Bone & Joint Research最新文献

{"title":"A novel strategy for reconstruction of AORI type III proximal tibial defects : surface-type knee reconstruction following defect reconstruction with 3D-printed extension-stem augment.","authors":"Xingzhen Li, Qing Han, Xue Zhao, Jinbo Zhang, Qian Wan, Zhennan Gan, Xiaonan Wang, Xin Zhao, Hao Chen, Aobo Zhang, Jincheng Wang","doi":"10.1302/2046-3758.1510.BJR-2025-0729.R1","DOIUrl":"https://doi.org/10.1302/2046-3758.1510.BJR-2025-0729.R1","url":null,"abstract":"<p><strong>Aims: </strong>For cases of Anderson Orthopaedic Research Institute (AORI) type III proximal tibial defects with intact medial collateral ligaments (MCLs), knee reconstruction is conventionally performed using semi-constrained prostheses with stemmed tibial components in conjunction with cones or sleeves. This study aimed to reconstruct AORI type III tibial defects using a 3D-printed extension-stem augment, followed by surface-type knee reconstruction to achieve long-term stability and promising clinical outcomes.</p><p><strong>Methods: </strong>A patient-specific porous extension-stem augment was designed based on the defect morphology. The microporous structure allowed direct contact for osseointegration, the proximal portion supported tibial baseplate, while the distal stem achieved intramedullary fixation. Finite element analysis (FEA) assessed the biomechanical stability of the augment. A retrospective analysis was conducted between July 2021 and September 2023 on patients who underwent reconstruction of AORI type III proximal tibial defects with extension-stem augment and surface-type total knee prosthesis.</p><p><strong>Results: </strong>FEA demonstrated favourable stress and strain distribution and micromotion at the prosthesis-bone interface, although localized high-strain regions were observed under higher-demand loading conditions. Four patients (0 male, 4 female) were included, with a minimum follow-up of 20.7 months (20.7 to 30) and a median age at surgery of 63.0 years (IQR 60.3 to 66.3). The mean Knee Society Score (KSS) improved significantly to 85 (82 to 87), and the mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score decreased by 18 (16 to 20). One patient developed periprosthetic joint infection on the femoral side at 20.7 months postoperatively and underwent revision surgery. Intraoperatively, the augment was securely integrated and could not be extracted. Radiological evaluation demonstrated satisfactory alignment and joint stability, with no evidence of prosthesis loosening or migration at the latest follow-up.</p><p><strong>Conclusion: </strong>The extension-stem augment achieved anatomical reconstruction of AORI type III proximal tibial defects and provided stable support for the surface-type prosthesis, ensuring reliable knee stability after reconstruction. This represents a feasible option for revision of AORI type III tibial defects.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"15 10","pages":"1263-1273"},"PeriodicalIF":5.5,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asymmetric metaphyseal cones versus medial modular block augment with central cone for medial tibial defects : a biomechanical comparison in varying bone quality.","authors":"Yi Ren, Chloe E H Scott, Nick D Clement, Shuqiao Xie, Pankaj Pankaj","doi":"10.1302/2046-3758.1510.BJR-2026-0180.R1","DOIUrl":"https://doi.org/10.1302/2046-3758.1510.BJR-2026-0180.R1","url":null,"abstract":"<p><strong>Aims: </strong>Managing large medial tibial bone defects during total knee arthroplasty (TKA) remains technically demanding, particularly in elderly patients. This study quantitatively compares two reconstructive strategies: 'bridging' the defect using an asymmetric metaphyseal cone versus 'anatomical reconstruction' employing a symmetrical cone with a metallic block augment, and assesses their sensitivity to osteoporotic bone quality.</p><p><strong>Methods: </strong>A finite element model of a tibia with a standardized medial defect (Anderson Orthopaedic Research Institute (AORI) Type 2a) was adapted to simulate both configurations under physiological loading cycles in healthy and severe osteoporotic bone. Cumulative interface micromotion was quantified using a coordinate-based post-processing algorithm that decouples normal separation from tangential shear. A parametric sweep of the tangential contact clearance evaluated near-surface biological interaction zones without additional simulations.</p><p><strong>Results: </strong>In healthy bone, both strategies demonstrated adequate stability with micromotions predominantly below 50 μm. In osteoporotic bone, the asymmetric cone exhibited a loss of stability, characterized by intermittent lift-off during walking and excessive tangential shear during stair descending. This instability induced a toggle effect at the distal stem. The augmented symmetrical cone maintained stable fixation regardless of bone quality. Expanding the tangential contact clearance revealed considerable unrecognized shear risk surrounding the asymmetric cone, while the augmented construct remained insensitive to this parameter in the high-risk range (> 100 μm).</p><p><strong>Conclusion: </strong>Asymmetric cones are viable in good bone stock but exhibit instability in osteoporosis due to the cantilever effect. Anatomical reconstruction with a modular augment and central cone provides a predictable, load-sharing structural column, making it the preferred strategy for large medial defects in osteoporotic patients.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"15 10","pages":"1274-1287"},"PeriodicalIF":5.5,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BIRC3 facilitates osteogenic differentiation of bone marrow mesenchymal stem cells via NGFR/β-catenin signalling axis.","authors":"Jun Tang, Ming Li, Yuanquan Chen, Yuwei Liang, Wenbin Yan, Hao Deng, Huatao Liu, Lin Huang","doi":"10.1302/2046-3758.1510.BJR-2025-0372.R2","DOIUrl":"10.1302/2046-3758.1510.BJR-2025-0372.R2","url":null,"abstract":"<p><strong>Aims: </strong>Osteoporosis primarily results from age-related declines in bone marrow mesenchymal stem cell (BMSC) differentiation into osteoblasts; however, the regulatory mechanisms remain unclear.</p><p><strong>Methods: </strong>Integrated analysis of Gene Expression Omnibus (GEO) and RNA sequencing (RNA-seq) data identified a key osteogenic regulator. Western blot, reverse transcription quantitative polymerase chain reaction (RT-qPCR), RNA-seq, immunohistochemistry (IHC), alkaline phosphatase (ALP), and alizarin red S (ARS) staining were employed to elucidate the functional and mechanistic aspects of modulating osteogenic differentiation. A C57 mouse tibial drill-hole model was used to evaluate therapeutic potential.</p><p><strong>Results: </strong>RNA-seq identified baculoviral inhibitor of apoptosis (IAP) repeat-containing protein 3 (BIRC3) as a potential regulator of BMSC osteogenesis, showing significant upregulation during BMSC osteogenic differentiation and upon monocyte stimulation. BIRC3 positively correlated with ALP and ARS staining intensity and significantly enhanced the expression of (runt-related transcription factor 2) RUNX2 and ALP proteins. RNA-seq, RT-qPCR, and western blot data indicated that BIRC3 positively regulates the expression of nerve growth factor receptor (NGFR). NGFR also promoted the osteogenic differentiation of BMSCs. Further experiments demonstrated that BIRC3 regulates BMSC osteogenesis through NGFR. Through XAV939 treatment, we demonstrated that both BIRC3 and NGFR promoted BMSC osteogenesis by enhancing β-catenin expression and nuclear translocation, thereby defining the functional role of the BIRC3/NGFR/β-catenin axis in BMSCs. In C57 mouse tibial bone defect models, BIRC3 overexpression group exhibited significantly enhanced callus formation and ossification compared to the control group.</p><p><strong>Conclusion: </strong>BIRC3 regulates BMSC osteogenic differentiation via NGFR/β-catenin signalling in vitro and promotes bone healing in vivo, suggesting therapeutic potential for osteoporosis and bone defects.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"15 10","pages":"1248-1262"},"PeriodicalIF":5.5,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191251","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":"Reported outcomes for patients following postoperative periprosthetic femoral fractures : a systematic review.","authors":"Wenjuan Cong, Emily Howell, Tom Krause, Rebecca Fox, Wendy Bertram, Josh Lamb, Hung-Yuan Cheng, Michael Whitehouse, Jonathan Evans, Vikki Wylde, Alex Aquilina","doi":"10.1302/2046-3758.1510.BJR-2025-0734","DOIUrl":"10.1302/2046-3758.1510.BJR-2025-0734","url":null,"abstract":"<p><strong>Aims: </strong>Postoperative periprosthetic femoral fracture (POPFF) is an increasingly common and morbid complication of arthroplasty. This review aims to determine what outcomes are reported for POPFF and how they are measured, to inform the development of a core outcome set.</p><p><strong>Methods: </strong>Systematic searches of major databases and clinical trial registries (June 2014 to May 2024) identified studies reporting outcomes for more than five POPFF patients in English or Chinese. Multiple reviewers performed study screening and data extraction. Outcomes were extracted verbatim, collapsed into outcome domain subcategories, and categorized. Outcomes were synthesized descriptively, with subgroup exploration by implant (hip/knee) and economic setting.</p><p><strong>Results: </strong>A total of 564 studies, comprising 119,445 POPFF patients (mean age 75.0 years (38.5 to 90.0); median percentage of female patients 61.8%), were included. Across the studies, 2,711 individual reported outcomes were collapsed into 671 unique terms within 59 outcome domain subcategories. Outcome reporting was dominated by the physiological/clinical core area (38.7%), followed by life impact (29.3%), resource use (12.8%), adverse events (11.7%), and death (7.6%). The most frequently reported subcategories were bone union/healing, surgical complications, component/prosthesis outcomes, hip function, and mortality/survival. Only 46.4% of outcomes were accompanied by a clear definition or named outcome measurement instrument; for bone union, just 7.4% provided a clear definition, 44.9% were vague, and 47.7% provided none. Health-related quality of life was measured in 6.9% of studies (39 instances) using seven instruments, most commonly the 12/36-Item Short-Form Health Survey questionnaire and EuroQol five-dimension questionnaire. Patterns varied between hip and knee POPFF and between high-income and low- to middle-income settings; one-year mortality was the most frequently reported survival timepoint.</p><p><strong>Conclusion: </strong>Outcome reporting after POPFF is heterogeneous, clinician-centred, and frequently undefined, with sparse use of patient-reported outcome measures and health-related quality of life instruments. These findings support the development of a POPFF core outcome set and recommended outcome measurement instruments to standardize reporting and promote patient-centred research.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"15 10","pages":"1236-1247"},"PeriodicalIF":5.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179319","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":"Differences in the collagen of semitendinosus tendon in patients with and without general joint laxity.","authors":"Kotaro Miyazaki, Akira Maeyama, Tetsuro Ishimatsu, Taiki Matsunaga, Takuaki Yamamoto","doi":"10.1302/2046-3758.1510.BJR-2025-0544.R1","DOIUrl":"https://doi.org/10.1302/2046-3758.1510.BJR-2025-0544.R1","url":null,"abstract":"<p><strong>Aims: </strong>Generalized joint laxity (GJL) has been reported to be a risk factor for anterior cruciate ligament (ACL) graft injury. There are no reports of differences in the collagen content of semitendinosus tendons used as graft tendon being a risk factor for ACL graft injury. The aim of this study was to determine the differences in the collagen type content in the semitendinosus tendon in patients with and without GJL.</p><p><strong>Methods: </strong>In total, 36 knees from 36 patients who underwent ACL reconstruction were analyzed. GJL was assessed using the Beighton score, with GJL defined as a Beighton score of ≥ 4, ≥ 5, or ≥ 6. The patients were divided into two groups: those with GJL (G-group) and those without (N-group). The parameters included the quantification of collagen types I, III, V, and XII in semitendinosus tendons via immunohistochemical staining, alongside preoperative radiological evaluation of the knee joint laxity. Comparisons were made between the two groups, and the correlation between the Beighton score and collagen content was analyzed.</p><p><strong>Results: </strong>There were significant differences between the G-group and the N-group in the type III collagen content (117.9 (SD 17.4) vs 130.0 (SD 11.5), p = 0.036) and the joint line convergence angle (JLCA) under varus stress (6.3° (SD 1.9°) vs 4.6° (SD 2.0°), p = 0.021) only when a Beighton score of ≥ 6 was defined as GJL. Hyperextension of the knee under anaesthesia differed significantly between the two groups across all definitions of GJL. The Beighton score was significantly correlated with the type III collagen content (<i>r</i> = 0.375, p = 0.024).</p><p><strong>Conclusion: </strong>Patients with GJL exhibited significantly higher collagen type III content in the semitendinosus tendon compared to those without GJL.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"15 10","pages":"1228-1235"},"PeriodicalIF":5.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179353","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":"Accelerometry-based comparison of functional outcomes across total and partial knee and hip arthroplasty : a propensity-matched UK Biobank Study.","authors":"Sevasti Panagiota Glynou, Omar Musbahi, Sara Sousi, Justin P Cobb","doi":"10.1302/2046-3758.1510.BJR-2025-0603.R1","DOIUrl":"https://doi.org/10.1302/2046-3758.1510.BJR-2025-0603.R1","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate objectively measured physical activity after hip and knee arthroplasty using accelerometry, by comparing bone-preserving procedures with total athorpalsties rthorpalsties and benchmarking both against non-arthritic controls.</p><p><strong>Methods: </strong>This observational study was conducted within the UK Biobank. Adults aged 40 to 69 years with total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), total hip arthroplasty (THA), or hip resurfacing (HR) were identified through linked hospital records and completed seven-day wrist-worn accelerometry (Axivity AX3). Outcomes included adjusted daily step count (primary), peak cadence, moderate-to-vigorous physical activity (MVPA), and Euclidean Norm Minus One (ENMO). Surgical groups were propensity score-matched to non-arthritic controls on demographics, lifestyle factors, and comorbidities. Direct comparisons between procedure types were examined using both propensity-matched analyses and complementary multivariable regression, and adjusted for demographic and clinical covariates. Subgroup analyses considered < 12 months and ≥12 months post-surgery.</p><p><strong>Results: </strong>A total of 2,283 participants were included (TKA = 860, UKA = 162, THA = 1,168, HR = 93). Compared with matched controls, TKA and THA patients showed persistently lower activity, while UKA and HR achieved levels similar to controls. In the knee cohort, UKA patients walked significantly more steps/day than TKA (9,150 vs 7,920; + 15.5%, p < 0.001) with higher cadence. In the hip cohort, HR patients outperformed THA (10,122 vs 9,139 steps/day; + 10.6%, p = 0.032) and demonstrated higher peak cadence, and HR remained comparable to controls. All groups fell within the 'somewhat active' to 'active' step-count range (7,500 to 12,499 steps/day).</p><p><strong>Conclusion: </strong>UKA and HR are associated with higher postoperative activity compared with total arthroplasty (TKA, THA). Accelerometry provides an objective, scalable assessment of functional recovery, highlighting procedure-specific differences that should be considered alongside implant longevity when selecting surgical options.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"15 10","pages":"1213-1227"},"PeriodicalIF":5.5,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179337","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":"Improving patient-reported outcome measure scoring in shoulder trials : comparing classical test theory, item response theory, and adaptive testing approaches.","authors":"Jon P Evans, Alex Mitchell, Jenna Shepherd, Harvinder Pal Singh, Amar Rangan","doi":"10.1302/2046-3758.1510.BJR-2026-0043.R1","DOIUrl":"10.1302/2046-3758.1510.BJR-2026-0043.R1","url":null,"abstract":"<p><strong>Aims: </strong>Patient-reported outcome measures (PROMs) underpin orthopaedic trials by capturing pain and function from the patient's perspective. Traditionally, PROMs such as the Oxford Shoulder Score (OSS) are scored using classical test theory (CTT), which assumes equal item contribution and uniform measurement error. Item response theory (IRT) and computerized adaptive testing (CAT) offer modern alternatives that may improve precision and reduce respondent burden, but their impact on trial outcomes is unclear.</p><p><strong>Methods: </strong>We reanalyzed patient-level OSS data from two major UK randomized controlled trials, UK FROST (n = 503) and PROFHER (n = 250). We used three scoring approaches: CTT sum scores, IRT-based expected a posteriori (EAP) scores, and a simulated CAT. Original statistical analysis plans were replicated to compare treatment effect estimates, CIs, and p-values across methods. CAT simulations assessed potential reductions in questionnaire length.</p><p><strong>Results: </strong>Across both trials, treatment effect estimates and statistical significance were highly consistent between CTT, IRT, and CAT. Differences in magnitude were minimal, and overall trial conclusions were unchanged. Simulated CAT reduced median questionnaire length to four to five items at early follow-up, increasing to eight to nine items at later timepoints.</p><p><strong>Conclusion: </strong>In these large orthopaedic trials, modern psychometric methods produced results consistent with traditional scoring, but demonstrated potential efficiency gains. IRT and CAT may facilitate lower-burden, patient-centred outcome measurement and support innovative trial designs, without compromising the interpretation of treatment effects.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"15 10","pages":"1206-1212"},"PeriodicalIF":5.5,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134573","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":"Predicting nonunion - a hybrid machine-learning model combining patient factors and mechanobiological simulation features exceeds clinician accuracy.","authors":"Jonas Armbruster, Felix Lamadé-Dootz, Nick Mattern, Eva Simone Steinhausen, Simon Hackl, Marie K Reumann, Dirk Stengel, Frank Niemeyer, Paul Alfred Grützner, Holger Freischmidt","doi":"10.1302/2046-3758.1510.BJR-2025-0788.R1","DOIUrl":"10.1302/2046-3758.1510.BJR-2025-0788.R1","url":null,"abstract":"<p><strong>Aims: </strong>To compare the accuracy of a mechanobiological simulation against that of clinicians in forecasting long bone nonunions, and to determine whether the simulation's results can be effectively used as input for a machine-learning algorithm.</p><p><strong>Methods: </strong>This was a retrospective diagnostic accuracy study using a cohort of 98 patients who underwent surgery for tibial shaft fractures at four tertiary care trauma institutions in Germany between January 2018 and December 2023, 20 of whom developed nonunion. Biplanar pre- and postoperative radiographs and detailed demographic and clinical information (sex, age, BMI, comorbidities, fracture characteristics, surgical protocol, and implants used) were provided to clinicians to predict the likelihood of nonunion. All data were also analyzed with the Leeds-Genoa Non-Union-Index (LEG NUI) and entered into a mechanobiological simulation model, a machine-learning model, and a hybrid model. Performance metrics were then compared across all five assessment methods.</p><p><strong>Results: </strong>Comparing the overall predictive performance of the clinicians' heuristic, the LEG NUI score, and the three computational models, the hybrid model outperforms all contenders concerning sensitivity (80%), positive predictive value (59%), negative predictive value (94%), and Matthews correlation coefficient (59%). Specificity was high (86%), solely outperformed by the specificity of the LEG NUI score (95%) and the mechanobiological simulation (90%).</p><p><strong>Conclusion: </strong>The AI-based hybrid model outperforms human experts in predicting nonunions in long bone fractures, enabling the early detection of patients at risk and the modification of treatment strategies to improve patient outcomes.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"15 10","pages":"1196-1205"},"PeriodicalIF":5.5,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134694","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":"Anti-RANKL antibody treatment mitigates subchondral bone loss and cartilage degeneration without affecting synovial inflammation in a mouse model of rotator cuff tear arthropathy.","authors":"Takayuki Ide, Yusuke Masuda, Kento Shimanoe, Suguru Saho, Seiya Takada, Kohei Uekama, Tomohiro Iuchi, Hiroki Tawaratsumida, Toshiro Ijuin, Hiroyuki Tominaga, Shingo Maeda, Noboru Taniguchi","doi":"10.1302/2046-3758.1510.BJR-2025-0759.R1","DOIUrl":"10.1302/2046-3758.1510.BJR-2025-0759.R1","url":null,"abstract":"<p><strong>Aims: </strong>Enhanced osteoclast activity in subchondral bone is implicated in osteoarthritis (OA) progression, but the contribution of osteoclasts versus synovial inflammation in cuff tear arthropathy (CTA) remains unclear. This study investigated whether inhibition of osteoclasts using an anti-receptor activator of nuclear factor κB ligand (RANKL) antibody can suppress joint degeneration in a mouse CTA model without affecting synovial inflammation.</p><p><strong>Methods: </strong>A modified CTA (mCTA) model was established in mice by resecting the supraspinatus and infraspinatus tendons, the superior joint capsule, and the long head of the biceps tendon in the right shoulder of C57BL/6J mice. Mice were assigned to four groups: sham or mCTA, each treated with phosphate-buffered saline or anti-RANKL antibody (5 mg/kg subcutaneously every two weeks). Four weeks post-surgery, histological analyses of the humeral head were performed using the Murine Shoulder Arthritis Score (MSAS), immunohistochemistry for osteoclasts, osteoblasts, RANKL/osteoprotegerin (OPG), inflammatory cytokines, and catabolic enzymes, and quantification of synovial M1 macrophages. Subchondral bone volume (BV) was assessed via the bone volume/tissue volume ratio.</p><p><strong>Results: </strong>The mouse mCTA model reproduced clinically relevant CTA phenotypes, including cartilage degeneration, subchondral bone loss, and joint surface collapse, within four weeks. RANKL expression and osteoclast surface increased in the superior and middle zones, while osteoblasts decreased. Synovial RANKL expression was low and unchanged after mCTA surgery. Anti-RANKL antibody administration significantly suppressed osteoclast surface and preserved subchondral BV, leading to attenuation of cartilage degeneration and reduced expression of inflammatory cytokines and catabolic enzymes in cartilage and subchondral bone. The synovitis score, synovial M1 macrophages, and inflammatory factors were unaffected, indicating that suppression of osteoclasts was sufficient to mitigate joint degeneration.</p><p><strong>Conclusion: </strong>Inhibition of subchondral osteoclasts via anti-RANKL antibody reduces CTA-associated cartilage and bone degeneration without altering synovitis. These findings suggest that targeting osteoclasts may represent a promising disease-modifying strategy for CTA, and targeting RANKL with denosumab may prevent or slow shoulder OA progression.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"15 10","pages":"1183-1195"},"PeriodicalIF":5.5,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134591","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":"Is it safe to use surgical instruments with debris from a previous surgery after sterilization?","authors":"Daniyil Semeshchenko, Alicia Farinati, Iván Alfredo Huespe, Jesica Iviglia, Martin Alejandro Buttaro, Pablo Ariel Slullitel, Fernando Comba, Gerardo Zanotti, Agustín F Albani-Forneris, Carlos M Lucero","doi":"10.1302/2046-3758.1510.BJR-2026-0010.R1","DOIUrl":"10.1302/2046-3758.1510.BJR-2026-0010.R1","url":null,"abstract":"<p><strong>Aims: </strong>The presence of biological debris on surgical instruments after reprocessing poses potential risks of infection in orthopaedic surgery. While autoclave sterilization is the standard method, its effectiveness in eliminating microbial contamination from residual bone, cement, and fatty tissue remains insufficiently studied. The primary objective was to study in vitro the sterility of retained cement, bone, and fat tissue debris on surgical instruments after autoclave sterilization. The secondary objective was to compare, based on colony-forming units (CFU), which material exhibits greater biofilm formation.</p><p><strong>Methods: </strong>An in vitro study was conducted to evaluate the sterility of retained biological debris on surgical instruments after autoclave sterilization. The autoclave sterilization procedure was performed at 1 atmosphere pressure (121°C) for 20 minutes. A total of 350 repetitions were performed, including five instruments used as sample specimens (drill bit, cannulated flexible reamer, femoral broach, cannulated screwdriver, and wire passer), with 70 repetitions per specimen. CFU/mL were counted and biofilm morphology was assessed through scanning electron microscopy (SEM).</p><p><strong>Results: </strong>After autoclave sterilization, no positive cultures were detected in any of the 350 repetitions (0%, 95% CI 0 to 5; n = 0), demonstrating complete absence of viable microorganisms. Due to the lack of microbial recovery, no statistical comparisons between instrument types were performed. We did not find any structural deformity in the mixed biofilms on bone, cement, and stainless steel as observed by SEM.</p><p><strong>Conclusion: </strong>Autoclave sterilization was effective in eliminating microorganisms from surgical instruments with retained biological debris. Although no apparent structural deformities of microorganisms were observed by SEM in the mixed biofilms, no bacterial growth was detected after sterilization, supporting the microbiological effectiveness of autoclave sterilization even in the presence of retained biological debris. These findings provide microbiological evidence supporting current sterilization practices, and highlight the need for further studies evaluating alternative sterilization methods such as ethylene oxide or plasma.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"15 10","pages":"1176-1182"},"PeriodicalIF":5.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134559","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}