01), deep SSI (RR = 2.566, <i>p</i> &lt; 0.01), wound dehiscence (RR = 1.722, <i>p</i> &lt; 0.01). Systemic Infections: sepsis (RR = 2.865, <i>p</i> &lt; 0.001), pneumonia (RR = 2.212, <i>p</i> &lt; 0.001). Hematologic/renal events: transfusion (RR = 2.382, <i>p</i> &lt; 0.001), anemia (RR = 2.826, <i>p</i> &lt; 0.001), acute kidney failure (RR = 2.344, <i>p</i> &lt; 0.001). Mortality: all-cause mortality was 2.05-fold higher (RR = 2.046, <i>p</i> &lt; 0.01). Demographic analysis identified five major risk factors: obesity, diabetes, tobacco use, malnutrition, and chronic kidney disease (CKD) as independent predictors of MRSA colonization.</p><h3>Conclusions</h3><p>Preoperative MRSA colonization is independently associated with significantly elevated risks of mortality, wound complications, systemic infections, hematologic morbidity, and acute renal injury after elective LSS. Clinically, preoperative recognition of MRSA colonization could prompt implementation of multimodal decolonization protocols and targeted counseling regarding heightened complication risks. This risk-stratified approach may optimize perioperative management and improve outcomes in high-risk LSS patients.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-025-06036-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144868862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Highly porous 3-D printed tritanium acetabular shell for aseptic revision total hip","authors":"Nick David Clement,&nbsp;Peter Richard Almeida,&nbsp;James T. Patton,&nbsp;Frazer Wade,&nbsp;Ewan Goudie,&nbsp;Philip M. S. Simpson,&nbsp;Gavin J. Macpherson,&nbsp;Paul Gaston","doi":"10.1007/s00402-025-06034-0","DOIUrl":"10.1007/s00402-025-06034-0","url":null,"abstract":"<div><h3>Aims</h3><p>To assess the survival, complications, patient-reported outcomes and radiographic integration of the uncemented Trident^® II tritanium acetabular component when used for aseptic revision total hip arthroplasty (rTHA).</p><h3>Methods</h3><p>A single-centre prospective cohort study of 101 aseptic rTHA in 100 patients was undertaken. Inclusion criteria were patients suitable for the use of the uncemented acetabular component, aged 18–95 years, willing and able to comply with the study protocol, and provide informed consent. Those with inadequate bone stock to support fixation of the prosthesis were excluded. Functional assessments included the Oxford hip score, Forgotten joint score, EQ-5D, EQ-VAS, pain VAS and satisfaction. Radiographic assessment included acetabular lucent lines and lysis according to Delee and Charnley zones and loosening.</p><h3>Results</h3><p>The mean age was 72.5 (standard deviation 11.6) and consisted of 54 females and 46 males. Mean follow-up was 3.1 (range 2 to 4.9) years during which 10 patients died. Indication for rTHA included: loosening of the acetabulum (<i>n</i> = 82), instability (<i>n</i> = 11), broken femoral stem (<i>n</i> = 3), metal on metal with pain and pseudotumour (<i>n</i> = 2), pain (<i>n</i> = 2) and loosening of femoral component (<i>n</i> = 1). There were two re-revisions for deep infection. This resulted in a 1-year all-cause survival of 99.0% (95% CI 97.1 to 100) and 4-year survival of 96.2% (95% CI 90.5 to 100). There was only one case with lucent lines in all three zones and had not osseointegrated, but the component remained stable at 3-years follow-up. All PROMs demonstrated a clinically meaningful improvement, which was significant (<i>p</i> &lt; 0.001) at both 1- and 2-years. Patient satisfaction with their revision THA was 85.6% and 85.3% at 1- and 2-years.</p><h3>Conclusion</h3><p>The uncemented highly porous 3-dimensional printed Trident^® II tritanium acetabular component was associated with excellent survivorship, clinically meaningful improvements in PROMs, and high patient satisfaction in the short term when used for aseptic rTHA.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144869038","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":"Are joint replacement registries cost-effective? Economic evaluation of the Australian orthopaedic association National joint replacement registry","authors":"Charles Okafor,&nbsp;Son Nghiem,&nbsp;Carl Holder,&nbsp;Christopher Vertullo,&nbsp;Joshua Byrnes","doi":"10.1007/s00402-025-06029-x","DOIUrl":"10.1007/s00402-025-06029-x","url":null,"abstract":"<div><h3>Introduction</h3><p>There is limited evidence on the cost-effectiveness of joint replacement registries. This study investigates two key questions: (i) Has the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) been cost-effective in improving the health outcomes of Australian joint replacement recipients? and (ii) Do the benefits of the registry outweigh its costs?</p><h3>Materials and methods</h3><p>A cost-utility and a cost-benefit analysis was performed from the healthcare system perspective, with a secondary analysis from the payer’s perspective. Participants were patients who underwent hip or knee replacements between July 1999 – December 2021. Health outcomes, measured as Quality-Adjusted Life Years (QALYs), revisions averted, and recalled prostheses, were converted to monetary terms using the value of a statistical life year, revision costs and protheses costs. Costs were presented in 2022 Australian dollars, with a discount rate 5% per annum. Decision-making thresholds were set at a willingness-to-pay of AU$50,000/QALY and a benefit-cost ratio of 1.</p><h3>Results</h3><p>From the healthcare system perspective, the incremental cost-effectiveness ratio (ICER) was dominant (cheaper and provides better outcomes) (AU$-170,982/QALY), with a benefit-cost ratio of 10.29. From the payer’s perspective, the ICER was also dominant (AU$-60,137/QALY) with a benefit-cost ratio of 10.49. Results remained robust across sensitivity analyses.</p><h3>Conclusion</h3><p>The AOANJRR is highly cost-effective, demonstrating significant health and financial benefits. For every dollar spent by the government, approximately nine dollars were saved. Verifying the cost benefits of clinical quality registries is crucial to justify ongoing investments, support informed clinical decisions, and ensure high-quality, accurate data for continuous improvements in patient care and safety.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-025-06029-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adductor tubercle as a reliable landmark for knee joint line determination: a comparative radiological study","authors":"Yüksel Yüksel,&nbsp;Mehmet Sait Akar","doi":"10.1007/s00402-025-06031-3","DOIUrl":"10.1007/s00402-025-06031-3","url":null,"abstract":"<div><h3>Introduction</h3><p>Accurate anatomical determination of the knee joint line is critically important for the success of both primary and revision total knee arthroplasty procedures. This study aimed to evaluate the reliability of anatomical landmarks for determining the knee joint line using plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI) in the Turkish population.</p><h3>Materials and methods</h3><p>This retrospective study included 186 patients. Anatomical reference points for the knee joint line were defined as the adductor tubercle, medial and lateral epicondyles, fibular head, tibial tuberosity, and inferior pole of the patella. Measurements obtained from all three imaging modalities were compared, and the relationships between femoral width (FW) and reference points were analyzed using correlation and linear regression analyses.</p><h3>Results</h3><p>No statistically significant differences were found between the measurement results of the reference points across the imaging methods (lowest <i>r</i> = 0.91, <i>p</i> &lt; 0.001). A strong correlation was observed between FW and the adductor tubercle joint line (ATJL) and medial epicondyle joint line (MEJL). Intraclass correlation coefficients (ICC) were greater than 0.90, indicating excellent reliability.</p><h3>Conclusions</h3><p>The adductor tubercle was identified as a reliable anatomical landmark for determining the knee joint line. Additionally, plain radiography, which offers advantages in terms of cost and reduced radiation exposure, may be a sufficient alternative for clinical applications. These findings can provide valuable contributions to surgical planning for accurate joint line determination. However, further studies are needed to validate these results in patients requiring surgical intervention.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820434","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":"Lateral clavicle fractures: grid pattern arrangement of screws in the lateral fracture fragment reduces the cut-out","authors":"Stefanie Hoelscher-Doht,&nbsp;Sophia Scheible,&nbsp;Maximilian Heilig,&nbsp;Eva Kupczyk,&nbsp;Rainer H. Meffert","doi":"10.1007/s00402-025-06027-z","DOIUrl":"10.1007/s00402-025-06027-z","url":null,"abstract":"<div><h3>Introduction</h3><p>Lateral clavicle fractures often need to be stabilized by a plate osteosynthesis and due to the acting high forces a cut-out of the screws of the lateral fracture fragment can occur. New plates enable to place anterior screws in addition to the screws placed from the top of the clavicle. This experimental in-vitro study will determine whether they have a substantial biomechanical effect.</p><h3>Materials and methods</h3><p>In synthetic bones, lateral clavicle fractures were created and stabilized in 4 different groups: In Group A, a lateral clavicle plate was fixed with 3 screws in the lateral fracture fragment. In group B, the same type of plate was fixed with additionally two screws from anterior in the lateral fragment. In group C, a coraco-clavicular banding was added to the fixation method of group B. A similar plate from another company was used in group D with a screw fixation method comparable to group A. In a material testing machine, the specimens were loaded by dynamic and static tests. The mode of failure and pull-out forces were analyzed.</p><h3>Results</h3><p>In the dynamic testing phase, five specimens failed already in group A and B, whereas in group C 11 specimens survived the cyclic tests. Lateral fractures and screw cut-out appeared in the static tests mostly in group A and B. In contrast, in group C, ten of eleven specimens failed by a medial fracture at the plate end. No significant differences were determined in-between groups for the displacement recorded by the optical system, even, when group A revealed the highest values of the groups A-C. In group D, the specimens showed an early screw cut-out of the lateral fracture fragment, and all failed during the dynamic testing phase.</p><h3>Conclusions</h3><p>The use of additional screws from anterior led in a significant lower cut-out and higher biomechanical stability at the lateral clavicle regarding axial tensile forces. From a biomechanical point of view, plates for stabilization of lateral clavicle fractures with additional screw holes from anterior and restoring the cc-bands is favorable to standard plates with screws from the top of the clavicle only.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-025-06027-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fixation of the mobile fragment in periacetabular osteotomy: a clinical study of two- vs. three-screw fixation with 4-week partial weight bearing","authors":"Sufian S. Ahmad,&nbsp;Quentin Karisch,&nbsp;Henning Windhagen,&nbsp;Marco Haertlé","doi":"10.1007/s00402-025-05996-5","DOIUrl":"10.1007/s00402-025-05996-5","url":null,"abstract":"<div><h3>Aim</h3><p>Fixation of periacetabular osteotomy (PAO) has been a matter of interest since development of the procedure. Despite the stability of the construct, no consensus regarding the minimum number of screws needed for fixation is present. The aim of this study was to compare two-screw and three-screw fixation techniques in the clinical setting.</p><h3>Methods</h3><p>The study included a consecutive series of 100 hips that had undergone PAO surgery by a single surgeon between January 2022 and July 2023 with complete radiographic follow-up. The mobile fragment was fixed using three screws in 27 <i>hips</i> and two screws in 73 <i>hips</i>. Both groups did not significantly differ in any morphometric measure. Lateral center edge angle (LCEA), Acetabular index (AI), extrusion index (EI), anterior wall (AWI), and posterior wall index (PWI) were measured by two independent investigators preoperatively, immediately after surgery and at 1 year follow-up and interobserver agreement measured. Analysis of variance (ANOVA) was used for comparison.</p><h3>Results</h3><p>No change of correction of &gt; 4° was observed in any hip in both groups. Both groups did not significantly differ regarding any change in radiographic measure in ΔLCEA (1.09 ± 2.46 vs. 0.52 ± 3.11, <i>p</i> = 0.34), ΔEI (− 1.94% ± 2.97% vs. − 0.44% ± 5.75%, <i>p</i> = 0.25), ΔAI (− 0.10 ± 1.71° vs. 0.21 ± 1.83, <i>p</i> = 0.72), ΔAWI (0.25% ± 7.78% vs. 0.02% ± 12.05%, <i>p</i> = 0.57), ΔPWI (4.03% ± 9.94% vs. 3.43% ± 10.79%, <i>p</i> = 0.38). There was no difference in complications between groups. The rate of non-union at 1 year was lower in the two screw group, although not significant (7% vs. 17%, <i>p</i> = 0.38).</p><h3>Conclusion</h3><p>The results emphasize the inherent stability of the PAO construct and demonstrate that the use of two screws for fixation of the mobile fragment is sufficient in PAO surgery, provided that the fragment was fully mobilized during surgery and at least 50% bony contact on the iliac wing was achieved. Furthermore, a 4 week partial weight bearing regimen is also adequate during the healing phase.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-025-05996-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144810874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"YouTube as a source of information on robotic knee replacement: a quality analysis","authors":"Ebubekir Eravşar,&nbsp;Musa Ergin,&nbsp;Mustafa Citak","doi":"10.1007/s00402-025-06024-2","DOIUrl":"10.1007/s00402-025-06024-2","url":null,"abstract":"<div><h3>Introduction</h3><p>With the rise in robotic-assisted surgery, platforms like YouTube have become popular for patient education. Robotic total knee replacement (RTKR) is frequently featured, but the quality of content remains uncertain. This study evaluated the quality and educational value of YouTube videos on RTKR using standardized scoring systems.</p><h3>Materials and methods</h3><p>A total of 100 videos related to robotic total knee replacement were identified through YouTube searches, and 38 of them were included in the study. Video characteristics, video sources, and video themes were recorded. Quality and content were assessed using DISCERN, JAMA Benchmark, Global Quality Score (GQS), and the Robotic Total Knee Replacement Score (RTKRS). The RTKRS scoring system was used to investigate the differences between robotic knee replacement and standard knee replacement.</p><h3>Results</h3><p>The median scores were 28.25 for DISCERN, 2 for JAMA, 2 for GQS, and 1 for RTKRS. RTKRS was lower in patient-sourced videos than in physician- and speaker-sourced videos (<i>p</i> &lt; 0.05). General knowledge-themed videos had higher RTKRS scores than patient testimony videos (<i>p</i> = 0.010). A negative correlation was found between view count and RTKRS, while video duration correlated positively with GQS. Only 24% of videos addressed differences in patient satisfaction. 21% discussed potential differences in complication rates, while only 13% covered prosthesis survival. In contrast, 82% mentioned alignment differences, and just 11% addressed cost differences.</p><h3>Conclusions</h3><p>Despite the increasing accessibility of robotic surgery information online, the quality of YouTube videos on robotic total knee replacement was generally low. Patient-generated content was particularly lacking in educational value, while professionally produced general information videos demonstrated better quality scores. Critical topics such as complication rates, prosthesis longevity, and patient satisfaction were underrepresented, suggesting a need for improved and more balanced online educational resources.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144810875","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":"Early versus delayed weightbearing for postoperative ankle fractures: a systematic review and meta-analysis of randomized controlled trials","authors":"Feifei Wu,&nbsp;Peidang Liu,&nbsp;Zhengkuan Ou,&nbsp;Shiran Zhou,&nbsp;Cheng Zhang","doi":"10.1007/s00402-025-06016-2","DOIUrl":"10.1007/s00402-025-06016-2","url":null,"abstract":"<div><h3>Background</h3><p>This meta-analysis aimed to compare the clinical effectiveness of an early weightbearing (EWB) strategy (walking two weeks after surgery) with a delayed weightbearing strategy (DWB) (walking six weeks after surgery) for postoperative ankle fractures.</p><h3>Methods</h3><p>Four databases were systematically searched for randomized controlled trials (RCTs) comparing EWB with DWB in patients with postoperative ankle fracture. Outcomes included the Olerud-Molander Ankle Score (OMAS), time to return to work/life, and complications. After screening the literature according to eligibility criteria, data extraction, quality evaluation, and meta-analysis were performed using RevMan 5.3 software. The review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.</p><h3>Results</h3><p>Ten RCTs with 1276 patients were included in this study. Compared with the DWB group, the EWB group showed greater improvement in OMAS in the early postoperative stage (six weeks) [MD = 5.86, 95% CI = (3.64, 8.08), <i>P</i> &lt; 0.001] and middle stage (12 weeks to four months) [MD = 3.17, 95% CI = (0.84, 5.50), <i>P</i> = 0.008]. However, no significant difference was observed in the late stage (12 months) [MD = 1.86, 95% CI = (-0.50, 4.22), <i>P</i> = 0.12]. In addition, the EWB strategy shortened the average time to return to work/daily life [MD=−1.75, 95% CI = (−2.52, −0.98), <i>P</i> &lt; 0.001]. There was no significant difference in complications between the EWB and the DWB groups [RR = 1.34, 95% CI = (0.96, 1.86), <i>P</i> = 0.08].</p><h3>Conclusion</h3><p>The results revealed that the EWB strategy was safe and effective in improving OMAS in the early and middle postoperative stages. Additionally, EWB enabled patients to return to work and daily life earlier than DWB did.</p><h3>Level of Clinical Evidence</h3><p>1</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144810823","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 of patellofemoral instability in patients with hypermobile Ehlers-Danlos syndrome","authors":"Sebastian Schmidt,&nbsp;Chilan Bou Ghosson Leite,&nbsp;Alexander Bumberger,&nbsp;Domenico Franco,&nbsp;Cale Andrew Jacobs,&nbsp;Christian Lattermann","doi":"10.1007/s00402-025-06022-4","DOIUrl":"10.1007/s00402-025-06022-4","url":null,"abstract":"<div><h3>Purpose</h3><p>Hypermobile Ehlers-Danlos Syndrome (hEDS) is a connective tissue disorder characterized by joint hypermobility and ligamentous laxity, leading to a high prevalence of patellar instability. While anatomical risk factors for patellar dislocation (PD) have been extensively studied in the general population, their specific role in hEDS remains unclear. This study aimed to evaluate anatomical predictors of patellar dislocation in patients with hEDS by comparing individuals with and without PD.</p><h3>Methods</h3><p>A retrospective analysis was conducted on 168 patients diagnosed with hEDS. Patients were screened to ensure they had MRI and X-ray imaging of the knee, identifying 17 patients (28 knees) with patellar dislocation (PD group) and 33 patients (38 knees) without dislocation (control group). Demographic data, imaging measurements, and patellar-specific parameters such as tibial tubercle lateralization, patellar height, axial alignment, trochlear morphology, and patellar shape were assessed. Statistical comparisons and regression analyses were performed to identify significant predictors.</p><h3>Results</h3><p>The PD group exhibited significantly smaller patellar width (<i>p</i> = 0.03), higher Insall-Salvati ratios (<i>p</i> = 0.04), and a greater prevalence of type C trochlear dysplasia (<i>p</i> = 0.02) and type III patellar shape (<i>p</i> = 0.02) compared to controls. Age was a significant predictor, with younger patients showing a higher likelihood of dislocation (<i>p</i> = 0.004; OR = 0.076;95% CI, − 0.128- − 0.024). No significant differences were found in tibial tubercle lateralization or tibiofemoral rotation between groups. Correlation analysis revealed complex relationships among imaging parameters, highlighting the interplay of anatomical factors.</p><h3>Conclusion</h3><p>This study identified anatomical differences associated with patellar dislocation in hEDS, but none of the measured parameters exceeded established clinical thresholds considered pathological in the general population. This highlights that patellar instability in hEDS may occur despite normal anatomy, underscoring the greater role of systemic laxity and the need for hEDS-specific assessment considerations.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144810822","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":"Tibial tubercle osteotomy decreases femorotibial rotation in patients with patellar instability.","authors":"Martin Hartmann, Jakob Ackermann, Niklas Bergheim, Lazaros Vlachopoulos, Florian Imhoff, Lukas Jud, Sandro Fucentese","doi":"10.1007/s00402-025-06023-3","DOIUrl":"10.1007/s00402-025-06023-3","url":null,"abstract":"<p><strong>Background: </strong>Patellar instability is a multifactorial pathology that poses significant challenges for orthopaedic surgeons in accurately diagnosing and effectively addressing its underlying causes. Recently, increased femorotibial (FT) rotation has been shown to contribute to patellar instability by further lateralizing the muscle force vector acting on the patella. However, there is a paucity of evidence regarding interventions that influence this parameter.</p><p><strong>Hypothesis/purpose: </strong>To assess whether patellar stabilizing procedures influence FT rotation in patients with trochlear dysplasia (TD) in the setting of patellar instability. It was hypothesized that tibial tubercle osteotomy (TTO) reduces FT rotation by changing the vector acting on the proximal tibia.</p><p><strong>Study design: </strong>Retrospective cohort study, level of evidence 3.</p><p><strong>Methods: </strong>One-hundred-forty-four knees who underwent patellar stabilizing surgery between January 2010 and December 2020 were retrospectively analysed. Caton-Deschamps index (CDI), tibial-tubercle-trochlear-groove distance (TTTG), tibial tubercle (TT) torsion, tibial tubercle-to-posterior cruciate ligament distance (TT-PCL), and pre- and postoperative FT rotation were assessed. Based on the performed patellar stabilizing procedures, knees were stratified into 4 groups: 1: Isolated medial patella-femoral ligament (MPFL) reconstruction (n = 51), 2: MPFL reconstruction and TTO (n = 24), 3: MPFL reconstruction and trochleoplasty (n = 37), 4: MPFL reconstruction, trochleoplasty, and TTO (n = 32).</p><p><strong>Results: </strong>Preoperative FT rotation differed significantly between groups (-0.2 ± 6.1° vs. 3.1 ± 6.7° vs. 5.0 ± 5.6° vs. 9.6 ± 6.0°, p < 0.001). Group 4 showed a significant reduction of FT rotation postoperatively, indicating a decrease in external rotation (ΔFT rotation: -2.0 ± 3.5°, p = 0.003). Group 1, 2 and 3 showed no reduction of FT rotation (group 1: 0.6 ± 4.8°; group 2: -1.3 ± 7°, group 3: 0.0 ± 5.3°, n.s.). Comparing knees with and without TTO, those with concomitant TTO (groups 2 and 4; n = 56) showed a significantly reduced postoperative FT rotation by a mean of 1.7 ± 5.3° compared to knees without TTO (0.3 ± 5°, groups 1 and 3; n = 88) (p < 0.021). The reduction in FT rotation significantly correlated with the reduction of the TT torsion but not with the medialization achieved by TTO (r = 0.511, p < 0.001 and r = 0.185, p = 0.173, respectively).</p><p><strong>Conclusion: </strong>Tibial Tubercle Osteotomy effectively reduces femorotibial rotation in patients with patellar instability and trochlear dysplasia. This reduction is directly associated with the decrease in tibial tubercle torsion. Therefore, TTO should be considered for patients with increased TT-TG distance and elevated femorotibial rotation to improve patellar stability outcomes.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"400"},"PeriodicalIF":2.1,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12334370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144798041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}