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Info — Since early 2025, Acta Orthopaedica has served as the official publisher of the International Society of Arthroplasty Registries (ISAR) congresses. Founded in 2005, ISAR (https://www.isarhome.org) is a global organization comprising national, regional, and institutional joint replacement registries. Its mission is to improve outcomes for patients undergoing joint replacement surgery worldwide. Since 2012, ISAR has organized annual congresses featuring register-based research. Following the 14th International Congress of Arthroplasty Registries, held in Christchurch, New Zealand, presenters were invited to submit their work to Acta Orthopaedica. Over the past year, this initiative has resulted in 13 publications covering a broad range of topics. This partnership has been extended, looking ahead to the 15th congress held in Lund May 30 to June 1, 2026. Presenters at the Lund Congress are welcomed to submit their studies to Acta Orthopaedic with a deadline of October 1, 2026.

RCTs are a key block in the evidence pyramid, but their quality relies on detailed, consistent reporting, and one best-practice standard is prospective registration. Prospective trial registration was intended to reduce publication bias, and adherence to a prespecified protocol helps limit bias from selective reporting; any protocol or end point changes should be transparently documented and justified. However, the degree to which articles published in the leading journals on orthopaedic surgery comply with this best-practice standard has, to our knowledge, not been evaluated. (1) Do RCTs published in leading, general-interest orthopaedic surgery journals comply with best practices regarding prospective clinical trial registration? (2) Do major discrepancies exist between registered protocols and published orthopaedic RCTs? (3) Are there specific study types that are more likely to demonstrate discrepancies? A review was performed on RCTs published in the top five general-interest orthopaedic surgery journals, based on the 2022 scientific journal rankings (from SciMago): Journal of Bone and Joint Surgery, Bone and Joint Journal, Clinical Orthopaedics and Related Research&#xae;, Journal of the American Academy of Orthopaedic Surgeons (JAAOS), and Acta Orthopaedica. During the study period, all journals maintained editorial policies requiring prospective clinical trial registration as a condition of consideration for publication except for JAAOS. A systematic search on PubMed retrieved 705 potential publications, of which 324 RCTs fulfilled the inclusion criteria. For each trial, nine essential elements from the 24-item WHO minimum data set were extracted and compared between the published article and its trial registry entry, focusing on health condition, intervention, sample size, outcomes, and eligibility criteria. To answer our first question regarding compliance, we audited each article to identify the presence of a registry code. For our second question, we performed a side-by-side comparison of nine essential elements from the WHO trial registration data set (including primary outcomes, sample size, and eligibility criteria) to identify discrepancies between the registry and the final publication. Finally, to address our third question, we used chi-square tests to determine whether study characteristics, such as country of origin or subspecialty, were associated with higher rates of reporting shifts. Most orthopaedic RCTs published in leading journals complied with registration standards, with 95% (309 of 324) having an identifiable registry entry. However, 2% (8 of 324) were published without any registry identifier or justification for its absence, and 2% (7 of 324) were identified as long-term follow-up visits that did not have unique prospective entries. Major discrepancies between registered protocols and published manuscripts were frequent. Discrepancies in the sample size occurred in 33% (102 of 309) of trials. Discrepancies in the primary outcome occurred in 25% (78 of 309) of trials. Discrepancies in the secondary outcome occurred in 60% (185 of 309) of trials. Discrepancies in the inclusion criteria occurred in 33% (102 of 309) of trials. Discrepancies in the exclusion criteria occurred in 53% (165 of 309) of trials. Trials conducted in the United States or as multicenter international collaborations were more likely to update their final results in the registry compared with single-country trials conducted outside the US (37% versus 10%; p < 0.001). No other study characteristics, including publication year or subspecialty, were associated with the presence of reporting discrepancies. Prospective registration has become the standard for RCTs in high-impact orthopaedic journals. However, our findings suggest that a gap still exists between having a registry and the accuracy of the information contained within it. These findings suggest that registration is often treated as a procedural requirement rather than a rigorous commitment to a fixed study protocol. The orthopaedic research community should adopt stricter standards for trial registration, reporting, and verification of registry entries to reduce undisclosed protocol changes and improve confidence in published evidence.

Despite growing interest, artificial intelligence (AI) applications in shoulder and elbow surgery remain underdeveloped. While adoption is accelerating and shows promise in addressing complex clinical problems, substantial technical and clinical barriers persist. Collaborative research may be relevant for generating high-quality datasets and more robust, generalizable, and clinically relevant algorithms. This study aimed to 1) analyze trends in AI research productivity and impact, 2) map collaboration patterns among affiliations and regions, and 3) assess the relationship between affiliation-based collaboration and research outcomes. We conducted a bibliometric analysis of Scopus-indexed articles published between January 2000 and November 2024, focusing on peer-reviewed studies involving AI applications in shoulder or elbow surgery. Data collected included number of publications, citation metrics, author affiliations, and index keywords. These variables were used to calculate composite metrics and to examine the geographic distribution of research and collaboration patterns using network analysis. Two linear regression models assessed the relationship between affiliation-based collaborations and publication volume and citation impact. Of 181 identified scholarly documents, 119 met eligibility criteria. These articles were published across 63 journals and cited a total of 1,519 times. The Journal of Shoulder and Elbow Surgery contributed the highest number of articles (n = 20), while Acta Orthopaedica had the highest average citations per article (n = 310), although in a single article. The annual publication rate increased rapidly after 2014, peaking at 49 in 2024. A small group of affiliations disproportionately influenced output and citations. Collaboration networks were sparse (density 0.03) yet showed distinct geographic clusters. Most research output originated from the United States (48%), followed by South Korea (12%) and China (8%). A total of 1,010 collaborations were identified among 260 affiliations. The network showed low density (0.03) but high modularity (0.81), indicating sparse overall connectivity yet tightly clustered communities. Regression models indicated that each additional collaboration established between affiliations was associated with 5 more publications (R2 = 1.0) and increased average citations per article by 0.2 (R2 = 0.77). Affiliation-based collaboration was strongly associated with both the volume and citation impact of AI research in shoulder and elbow surgery. Strengthening and expanding these networks may enhance global research participation, foster innovation, and improve the clinical applicability of future work.

Transparent and complete reporting is essential to the credibility and utility of health research, yet the quality of such reporting remains inconsistent. Also, in osteoarthritis (OA) research, poor reporting undermines reproducibility, synthesis, and translation into practice and policy. Therefore, clear and accurate reporting is not merely a bureaucratic exercise but foundational because it establishes trust and confidence in the reported outcomes. This editorial emphasizes the ultimate importance of adopting reporting guidelines developed by the Enhancing the Quality and Transparency of Health Research (EQUATOR) Network. Such guidelines include CONSORT for randomized trials, STROBE for observational studies, PRISMA for systematic reviews, and SPIRIT for protocols. Altogether, these helpful tools provide structured frameworks that enhance clarity, rigor, and reproducibility across study designs. We also adapt the concept of "value streams" from lean management as a metaphor for scientific reporting: each checklist item coherently contributes incremental value within a logical, unidirectional flow that transforms research into coherent and trustworthy publications. Early adoption of these value streams and reporting guidelines by authors-and their integration into the publishing process, including reviewer training-will strengthen the quality, relevance, and long-term value of OA research and help ensure that reporting frameworks are truly transparent and accessible.

The purpose of this study was to define the prevalence of os acromiale on magnetic resonance imaging (MRI) in patients presenting with shoulder pain, to document how often it coexists with rotator cuff tears, and to assess whether focused review detects this variant more reliably than routine radiology reporting.&#xa0; Methods: A retrospective review was conducted on 3697 shoulder MRI examinations obtained between 2020 and 2025 at a tertiary referral center. All studies were independently evaluated by 2 fellowship-trained shoulder surgeons and 1 musculoskeletal radiologist, focusing specifically on the presence, subtype, and coexistence of os acromiale with rotator cuff pathology. Interobserver reliability was assessed using Cohen's kappa coefficient, and findings were compared with the original radiology reports.&#xa0; Results: Os acromiale was identified in 26 cases, corresponding to a prevalence of 0.7%. Only 11 cases were mentioned in the original radiology reports. Interobserver agreement between shoulder surgeons was almost perfect (&#x3ba; = 0.98) and excellent between surgeons and the radiologist (&#x3ba; = 0.92). Subtypes included 12 preacromion, 13 mesoacromion, and 1 metaacromion. Rotator cuff tears were present in 20 of 26 patients with os acromiale (77%), including isolated supraspinatus tears (n = 9), combined supraspinatus-infraspinatus tears (n = 4), supraspinatus-subscapularis tears (n = 3), massive tears (n = 2), and cuff tear arthropathy (n = 2).&#xa0; Conclusion: Os acromiale was uncommon in this MRI-based cohort but frequently coexisted with full-thickness rotator cuff tears. Although causality cannot be inferred, this coexistence may carry clinical relevance. Notably, focused evaluation documented more cases than routine radiology reports, underscoring the added value of targeted assessment.&#xa0; &#xa0; &#xa0; &#xa0;Cite this article as: Birsel O, Y&#x131;&#x11f;man GT, G&#xfc;nerb&#xfc;y&#xfc;k C, Ba&#x15f; A, Chodza M, Eren &#x130;. Prevalence of os acromiale and concomitant rotator cuff tears: a focused assessment of 3697 shoulder magnetic resonance imagings. Acta Orthop Traumatol Turc. 2026; 60(1), 0714P doi: 10.5152/j.aott.2026.25714.

Total hip replacement is a successful operation that aims to restore function and quality of life to millions of people globally. Knowing how long a total hip replacement might last is important for patients, surgeons, and health-care institutions for planning and resource allocation. Over the past 20 years, the use of contemporary bearing surfaces for total hip replacement has substantially altered implant wear and, possibly, longevity. To date, there has been no large-scale study that examines survivorship of these modern implants. We aimed to determine the survivorship of contemporary total hip replacements and bearing materials. We focused solely on the assessment of modern bearing surfaces: highly cross-linked polyethylene versus metal or third-generation and fourth-generation ceramic heads and ceramic-on-ceramic primary total hip replacement in adult patients. We conducted a search of MEDLINE and Embase from database inception to June 13, 2024, including articles that reported a minimum of 10 years of survivorship, irrespective of fixation method or surgical approach. We then conducted a meta-analysis combining data from eight national joint registries assessing all-cause revision within the various bearing combinations. We extrapolated the extracted data to estimate survivorship to 30 years, using the multivariable random-effects model from the registry data. The primary outcome was survivorship of the hip replacement, defined as time from primary total hip replacement to first all-cause revision, expressed as a percentage of unrevised implants at specific timepoints. This study is registered with PROSPERO (CRD42024572518). We identified 1&#x2008;904&#x2008;237 total hip arthroplasties across 29 clinical studies (n=5203) and eight national joint registries (n=1&#x2008;899&#x2008;034). Pooled analysis of the included studies showed an all-cause implant survivorship of 0&#xb7;97 (0&#xb7;96-0&#xb7;98) under the random-effects model. Survivorship estimate based on joint registry data was at 93&#xb7;6% (95% CI 92&#xb7;3-94&#xb7;7) at 20 years. Extrapolating these data indicates a predicted survivorship of 92&#xb7;8% (91&#xb7;2-94&#xb7;2) at 25 years and 92&#xb7;1% (90&#xb7;1- 93&#xb7;7) at 30 years. The estimated 92% 30-year survivorship of contemporary total hip replacement suggests that advances in bearing surface technology have greatly improved the long-term durability of total hip replacements and might influence patient counselling, health-care planning, and device regulation. None.

The resistance to gap development under repetitive loading influences the probability of meniscal healing after meniscal repair. The optimal meniscal suture interval spacing for repairing longitudinal meniscal tears is poorly understood. This study aimed to investigate the effect of varying suture interval spacings on the biomechanical properties of vertical meniscal repairs. There is a critical meniscal suture interval spacing beyond which the gap development during cycling loading increases and the stiffness of the construct decreases. Controlled laboratory study. In 50 bovine menisci, complete vertical circumferential meniscal tears were created. All lesions were repaired using two 2-0 braided sutures with the vertical mattress inside-out technique. Five suture spacings (3, 5, 7, 9, and 11 mm) with 10 samples each were tested. Each sample underwent 1000 loading cycles between 5 and 20 N (combined load) at a 75-mm/min crosshead speed and subsequent load-to-failure testing. The tear opening gap between the 2 meniscal sutures was measured using the Digital Image Correlation system with 2 high-speed cameras after 10, 100, 500, and 1000 cycles. Gap formation, cyclic stiffness, and failure modes were measured. A 1-way analysis of variance with post hoc t testing with Bonferroni correction for significant pairwise analysis of all outcome variables was performed. Statistical significance was set at a P value <.05. Meniscal repairs with suture interval spacings of 3 mm, 5 mm, and 7 mm demonstrated statistically significantly smaller gap formation-a mean of 36% less-compared with spacings of 9 mm and 11 mm. There were no significant differences in gap formation between the suture interval spacings of 3 mm, 5 mm, and 7 mm. Construct stiffness was significantly higher with a suture interval spacing of 7 mm and less compared with &#x2265;9 mm (all P < .05). No significant differences in construct stiffness were observed among the 3-mm, 5-mm, and 7-mm suture intervals. Suture breakage occurred in 76% of cases (38/50), suture cut-through in 22% (11/50), and a combination of both in 2% (1/50). Failure mode did not correlate with suture distance. Meniscal repair with a suture interval spacing of &#x2264;7 mm demonstrates significantly lower gap formation and higher construct stiffness during cyclic loading than interval spacings of >7 mm. Based on these biomechanical data, surgeons should consider a &#x2264;7-mm suture interval spacing for vertical mattress meniscal repair of longitudinal tears. On the basis of this biomechanical data, surgeons should consider a &#x2264;7-mm suture interval spacing for vertical mattress meniscal repair of longitudinal tears.

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The aim of this study was to investigate patient safety, defined using in-hospital complications, early readmissions, mortality, and days alive and at home (DAH), after day-case and non-day-case hip and knee arthroplasty in a public healthcare setting. This multicentre cohort study included consecutive patients who underwent primary total hip arthroplasty (THA), total knee arthroplasty (TKA), or unicompartmental knee arthroplasty (UKA) between September 2022 and May 2024. All eight public hospitals which were involved followed the same standardized protocol with consistent eligibility for day-case surgery and discharge criteria. Postoperative hospital contacts within 30 days were recorded using the patients' medical records and electronic questionnaires. Day-case surgery was defined as discharge on the day of surgery to the patient's own home. A total of 12,607 patients were included, of whom 3,159 (25%) were day-case and 9,430 (75%) were non-day-case patients. The mean length of hospital stay (LOS) was one day (0 to 70); 5% of patients (95% CI 4.9 to 5.5) had a LOS of > two days, primarily due to mobilization issues (1.4%) and pain (1.3%). The overall readmission rate was 0.5% (95% CI 0.4 to 0.7) within 48 hours and 4.4% (95% CI 4.1 to 4.8%) within 30 days. Readmission rates were 0.7% (95% CI 0.5 to 1.1) and 1.9% (95% CI 1.5 to 2.5) for day-case patients, and 0.5% (95% CI 0.3 to 0.6) and 5.3% (95% CI 4.8 to 5.8) for non-day-case patients within 48 hours and 30 days, respectively. When stratified by the type of surgery, there were only minor variations. No patients died within 48 hours, and the overall 30-day mortality was 0.08% (n = 10), with no deaths among day-case patients. The median DAH30 was 30 (IQR 30 to 30) for day-case patients and 29 (IQR 29 to 29) for non-day-case patients. These findings indicate that fast-track surgery with a one-day LOS and a 25% day-case rate in a national, publicly funded healthcare system is safe, based on low rates of in-hospital complications, early readmission, mortality, and a high DAH30.

To evaluate short-term anterior cruciate ligament (ACL) graft maturity in skeletally immature patients undergoing ACL reconstruction (ACLR) with physeal-sparing over-the-top (OTT) technique using hamstring tendon (HT) autograft with preserved tibial insertion, and to compare the results with adult patients operated using an OTT technique with similar features. Skeletally immature patients who underwent primary ACLR with OTT between February 2022 and January 2025 with post-operative Magnetic Resonance Imaging (MRI) performed between 10 weeks and 6 months were retrospectively reviewed. Graft maturation was evaluated via the Howell grading system and ACL signal/noise quotient (SNQ) on MRI. Additionally, graft continuity, tunnel widening, fluid collection within the graft, and bone oedema of the tibial tunnel wall were assessed. Skeletally immature patients were propensity-matched at a 1:1 ratio to adult patients, and comparisons were performed. A total of 22 skeletally immature patients (average skeletal age 12.9&#x2009;&#xb1;&#x2009;2.3 years) out of 79 patients were included. MRI assessment of graft maturity was performed at an average of 4.0&#x2009;&#xb1;&#x2009;1.3 months postoperatively. All patients presented graft continuity, with Grade I or II Howell grade in 86% of cases. For the comparative analysis, a subset of 10 skeletally immature patients (those with a tibial tunnel) was matched with 10 adult patients (90% males, mean age 25.9&#x2009;&#xb1;&#x2009;10.0 years) who underwent MRI 4.0&#x2009;&#xb1;&#x2009;1.2 and 18.0&#x2009;&#xb1;&#x2009;2.1 months after surgery. No significant differences were reported for all individual items, such as the Howell graft score, SNQ, and tunnel features, between skeletally immature and adult patients at the 4-month assessment (p&#x2009;>&#x2009;0.05). ACLR with OTT technique via HT autograft with preserved tibial insertion may provide satisfactory ligamentization in skeletally immature patients. Graft maturity was comparable to that of the adult population. These data suggest that graft maturation using this specific surgical approach is satisfactory in skeletally immature patients and is comparable to adults. Level IV, retrospective study.

The aim of this study was to compare in vivo and ex vivo Photon Counting CT (PCCT) of subchondral bone features in patients with knee osteoarthritis (KOA). Pre-surgery in vivo and post-surgery ex vivo PCCT of the tibial plateau from participants with severe KOA referred to arthroplasty surgery from January 2022 through September 2023 were compared. Linear regression and Bland-Altman plots were used to assess correlation and agreement between in vivo and ex vivo measures of bone volume fraction (BV/TV), trabecular thickness (Tb.Th.) and attenuation in healthy and sclerotic trabecular bone. Delineated areas of bone sclerosis were compared using the Dice coefficient and Hausdorff distance. 18 in vivo/ex vivo PCCT scans were included. Strong correlations were found for BV/TV, R2&#x2009;=&#x2009;0.82 and attenuation; healthy, R2&#x2009;=&#x2009;0.89, and sclerotic, R2&#x2009;=&#x2009;0.79, bone, while a moderate correlation was found for Tb.Th., R2&#x2009;=&#x2009;0.55. Bias for BV/TV and Tb.Th. was -4.1% and -0.598&#x2009;mm, respectively, and -41.4 HU and -81.1 HU for healthy and sclerotic bone, respectively. A proportional bias was observed for Tb.Th. and BV/TV. There was excellent agreement between the segmentations of sclerotic areas (Dice coefficient&#x2009;=&#x2009;0.91, Hausdorff distance&#x2009;=&#x2009;0.11&#x2009;mm). In patients with severe KOA, BV/TV and attenuation can be obtained with a high correlation and small bias between in vivo and ex vivo scans, while Tb.Th. showed moderate correlation and larger bias. Longitudinal studies using in vivo PCCT are feasible, but caution may be advised when measuring Tb.Th. The key OA feature of subchondral bone sclerosis is well translated from ex vivo to in vivo PCCT. Question Bone changes occur with osteoarthritis development; the role of these changes is unclear, and no method for visualising bone microstructure in vivo exists. Findings Photon-counting CT showed a strong correlation between in vivo and ex vivo subchondral density measures, while a moderate correlation was found for trabecular thickness. Clinical relevance Photon-counting CT is feasible for in vivo longitudinal evaluation of bone in patients with knee osteoarthritis, allowing studies into the earlier stages of the disease.

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The Masquelet technique is a 2-stage surgical method used for the reconstruction of critically sized bone defects due to various etiologies. Estrogen is known to have anabolic effects on bone metabolism. In this study, based on literature data, the aim is to systematically evaluate the histological and immunohistochemical effects of adding different doses of estrogen to polymethylmethacrylate cement on induced membrane tissue.&#xa0; Methods: Twenty-eight male rats were included in the study and divided into 4 groups. Three experimental groups received different doses of estradiol, a subtype of estrogen mixed with bone cement, while a control group received only bone cement. Approximately 10 mm defects were created in single femurs of all rats. Bone cement appropriate for each experimental group was placed in these defects, and bone fixation was performed with mini plates and screws. Tissue samples taken from all animals at the end of the sixth week were evaluated by histological and immunohistochemical methods.&#xa0; Results: Histological and immunohistochemical evaluations of the induced membranes obtained at the end of the experiment revealed signs of bone formation in all subgroups. A significant increase in bone formation was observed with increasing doses in groups E1, E2, and E3 compared to the control group (P < .05). The histological scores of the study groups were found to increase statistically significantly with increasing estrogen dose (P < .05). Furthermore, immunohistochemical analyses revealed that the immuno-reactive scores for bone morphogenetic protein-4 and insulin-like growth factor-1 expression were significantly higher in the E3 group compared to the other groups (P < .05).&#xa0; Conclusion: In this study, it was found that enriching the cement content with estrogen during bone cement placement, the first step of the Masquelet technique, improved the quality of the formed membrane. This improvement in membrane quality is promising for increasing treatment efficacy and shortening the treatment duration.&#xa0; &#xa0; Cite this article as: &#xc7;ift&#xe7;i MU, Purelku M, &#xd6;z&#xf6;nder F, et al. Dose-dependent effects of estrogen-enriched bone cement on membrane quality in the masquelet technique: experimental rat model. Acta Orthop Traumatol Turc., 2026; 60(1), 0355, doi: 10.5152/j.aott.2026.25355.