To systematically synthesize pre- and postoperative outcomes of arthroscopic repair for isolated subscapularis (SSC) tears across functional scores, pain, strength, range of motion (ROM), and clinical tests.  Systematic review and meta-analysis.  A systematic literature search was conducted across PubMed, Cochrane Library, and SCOPUS for studies reporting pre- and postoperative outcomes after arthroscopic repair of isolated SSC tears in adults with a minimum 12-month follow-up. Data on functional outcome scores, pain measures, and subscapularis-specific clinical tests were assessed. Functional outcomes were assessed using validated shoulder scoring systems, including the Constant-Murley Score (CMS), University of California, Los Angeles Shoulder Score (UCLA), American Shoulder and Elbow Surgeons Score (ASES), Simple Shoulder Test (SST), and Subjective Shoulder Value (SSV). These scores generally evaluate a combination of pain, shoulder function, strength, and activities of daily living. Pain was assessed using the Visual Analogue Scale (VAS). Subscapularis-specific function was evaluated using clinical tests such as the lift-off, belly-press, and bear-hug tests. The outcomes were presented as a mean difference between the preoperative and postoperative values using random or fixed effects. Results are reported as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI) and exact P values. Certainty of evidence was evaluated using the GRADE approach. The evidence base consisted predominantly of non-randomized studies at serious risk of bias, with outcomes rated as low or very low certainty. Seventeen non-randomized studies (Level II-IV evidence) comprising 537 patients were included. In the absence of a control group, mean postoperative functional outcome scores were higher than preoperative values across studies, although individual patient outcomes varied. All included studies were judged to be at serious risk of bias using the ROBINS-I tool, and GRADE certainty of evidence was low to very low for all outcomes. Improvements were reported in multiple domains including shoulder function, strength, ROM, pain, and ability to perform daily activities. The mean differences ranged from 16.9 to 45.8 points for the CMS (pooled MD = 31.4, 95% CI [27.0-35.9]), 14.5 to 16.0 points for the UCLA (pooled MD = 15.4, 95% CI [14.8-15.9]), 33.0 to 58.3 points for the ASES (pooled MD = 48.1, 95% CI [46.8-49.9]), and 4.3 to 5.1 points for the SST (pooled MD = 4.9, 95% CI [4.4-5.5]). Consistent improvement was also observed in the SSV (pooled MD = 48.2, 95% CI [46.7-49.8]). In addition, pain assessed using the Visual Analogue Scale showed a significant postoperative reduction (MD =  - 5.0, 95% CI [- 5.2 to - 4.8]). Subscapularis-specific clinical tests showed a significant decrease in the rate of positive lift-off (RR = 0.19, 95%CI (0.14-0.27)), belly-press (RR = 0.36, 95% CI (0.29-0.46)), and bear-hug tests (RR = 0.46, 95% CI (0.35-0.61)). Furthermore, ROM, which was primarily assessed clinically through measures of internal rotation was evaluated using either the Constant-Murley internal rotation subscore or spinal level assessment scales, depending on the study, improved significantly postoperatively. Subscapularis strength, evaluated clinically using lift-off and/or belly-press strength testing, most commonly graded according to the Medical Research Council (MRC) scale ranging from 0 to 5, also demonstrated significant postoperative improvement. Although overall postoperative strength improved significantly at the study level, some patients continued to demonstrate residual weakness or persistent positive subscapularis-specific clinical tests following repair. A major confounder was the frequent co-performance of long head of the biceps tenotomy or tenodesis (reported in 55.6-100% of cases across studies), which limits the ability to attribute postoperative improvements to subscapularis repair alone.  Arthroscopic repair of isolated SSC tears was associated with postoperative improvements in pain, functional scores, range of motion, and subscapularis-specific clinical tests in this predominantly observational evidence base. However, these findings should be interpreted with caution, as the certainty of evidence was low to very low for all outcomes (GRADE), all included studies were at serious risk of bias (ROBINS-I), and the frequent co-performance of long head of the biceps procedures (tenotomy or tenodesis) represents a major confounder that limits attribution of improvements to subscapularis repair alone. The durability of these outcomes and the extent to which muscle strength is restored remain uncertain, particularly in the long term, and may be limited by pre-existing muscle degeneration.
Reliable measurement of mounting parameters (MP) is crucial for effective deformity correction using the Taylor Spatial Frame (TSF). Intraoperative fluoroscopy (IF) allows real-time parameter acquisition but is technically demanding, requiring precise projection angles; otherwise, projection distortion may occur. In contrast, postoperative radiographic measurement is simpler but prone to parallax errors inherent to two-dimensional imaging. The consistency between these two methods and their respective effects on correction efficiency remains unclear. Therefore, this study aims to compare the consistency of IF with postoperative radiography (PR) for measuring the MP of TSFs and to evaluate their clinical impact. This single-center retrospective cohort study included 86 patients aged 20-60 years with tibial fractures who underwent TSF treatment between May 2021 and May 2024. Based on the measurement method for MP, the patients were divided into two groups: an IF group (n = 41, measured via IF) and a PR group [n = 45, measured via postoperative standard anteroposterior (AP) and lateral (LAT) radiographs]. Primary outcome measures included measurement of operation time, surgical time, number of electronic prescriptions, and fracture reduction time (interval from the execution of the first prescription to imaging-confirmed satisfactory reduction). Secondary outcome measures included final radiological outcomes (AP and LAT angulation and translation), fracture healing time, and Johner-Wruhs functional scores at the study endpoint. The intraclass correlation coefficient (ICC) was used to evaluate the inter-observer consistency of parameters between two independent observers, and the satisfactory reduction rate of the initial prescription was compared between the two groups. All 86 patients completed the follow-up, with a mean follow-up of 28.1 months. The two groups were comparable at baseline for age, sex, injury mechanism, AO/OTA classification, and Gustilo-Anderson classification (all P > 0.05). Regarding consistency, the inter-observer consistency in the IF group appeared higher than that in the PR group based on descriptive comparison of 95% CIs (ICC: 0.92 vs. 0.81), and parallax errors caused by suboptimal radiographic positioning were the primary reason for measurement inconsistency in the PR group. In terms of intraoperative workflow, the software-based measurement time in the PR group was shorter than that in the IF group (11.8 ± 2.4 min vs. 18.4 ± 2.1 min). Because the measurement process was shifted to the postoperative period, the total surgical time was significantly shorter than that in the IF group (73.7 ± 6.2 min vs. 92.1 ± 7.2 min), with both differences being statistically significant (P < 0.001). Regarding reliability and reduction efficiency, the IF group required fewer electronic prescriptions (median [IQR]: 1 [1, 2] vs. 2 [1, 2], P = 0.003) and had a shorter fracture reduction time (3.9 ± 0.7 d vs. 4.8 ± 0.8 d, P < 0.001); although the satisfactory reduction rate after a single prescription was numerically higher in the IF group than in the PR group (68.3% vs. 57.8%), the difference was not statistically significant (P = 0.314). No statistically significant differences were observed between the two groups in final radiological alignment, fracture healing time (25.2 ± 3.1 weeks vs. 24.4 ± 2.7 weeks), or the excellent and good rate of Johner-Wruhs functional scores (90.2% vs. 88.9%) (all P > 0.05). IF appeared to offer higher inter-observer consistency for MP measurement versus PR, though this finding should be interpreted cautiously given the retrospective design. IF was associated with significantly fewer electronic prescriptions and shorter fracture reduction time, suggesting improved correction efficiency. Although postoperative radiographic measurement is simpler to perform and involves shorter intraoperative time for parameter acquisition, it is inferior to IF in reduction efficiency. However, both methods can ultimately achieve satisfactory radiological alignment, fracture healing time, and functional prognosis, yielding comparable endpoint outcomes. Therefore, the clinical selection of measurement strategies should balance efficiency demands and time costs: for complex cases requiring high reduction precision, IF may be the optimal choice; whereas for specific patients sensitive to surgical time, postoperative radiographic measurement can also serve as a safe and effective alternative. However, the lack of quantitative radiation dose data in the IF group is a key limitation of this study, and future research should include dosimetry to enable a more complete comparison.
Half of all patients with a hip fracture (HF) do not recover their pre-fracture mobility after 1 year. Mobility and functional capabilities may be impaired by postoperative low haemoglobin levels and iron deficiency. The primary objective of this trial is to compare the effect of a single postoperative dose of ferric derisomaltose 20 mg/kg body weight relative to placebo on the recovery of functional mobility in patients. The IronHip trial is a multicentre, randomised, double-blind, placebo-controlled trial with participants allocated in a 1:1 ratio to receive intravenous iron or placebo. The eligible population is participants aged 65 years or older who have undergone HF surgery and have a haemoglobin concentration below 105 g/L measured between postoperative day 1 and 5. In total, 210 participants will be randomised. Main analyses will be conducted in the intention-to-treat population using a mixed model for repeated measures, including assessments at baseline and at 4, 6 and 12 weeks after randomisation. Treatment effects will be estimated from the treatment-by-time interaction and reported as between-group differences in least-squares mean New Mobility Score with 95% CIs. The secondary outcomes are haemoglobin, red blood cell transfusions, fatigue, quality of life, self-rated health, fear of falls, 30 s sit-to-stand test, activities of daily living, pain, days alive and at home up to 30 days, mortality and serious adverse events. Exploratory outcomes are cost-effectiveness, physical activity, hand grip strength, knee extension strength, cognition, ferritin and transferrin saturation. Recruitment was initiated on 9 June 2025. The IronHip trial has been approved by the Danish Medicines Agency and the Danish Medical Research Ethics Committee. The protocol follows the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines, the Declaration of Helsinki and the Good Clinical Practice guidelines. The trial findings will be reported according to the Consolidated Standards of Reporting Trials (CONSORT) statement in peer-reviewed journals. EU CT number: 2024-5 15 116-42-00, authorised 9 February 2025. gov: NCT06898814.
Distal radius fractures are among the most common surgically treated fractures in adults. While many patients recover well after surgery, a substantial number continue to experience pain, stiffness, and limitations in hand function that affect daily life and well-being. These difficulties are not always explained by physical healing alone. Psychological responses such as worry, low motivation, or reduced confidence in recovery are often observed in clinical encounters. Two psychological constructs, sense of coherence and self-efficacy, have been associated with outcomes in musculoskeletal rehabilitation. However, their contribution to recovery after distal radius fracture has not been fully established. This study aimed to explore how sense of coherence and self-efficacy are associated with hand disability during the first year after surgical treatment. This prospective cohort study included adults (18-74 years) with surgically treated distal radius fractures. Data were collected at cast removal and at three months, six months, and one year post-surgery. Outcome measures included hand disability (DASH), sense of coherence (SOC-13), task-specific self-efficacy, pain, grip strength, and range of motion. Nonparametric statistics were used. Group differences were analyzed with Mann-Whitney U and chi-squared tests. Logistic regression explored associations between psychological factors and disability. 74 patients completed the three-month follow-up, and 61 remained at one year. Sense of coherence scores were stable and not associated with disability at any time point. Self-efficacy was generally high. At six months, higher self-efficacy for goal fulfilment was associated with lower disability, but no associations were found at three months or one year. Median DASH scores improved from 12 at three months to 2 at one year. Pain at rest was normalized by one year, while pain during activity remained. Grip strength and volar flexion had not fully recovered at 12 months. Supination, pronation, and radial/ulnar deviation returned to near normal by six months. Neither sense of coherence nor self-efficacy consistently predicted outcomes after a surgically treated distal radius fracture across all time points. However, our exploratory results contribute to the overall understanding of the multifactorial nature of recovery in this patient population.
Osteoarthritis (OA) is a degenerative joint disorder marked by chronic inflammation, extracellular matrix (ECM) breakdown, and subchondral bone remodeling, ultimately leading to loss of cartilage integrity and joint function. Hyaluronic acid (HA), a key component of synovial fluid, contributes to joint lubrication and has been implicated in the regulation of inflammatory and anabolic processes. High-molecular-weight (HMW) HA (> 1 MDa) is reported to exert anti-inflammatory and matrix-preserving effects; however, its role in multicellular systems remains incompletely understood. In this study, we investigated the effects of HMW HA using an in vitro chondrocyte-osteoclast co-culture model designed to reflect key features of the osteoarthritic microenvironment. Bone marrow-derived mesenchymal stem cells were differentiated into chondrocytes, while RAW 264.7 macrophages were induced into osteoclast-like cells using M-CSF and RANKL. Cells were co-cultured at a 1:1 ratio and stimulated with lipopolysaccharide (LPS; 1 µg/mL) to induce inflammatory stress, followed by HA treatment (50-500 µg/mL) for 24-48 h. Cell viability, morphology, and TRAP staining were assessed. Expression of inflammatory and matrix-associated markers was analysed by Western blot, qPCR, and ELISA. Cell-cycle distribution and DNA integrity were evaluated using flow cytometry and agarose gel electrophoresis. LPS exposure reduced metabolic activity, altered morphology, and was associated with increased expression of NF-κB-related inflammatory markers and elevated expression of IL-1β, TNF-α, MMP-13, and ADAMTS-5, alongside reduced COL2A1 and ACAN levels. HA treatment improved metabolic activity and preserved cellular morphology in a concentration-dependent manner, with the most pronounced effects observed at 200-500 µg/mL. HA-treated cultures showed lower levels of inflammatory and catabolic markers together with increased expression of ECM-associated genes. In addition, HA treatment was associated with a more balanced cell-cycle profile and reduced DNA fragmentation. HMW HA was associated with coordinated modulation of inflammatory and matrix-related markers in an LPS-induced co-culture system. These findings suggest that HA may contribute to maintaining cellular homeostasis under inflammatory conditions in vitro. Further studies are needed to clarify the underlying mechanisms and translational relevance.
Two-stage revision arthroplasty remains the gold-standard treatment in the United States for patients diagnosed with periprosthetic joint infection (PJI) of the hip and knee. However, during treatment, patients have an extended interstage period between prosthesis removal and reimplantation which is frequently characterized by substantial reductions in mobility, prolonged rehabilitation, and a high incidence of medical and psychosocial complications. This review examines the physical, psychological, and social effects of immobility during the interstage period. A comprehensive literature review was conducted to identify studies addressing mobility limitations, functional assessment tools, and associated outcomes in patients undergoing two-stage revision arthroplasty for PJI. Studies were included if they reported on clinical complications and psychosocial outcomes affected by the prolonged interstage period and mobility limitations. Patients undergoing two-stage revision often experience significant immobility lasting several months, which can be influenced by pain, soft-tissue compromise, and spacer type. Prolonged inactivity can contribute to muscle atrophy, joint stiffness, and impaired range of motion and is often associated with an increased risk of venous thromboembolism, pressure injuries, and bleeding complications related to extended thromboprophylaxis use. Psychologically, patients frequently report heightened anxiety and depression during the interstage period, compounded by uncertainty regarding infection eradication. Socially, patients have restricted independence, are dependent on caregivers, and have occupational disruption that further diminishes their overall quality of life (QoL). Current studies demonstrate wide variability in how mobility is assessed, hindering cross-study comparison and limiting targeted rehabilitation strategies. The interstage period of two-stage revision arthroplasty is a critical, yet understudied phase marked by significant physical, psychological, and social challenges that are not fully captured by traditional orthopedic patient-reported outcome measures . Standardized measurement of mobility is needed to assess the impact of limited mobility during the interstage period. Also, novel treatment approaches that shorten or eliminate the interstage period have the potential to mitigate complications, enhance functional recovery, and improve overall QoL for patients undergoing staged management of PJI.
Tenosynovial giant cell tumors (TGCT) are rare, locally aggressive neoplasms causing pain, stiffness, swelling, limited range of motion, and joint degeneration, which can be debilitating. Therapeutic options include surgery or systemic therapy with colony-stimulating factor 1 receptor (CSF-1R) pathway inhibitors. However, many are not amenable to surgery or have high postsurgical recurrence rates. Available systemic therapies require long-term administration and can have burdensome side effects. Emactuzumab is a novel, potent, CSF-1R inhibiting monoclonal antibody with a unique mechanism of action targeting the receptor dimerization interface of the CSF-1R to reduce tumor-associated macrophages and inflammation within the TGCT microenvironment. It is the only short-course, intravenous therapy in development for TGCT. In a phase I study, emactuzumab resulted in robust and durable responses, and a manageable safety profile in patients with TGCT, supporting further research as a treatment option to address unmet need and improve quality of life in patients with TGCT. TANGENT is a randomized, double-blind, global, phase III study (NCT05417789) to investigate the safety and efficacy of intravenous emactuzumab versus placebo in patients with TGCT not amenable to surgery.Clinical trial registration: www.clinicaltrials.gov identifier is NCT05417789 initially registered on 1 June 2022. What is this article about?The TANGENT trial examines a new treatment for tenosynovial giant cell tumors (TGCTs). TGCTs are rare tumors in the joints or tendon. TGCTs have two types, nodular (N-TGCT), which is typically a single tumor, and diffuse (D-TGCT), which spreads out more. TGCTs grow quickly and can cause joint damage, pain, stiffness, and decrease joint movement. Surgery is usually done to remove the tumor. However, surgery is not an option for all tumors and some tumors may return after surgery. Oral medications that target a pathway involved in TGCT development (CSF-1 inhibitors) are another treatment option. These are taken long term and can have side effects.Emactuzumab is a new treatment for TGCT given intravenously for 8-weeks. In an earlier study, patients treated with emactuzumab responded to treatment and side effects were manageable.What will the study look at?This article describes a trial looking at the safety and effectiveness of emactuzumab in patients with TGCT that cannot have surgery. The trial evaluates a short 8-week Intravenous treatment. If emactuzumab reduces tumor burden and improves function, it could become a new treatment for TGCT.
Fractures are a common cause of emergency department visits, and immobilization choice affects not only fracture healing but also comfort, hygiene, mobility, and quality of life. Conventional casting remains standard but is associated with limitations, including bulk, discomfort, and poor water tolerance. 3-Dimensional (3D)-printed, patient-specific immobilization may improve ventilation and functional tolerance while maintaining stability, but clinical evidence is still emerging and heterogeneous. This systematic review aims to evaluate the current clinical evidence on 3D-printed immobilization technologies versus traditional standard methods for fracture management in both pediatric and adult patients with respect to fracture healing, stability, pain, and functional recovery. A comprehensive search of PubMed, Scopus, and Web of Science databases was performed from database inception until November 2025 on the topic of evaluating 3D-printed technology to create casts, splints, or orthoses for upper-extremity fracture immobilization. Due to heterogeneity in design, interventions, and outcome reporting, results were synthesized narratively. Of 828 articles retrieved from the initial search, 581 studies were included for screening after removing duplicate articles, and underwent title and abstract screening, with 32 full-text studies assessed for eligibility. Thirteen studies met full inclusion criteria, while 19 studies were excluded. Twelve (n = 456) were included in the result analysis as they all focused on upper-extremity fractures, all of which had a moderate-to-high risk of bias. Fracture union was reported at or near 100% across studies. Patient satisfaction generally favored 3D-printed immobilization (10/11 studies), with a non-significant large, pooled effect (Hedges' g = 0.83; 95% CI = 0.21-1.88; p = 0.085; I2 = 77.5%). Pain showed a non-significant small-to-moderate benefit (g = 0.36; 95% CI = 1.94-2.66), and functional outcomes were similar between groups (g = 0.13; 95% CI = 1.02-1.28). Skin-related outcomes more often favored 3D-printed devices (7/9 studies), with reduced irritation and hygiene burden, while device weight was consistently lower, but cost and production time were higher. 3D-printed immobilization devices show comparable fracture healing and improved patient satisfaction and skin tolerability compared with conventional casting, with early functional advantages that are not consistently sustained long term. However, the evidence is limited by small sample sizes, short follow-up, moderate-to-high risk of bias, and substantial heterogeneity, resulting in low-to-moderate certainty. Larger, high-quality randomized trials with longer follow-up are needed to confirm these findings and inform clinical recommendations. Protocol registered prospectively in an international systematic review registry (PROSPERO) (registration number: CRD420251182244).
Ramp lesions are injuries of the peripheral meniscocapsular attachment of the posterior horn of the medial meniscus and are commonly associated with anterior cruciate ligament (ACL) tears. Failure to identify these lesions may compromise knee stability and outcomes after ACL reconstruction (ACLR). The primary objective of this study was to determine the prevalence of ramp lesions among patients undergoing primary ACLR at a tertiary center in Saudi Arabia. The secondary objective was to identify patient- and injury-related risk factors associated with ramp lesions. Retrospective cross-sectional study. This retrospective cross-sectional study included adult patients who underwent primary ACL reconstruction between November 2022 and December 2025. Patients with prior surgery, multiligamentous injuries (except MCL injuries), fractures, or incomplete records were excluded. Ramp lesions were identified intraoperatively. Demographic and clinical variables were analyzed using univariate logistic regression. Among 155 patients, ramp lesion prevalence was 3.9% (6/155). Older age and longer time from injury to surgery were significant predictors (p < 0.05). On continuous analysis, both age (OR = 1.151, 95% CI 1.024-1.294; p = 0.018) and time from injury to surgery (OR = 1.028, 95% CI 1.005-1.052; p = 0.017) remained significant. Sex, BMI, MCL injury, and lateral meniscal injury were not significantly associated. Our findings suggest that older age and longer time from injury to surgery are associated with the occurrence of ramp lesions. Future prospective studies should assess the prevalence of ramp lesions while minimizing information and observer bias and should investigate the interplay among knee morphometry, activity level, and biomechanical forces leading to ramp lesion development across diverse populations. The relatively low prevalence observed in this study may be related to diagnostic limitations, as ramp lesions are often missed when only standard anterior arthroscopic portals are used. Techniques such as posteromedial exploration or trans-notch visualization may improve detection. Differences in surgical technique and surgeon awareness may also influence identification, highlighting the need for systematic intraoperative evaluation.
Chronic ankle instability (CAI) is a prevalent consequence of lateral ankle sprain. Electromyographic (EMG) investigations examining neuromuscular control during unilateral landing tasks have produced inconsistent findings, particularly during the critical post-initialcontact (post-IC) phase. This systematic review and meta-analysis aimed to synthesize current evidence on post-IC muscle activation patterns in individuals with CAI during unilateral landing tasks. This PRISMA-compliant review (PROSPERO: CRD420261415793) searched PubMed, Scopus, and Web of Science from inception to June 2026. Cross-sectional studies comparing EMG activity between individuals with CAI and healthy controls during unilateral landing tasks were included. Study quality was assessed using Joanna Briggs Institute checklists; random-effects meta-analysis was performed with Comprehensive Meta-Analysis software, evaluating heterogeneity (I2, Q-test) and publication bias (Egger's test). Seventeen studies involving 757 participants met the inclusion criteria. Compared with healthy controls, individuals with CAI demonstrated significantly lower post-IC activation of the peroneus longus (p = 0.005), gluteus medius (p = 0.027), and biceps femoris (p = 0.010), alongside significantly greater activation of the soleus (p = 0.036) and rectus femoris (p = 0.013). No significant differences were observed for the tibialis anterior (p = 0.453), medial gastrocnemius (p = 0.552), or lateral gastrocnemius (p = 0.845). Substantial heterogeneity was identified for several muscles, particularly the peroneus longus, tibialis anterior, soleus, and rectus femoris (I2 = 76-90%). Subgroup analyses suggested potential sex-related differences in peroneus longus activation patterns. Individuals with CAI exhibit distinct neuromuscular alterations during the post-IC phase of unilateral landing tasks, characterized by reduced activation of key lateral ankle and proximal stabilizing muscles and increased activation of muscles associated with joint stiffening and impact attenuation. Rehabilitation strategies should extend beyond the ankle to target proximal muscle function and landing mechanics to optimize dynamic stability and reduce recurrent injury risk.
To compare functional, radiographic, and safety outcomes between internal brace (IB) augmentation and modified Broström-Gould (MBG) repair for chronic lateral ankle instability (CLAI), and to determine whether IB provides clinically relevant advantages over conventional anatomic repair. A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 and prospectively registered in PROSPERO. PubMed/MEDLINE, Embase, Cochrane CENTRAL, Web of Science, and Scopus were searched from inception to January 2026. Randomized controlled trials and observational studies comparing IB augmentation with MBG repair for CLAI were included. The primary outcome was the Foot and Ankle Ability Measure (FAAM) Sports score. Secondary outcomes included Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot & Ankle Society (AOFAS) score, return-to-sport time and rate, complications, recurrence, talar tilt angle (TTA), anterior talar translation (ATT), and operative time. Risk of bias was assessed using RoB 2 and ROBINS-I. Random-effects meta-analyses were performed. Thirteen comparative studies involving 1,015 patients (472 IB, 543 MBG) were included. IB was associated with a significant improvement in FAAM Sports score versus MBG (mean difference [MD] + 4.59; 95% confidence interval [CI] + 1.35 to + 7.82; I²=67.1%). After exclusion of a young female-specific cohort, the effect increased (MD + 6.06; 95% CI + 4.26 to + 7.86; I²=0%). Descriptively, IB patients returned to sport 4-8 weeks earlier than MBG patients across two studies; formal meta-analysis was not performed owing to the limited number of studies (k = 2). No significant between-group differences were observed for FAOS, AOFAS, return-to-sport rate, complications, recurrence, TTA, ATT, or operative time. IB augmentation was associated with better sports-specific function and earlier return to sport than MBG repair in patients with CLAI, without evidence of inferior radiographic or safety outcomes. These findings support IB as a useful surgical option, particularly for active patients in whom recovery trajectory and return to sport are important clinical priorities. This systematic review and meta-analysis was prospectively registered in PROSPERO (Registration No. CRD420261355719; registration date: 30 March 2026).
Osteosarcoma occurs most commonly during adolescence, a period of active skeletal growth. Beyond concerns regarding survival, patients and their families often worry that surgery, perioperative chemotherapy, and the physiological stress of treatment may adversely affect growth. Therefore, the purpose of this study was to evaluate growth patterns in the contralateral limb following treatment for high-grade osteosarcoma. Consecutive patients 14 years of age or younger treated for high-grade osteosarcoma of the distal femur or proximal tibia between 2012 and 2020, with a minimum follow-up of 5 years and contralateral limb MRI available, were retrospectively reviewed. Serial lower-extremity MRI was used to measure assess longitudinal and transverse skeletal growth. Growth trajectories were analyzed using linear mixed-effects models. Age- and sex-matched percentile curves were used to assess deviations from expected growth. Twenty patients (8 boys, 12 girls; mean age 11.7 ± 2.0 years) were analyzed. Continued contralateral femoral and tibial growth was observed in all patients until physeal closure, without premature growth arrest. Mean annual growth rates were 0.64 ± 0.47 cm/year and 0.41 ± 0.14 cm/year, respectively. Transverse skeletal growth remained proportionate. Nine of twenty patients (45%) demonstrated downward crossing of age- and sex-matched growth percentile bands during skeletal maturation. Pediatric osteosarcoma patients treated with surgery and systemic chemotherapy demonstrated continued growth of the contralateral lower limb without premature physeal closure or disproportionate transverse remodeling. However, downward shifts in growth percentile trajectories were observed, and their clinical significance warrants further investigation. Level of Evidence III, Retrospective cohort study.
Surgical site analgesic injections are used as part of multimodal analgesia in elective orthopedic surgery, but their effectiveness in orthopedic trauma surgery, particularly for distal extremity fractures, remains controversial. This meta-analysis aimed to assess the efficacy of peri-fracture site local analgesic injections on postoperative pain and opioid consumption after distal radius and ankle fracture surgery. A comprehensive search of PubMed, the Cochrane Library, and EMBASE was performed to identify randomized controlled trials assessing the efficacy of perifracture site injections for pain control after distal extremity fracture surgery. Pooled analyses compared postoperative pain intensity and total opioid consumption between the injection and control groups. Five randomized controlled trials comprising 390 participants were included. The pooled analysis showed that the injection group had significantly lower pain scores at 4 h postoperatively (SMD - 0.34; 95% CI - 0.56 to - 0.12; I2 = 37%). However, no significant differences in pain scores were observed between 8 and 48 h, with substantial heterogeneity at 8 and 24 h (8 h: SMD - 0.18; 95% CI - 0.78 to 0.42, I2 = 86%; 24 h: SMD - 0.23; 95% CI - 0.81 to 0.35, I2 = 85%). Total opioid consumption was significantly lower in the injection group (SMD - 0.29; 95% CI - 0.52 to - 0.07; I2 = 6%). Peri-fracture site injection for distal radius and ankle fractures provided significant analgesic efficacy confined to the early postoperative period, along with an overall reduction in opioid consumption. Further investigations are needed to establish optimal injection protocols and to determine whether this approach can provide more sustained postoperative pain relief. Registry number: CRD420251185330.
The aim of this study is to evaluate the clinical and radiological factors affecting the development of recurrent shoulder dislocation in patients who have been followed up with conservative treatment after the traumatic primary anterior shoulder dislocation (TPASD), and to identify patient subgroups at high risk of recurrence. Fifty-four patients (40 males and 14 females) aged 18-65 years who presented with first-time traumatic anterior shoulder dislocation and were treated conservatively were retrospectively evaluated. Patients with and without recurrent instability during a minimum follow-up of 12 months were compared regarding age, sex, affected side, Bankart lesion, bony Bankart lesion, greater tuberosity fracture, rotator cuff tear, Hill-Sachs lesion, Hill-Sachs lesion depth, glenoid version, and rotator interval width. Multivariable logistic regression analysis was performed to identify independent predictors of recurrent instability. The recurrence rate was 46.3% after a minimum follow-up of 12 months. Univariate analysis demonstrated significant associations between recurrent instability and younger age, male sex, the presence of bony Bankart lesions, the presence and depth of Hill-Sachs lesions, and the absence of rotator cuff tears. No significant differences were observed regarding affected side, Bankart lesions, greater tuberosity fractures, glenoid version, or rotator interval width. In multivariable logistic regression analysis, the presence of a Hill-Sachs lesion remained an independent predictor of recurrent instability (OR 7.88, 95% CI 1.77-35.08, p = 0.007). Recurrent instability following conservative treatment of first-time traumatic anterior shoulder dislocation is strongly associated with structural bone defects. Although younger age and male sex were associated with recurrence in univariate analyses, multivariable analysis identified the presence of a Hill-Sachs lesion as the strongest independent predictor of recurrent instability. Detailed radiological assessment may therefore facilitate risk stratification and treatment decision-making following TPASD.
Retrospective study. To investigate the association between endplate defects and patient-reported outcomes and to further clarify the role of lipotoxicity-induced EGFR/COX-2 signalling in the pathogenesis of low back pain. As the hub of intervertebral discs, the metabolic status of the endplate remains poorly characterized. Investigating metabolic stress conditions and downstream biological events in the endplate may provide insights into the pathological mechanisms of endplate defects and their association with patient-reported outcomes. Patients were classified into defect and non-defect groups based on radiographic evidence of endplate defects. Endplate cells were analyzed using lipidomics, transcriptomics, and functional assays. Outcome measures were compared between groups. Pearson's correlation was used to assess relationships among symptoms, immune-positive cells, and lipid content. Multivariate linear analysis evaluated the contribution of different variables to patient-reported symptoms. Preoperative VAS-Back scores (6.6 vs. 4.9, p < 0.01) and ODI scores (61.8 vs. 49.7%, p < 0.05) were significantly higher in the defect group compared to the non-defect group. Integrated analysis revealed that the defect group was characterized by lipid droplets accumulation in endplate cells and activation of the EGFR/COX2 signalling. In vivo animal studies confirmed that lipotoxicity induces endplate defects and activates EGFR/COX2 signalling. Preoperative VAS-Back and ODI scores showed positive correlations with EGFR expression (r = 0.403, p < 0.01; r = 0.466, p < 0.01) and relative lipid content (r = 0.432, p < 0.01; r = 0.358, p < 0.001) in the endplate cells. Multivariate linear analysis identified EGFR-positive cells (p = 0.010), relative triglyceride content (p = 0.049), and the presence of endplate defects (p = 0.046) as significant factors influencing preoperative VAS-Back pain. Patients with endplate defects reported severe symptoms and exhibited upregulation of the lipid droplet-EGFR/COX-2 pathway in endplate cells. Lipotoxicity-associated inflammatory factors significantly contribute to chronic low back pain and influence patient-reported outcomes.
Anterior cervical corpectomy and fusion (ACCF) is a commonly performed procedure for cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL), but the choice of reconstructive device after corpectomy remains unsettled. Titanium mesh cages (TMCs) and nanohydroxyapatite/polyamide-66 (n-HA/PA66) cages are both widely used in clinical practice, although subsidence and postoperative loss of cervical alignment remain important concerns. Three-dimensional printed artificial vertebral bodies (3DP-AVBs) have been introduced as an alternative reconstructive option. This study assessed the long-term radiographic and clinical outcomes of 3DP-AVB, n-HA/PA66, and TMC reconstruction after single-level ACCF. This retrospective cohort study included 101 patients with CSM or OPLL who underwent single-level ACCF at two centres. Reconstruction was performed using a 3DP-AVB (n = 33), an n-HA/PA66 cage (n = 34), or a TMC (n = 34). Clinical and radiographic data were reviewed with a minimum follow-up of 5 years. Radiographic outcomes included fusion status, subsidence, fused segment height (FSH), and cervical sagittal alignment. Clinical outcomes included the Visual Analog Scale (VAS), Japanese Orthopaedic Association (JOA) score, and Neck Disability Index (NDI). Complications and revision procedures were also recorded. At final follow-up, the 3DP-AVB group had less loss of FSH than the n-HA/PA66 and TMC groups (1.99 ± 0.73 vs. 2.80 ± 0.70 vs. 3.07 ± 0.81 mm; P < 0.001) and better preservation of cervical sagittal alignment (C2-7 Cobb angle, 19.47 ± 3.31° vs. 15.19 ± 3.25° vs. 15.75 ± 3.54°; P < 0.001). The unweighted subsidence rate was lower in the 3DP-AVB group (15.2% vs. 32.4% vs. 44.1%; P= 0.036), whereas IPTW-weighted analysis showed a numerically lower but nonsignificant trend (17.9% vs. 35.7% vs. 45.8%; P = 0.067). Fusion was achieved in all patients by 12 months. All three groups improved after surgery. Differences in JOA and NDI were observed at 3 months and remained significant at final follow-up (final JOA, 15.09 ± 1.28 vs. 13.59 ± 1.37 vs. 13.53 ± 1.44; final NDI, 10.03 ± 1.57 vs. 11.88 ± 1.45 vs. 11.88 ± 1.61; both  P < 0.001). VAS scores were similar among groups. In patients undergoing single-level ACCF, 3DP-AVB reconstruction was associated with better preservation of fused segment height and cervical sagittal alignment during long-term follow-up than n-HA/PA66 or TMC reconstruction. Although subsidence was less frequent in the 3DP-AVB group in the unweighted analysis, the IPTW-weighted comparison showed only a nonsignificant trend and should be interpreted cautiously. All three reconstructive methods achieved fusion and postoperative clinical improvement. Compared with the other two implants, 3DP-AVB may provide greater radiographic durability. Although JOA and NDI scores were statistically more favorable in the 3DP-AVB group, the clinical relevance of these differences should be interpreted cautiously.
Previous meta-analyses often lacked explicit time and included heterogeneous case types and surgical strategies. This led to substantial heterogeneity and limited the clinical applicability of these meta-analyses. This study focuses on evidence from the past 15 years, systematically comparing percutaneous pedicle screw fixation (PPSF) with open pedicle screw fixation (OPSF) for unstable traumatic thoracolumbar fractures (TTF). We aim to evaluate perioperative outcomes and radiographic correction based on contemporary practice. Randomized controlled trials (RCTs) published in English between January 2011 and January 2026 were retrieved from PubMed, Embase, the Cochrane Library, and the Web of Science Core Collection. Studies were screened using predefined inclusion and exclusion criteria. Six RCTs involving 305 patients were included, with 151 patients in the experimental group and 154 in the control group. Meta-analysis was performed using Review Manager 5.4. Mean difference (MD) was used as the effect size. Heterogeneity was assessed with the I2 statistic. Sensitivity analysis was used to identify the main source of heterogeneity. Publication bias was evaluated using Egger's test. The random-effects meta-analysis showed that the experimental group had significantly less intraoperative blood loss (MD = - 32.51 mL, 95% CI - 57.52 to - 7.51, P = 0.01), shorter postoperative hospital stay (MD = - 2.09 d, 95% CI - 3.89 to - 0.29, P = 0.02), and smaller postoperative Cobb angle (MD = - 1.06°, 95% CI - 1.67 to - 0.46, P < 0.001). There was no significant difference in operative time (MD = - 10.15 min, 95% CI - 28.75 to 8.46, P = 0.29) or postoperative vertebral wedging angle (MD = 0.25°, 95% CI - 1.73 to 2.24, P = 0.80) between groups. Sensitivity analyses identified the study by Yang et al. as the main source of heterogeneity for operative time. After excluding this study, the fixed-effects model showed a shorter operative time in the experimental group (MD = - 8.85 min, 95% CI - 12.74 to - 4.95, P < 0.001). Perioperative outcomes showed high heterogeneity, whereas radiographic outcomes showed low to moderate heterogeneity. Egger's test indicated no significant publication bias. Risk-of-bias assessment classified four RCTs as having a low risk of bias and two as having some concerns; no study was judged to have a high risk of bias. PPSF may offer perioperative advantages over OPSF in selected unstable traumatic thoracolumbar fractures, mainly by reducing visible intraoperative blood loss and shortening postoperative hospital stay. PPSF was also associated with a modestly smaller postoperative segmental Cobb angle, although its clinical relevance and long-term durability remain uncertain. The operative-time finding should be interpreted cautiously because it became significant only in exploratory sensitivity analysis.
Lumbar spinal stenosis is a common cause of pain and disability in older adults, increasingly treated with minimally invasive indirect decompression techniques such as standalone oblique lateral lumbar interbody fusion (OLIF), anterior lumbar interbody fusion (ALIF), and interspinous spacers. Although these three approaches are widely used for single-level disease, no randomized trials directly compare their clinical and radiological outcomes, and existing observational data have not been synthesized within a unified indirect decompression framework. Systematic review following PRISMA 2020 guidelines; searches of PubMed, Scopus, Cochrane CENTRAL, and ProQuest through November 2025. Eight observational studies (N = 465) comparing standalone OLIF, ALIF, or interspinous spacers for single-level LSS were included. Follow-up ranged from 1 week to 36 months. Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) at 12 and 24 months. radiological measures and reoperation rates. Risk of bias was assessed using ROBINS-I; evidence certainty via GRADE. This review was prospectively registered with PROSPERO (CRD42023411729). OLIF (3 studies, 102 participants) showed substantial 12-month ODI improvement (- 34.2 points; 95% CI: - 38.3 to - 30.1). ALIF (single 64-patient cohort) showed 24-month ODI improvement of - 37.4 points (95% CI: - 40.8 to - 34.0) with greatest lordosis correction (6.2°). Interspinous spacers (253 participants) achieved initial improvement that deteriorated by 24 months (ODI: - 16.8 points, below MCID threshold), with higher reoperation rates (7.5%) versus ALIF (3.1%) and OLIF (0% in limited data). All radiological parameters significantly favored fusion techniques (p < 0.001). Moderate-quality observational evidence suggests standalone OLIF and ALIF are associated with greater sustained functional improvement than interspinous spacers for single-level LSS beyond 12 months. However, the absence of randomized trials and potential selection bias in treatment allocation preclude definitive causal inferences. Interspinous spacers may be considered for carefully selected high-risk patients with explicit counseling regarding higher reoperation rates. Prospective randomized trials with standardized patient selection criteria are needed.
As the population ages, nursing homes are key end-of-life care settings, making high-quality palliative care essential for safeguarding older adults' quality of life. However, China currently lacks a unified and systematic tool for evaluating the quality of palliative care services in nursing homes. To develop a quality assessment index system for palliative care services tailored to Chinese nursing homes. The study employed a mixed-methods design with three phases: (1) a literature review (40 studies, 36 policy/guideline documents; 2013-2023) and semistructured interviews with stakeholders from 6 nursing homes; (2) three rounds of modified Delphi expert consultation (n = 31, 27, 23) to revise and refine the indicators; and (3) application of the analytic hierarchy process (AHP) to determine indicator weights. The final index system comprises 3 first-level, 22 second-level, and 47 third-level indicators. The expert authority coefficient (Cr) exceeded 0.85 across all consultation rounds. Expert consensus increased with each round (Kendall's W: 0.189 to 0.315, p < 0.05). AHP results indicated that among the first-level indicators, "process" had the highest weight (0.4114), followed by "structure" (0.3208) and "outcome" (0.2678). Within these dimensions, the highest weighted second-level indicators were "human resources planning and management" (0.0836), "comfort care services" (0.0861), and "quality of symptom management" (0.0438). Furthermore, key third-level indicators included "financial support and management" (0.0632), "basic nursing services" (0.0465), and "quality of symptom assessment and management" (0.0438). This study developed a scientifically grounded quality assessment index system for palliative care services in Chinese nursing homes, which offers a preliminary framework for institutional self-evaluation and quality improvement efforts pending further empirical validation. Once empirically validated, the framework may assist managers and staff in nursing homes to identify service gaps, optimize resource allocation, and support a shift toward an "older adult-centered" holistic care model.
Displaced intra-articular calcaneal fractures (DIACFs) pose substantial challenges due to their complex three-dimensional deformity and the high risk of soft tissue complications. Minimally invasive percutaneous methods and subtalar arthroscopy have emerged to mitigate soft tissue injury, but their limited exposure often hinders reliable reduction of the medial wall. To address these limitations, we developed a novel MAP strategy (Medial wall/Arthroscopy/Posterior facet) that prioritizes a medial-to-lateral sequence to achieve effective and stable reduction. This retrospective analysis included 180 cases of unilateral DIACFs treated between 2022 and 2024. Patients were classified into three groups based on the surgical treatment as follows: arthroscopy-assisted percutaneous screw fixation (MAP, 40 cases), percutaneous screw fixation (PF, 49 cases), and open reduction and internal fixation (ORIF, 91 cases). Outcomes were assessed at 12 months postoperatively, including complications, radiographs, and functional scores using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot score, visual analog scale (VAS) and Maryland Foot Score. The MAP group exhibited the longest surgical duration (80.0 [70.0, 90.0] min) but had the shortest hospital stay (5.0 [4.0, 6.0] days). The ORIF group experienced a longer preoperative delay (6.0 [6.0, 7.0] days) and had a significantly higher overall complication rate compared to the MAP and PF groups (31.9% vs. 15.0% and 14.3%, p = 0.027). At the 12-month postoperative follow-up, the MAP group demonstrated significantly greater AOFAS scores (84.50 [78.25, 86.00]) compared to the PF group (80.00 [75.00, 84.00], p = 0.029) and the ORIF group (81.00 [74.00, 86.00], p = 0.021). The VAS pain score in the MAP group (2.00 [1.25, 3.00]) was significantly lower than that in the ORIF group (3.00 [2.00, 3.00], p = 0.009). Regarding radiographic assessments, all three groups demonstrated satisfactory postoperative restoration in Böhler's angle, calcaneal height, and calcaneal width compared to preoperative baselines, with no significant intergroup differences observed. In this retrospective cohort study, the MAP strategy was associated with favourable short-term functional outcomes and a low rate of soft-tissue complications in DIACFs.