Int Orthop. 2025 Mar 5. doi: 10.1007/s00264-025-06469-5. Online ahead of print.

ABSTRACT

PURPOSE: Tunnel syndromes around the foot and ankle are underrecognized and frequently misdiagnosed nerve entrapments that can significantly impact patients' quality of life. This review aims to provide a comprehensive overview of the etiology, clinical presentation, diagnostic challenges, and management strategies for these syndromes, focusing on the sural nerve, deep peroneal nerve, tibial nerve, medial plantar nerve, and inferior calcaneal nerve.

METHODS: A thorough literature review was conducted, examining studies and case reports on nerve entrapments in the foot and ankle. The review covers the clinical assessment, differential diagnosis, and treatment options, including conservative and surgical interventions.

RESULTS: Tunnel syndromes of the foot and ankle can arise from various causes, including trauma, anatomical variations, repetitive strain, and systemic conditions. Clinical manifestations often include burning pain, tingling, and motor weakness, depending on the affected nerve. Accurate diagnosis relies on a detailed patient history, physical examination, and adjunctive tests such as electrodiagnostic and imaging. Conservative treatments, such as physical therapy, orthotics, and corticosteroid injections, are often effective, while surgical decompression is reserved for refractory cases.

CONCLUSIONS: Recognizing and diagnosing tunnel syndromes in the foot and ankle is essential for effective management and preventing permanent nerve damage. A systematic approach that integrates clinical evaluation and appropriate imaging can improve patient outcomes. Timely intervention, whether conservative or surgical, is crucial for alleviating symptoms and restoring function.

PMID:40042611 | DOI:10.1007/s00264-025-06469-5

Int Orthop. 2025 Mar 5. doi: 10.1007/s00264-025-06451-1. Online ahead of print.

ABSTRACT

PURPOSE: While robotic-assisted total knee arthroplasty (RA-TKA) has demonstrated improved surgical precision, its impact on early postoperative pain management remains unclear. This study compared early postoperative pain outcomes between RA-TKA and conventional TKA (C-TKA).

METHODS: In this retrospective study, 230 consecutive patients (309 knees) who underwent primary TKA were analyzed: 143 patients (181 knees) in the C-TKA group and 87 patients (128 knees) in the RA-TKA group. Pain scores at rest and during movement were assessed using the Numerical Pain Rating Scale for 72 h postoperatively. Secondary outcomes included opioid consumption and length of hospital stay.

RESULTS: While pain scores at rest showed no significant differences between groups, RA-TKA patients reported significantly lower pain scores during movement at 24 h post-surgery (p = 0.023). The RA-TKA group demonstrated significantly reduced opioid consumption during the first 48 postoperative hours (p = 0.001 for 0-24 h; p = 0.03 for 24-48 h) and shorter length of hospital stay (p = 0.011). Subgroup analysis of unilateral procedures showed similar advantages in the RA-TKA group.

CONCLUSION: RA-TKA was associated with reduced pain during movement, decreased opioid consumption, and shorter hospital stay in the early postoperative period compared to C-TKA.

PMID:40042610 | DOI:10.1007/s00264-025-06451-1

Int Orthop. 2025 Mar 4. doi: 10.1007/s00264-025-06464-w. Online ahead of print.

ABSTRACT

PURPOSE: Medializing displacement calcaneal osteotomies are part of conservative surgical treatments and represent a reliable option in valgus flatfoot deformities. Favorable short-term results of this procedure is well-known. However, there are few series with follow-up beyond five years. This study reports the clinical outcomes of calcaneal medialization osteotomy with a minimum follow-up of five years. The primary objective was to compare functional scores and radiographic measurements at the preoperative stage, immediately post operative, and at the final follow-up.

MATERIALS AND METHODS: This was a retrospective, single-centre, multi-operator study of 32 patients, who underwent a medialization calcaneal osteotomy for type II flatfoot. Clinical evaluation of the patients was conducted using the American Orthopaedic Foot and Ankle Surgery (AOFAS) score and the European Foot and Ankle Society (EFAS) score. Radiographic evaluation used the plantar arch angle angle, the talus-first metatarsal axis (T-M1) on lateral weight-bearing radiographs, and calcaneal valgus on Meary's angle in a hindfoot alignment view.

RESULTS: Mean follow-up was seven years. AOFAS score improved from 46 to 87 and EFAS score from 11 to 20 (p < 0.05). Each radiographic parameter was significantly modified between the preoperative and immediate postoperative periods.

CONCLUSION: We observed a significant and lasting improvement in functional scores at a mean follow-up of seven years. The correction of the evaluated radiographic parameters was significant and remained stable over time.

PMID:40035852 | DOI:10.1007/s00264-025-06464-w

Int Orthop. 2025 Mar 3. doi: 10.1007/s00264-025-06461-z. Online ahead of print.

ABSTRACT

PURPOSE: Groin pain in athletes, particularly inguinal-related groin pain, remains a diagnostic and therapeutic challenge despite recent consensus on terminology. This study aims to explore nerve disorders as a key contributor to groin pain in athletes, focusing on the anatomy, aetiology, diagnosis, and management options.

METHODS: A comprehensive review of the literature was conducted, focusing on the anatomical variability of the ilioinguinal, iliohypogastric, and genital branch of the genitofemoral nerves, clinical presentations, diagnostic methods, and conservative and surgical treatments for nerve-related inguinal pain. Key studies on nerve entrapment, neuropathic and nociceptive pain mechanisms, and surgical outcomes were analyzed.

RESULTS: Variability in nerve pathways and sensory overlap complicate diagnosis and management. Neuropathic pain often presents with burning or electric sensations due to nerve compression or entrapment, while nociceptive pain manifests as dull or stabbing pain. Conservative treatment, including exercise-based rehabilitation and nerve blocks, offers relief in many cases. For refractory cases, surgical treatment can provide significant pain resolution, with nerve identification and potential neurectomy improving outcomes.

CONCLUSION: Nerve disorders play a critical role in inguinal-related groin pain in athletes. Accurate diagnosis relies on detailed clinical examination and targeted imaging. Conservative treatments are first line, but surgical interventions addressing nerve entrapment or compression are effective for persistent cases. Future research should focus on the role of collagen deficiencies, nerve histopathology, and long-term outcomes of different treatment modalities.

PMID:40032740 | DOI:10.1007/s00264-025-06461-z

Int Orthop. 2025 Mar 1. doi: 10.1007/s00264-025-06458-8. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to evaluate the outcomes of scaphocapitate arthrodesis with lunate excision in patients with stage IIIB and IIIC Kienböck's disease.

METHOD: Between September 2013 and April 2024, 106 consecutive patients were screened, with 64 consenting to participate. Final analysis included 56 patients (32 stage IIIB and 24 stage IIIC) who underwent scaphocapitate arthrodesis with lunate excision, utilizing distal radius bone grafting stabilized by Herbert compression screws. Preoperative and postoperative assessments (6, 18, 36, and 84 months) included VAS score for pain, ROM, grip strength, MMWS, PRWE scores, and radiographic evaluations including RS angle, CHR, CUDR, and ulnar variance.

RESULTS: The mean operative time was 75 ± 11 min, and the average follow-up was 86 ± 2.5 months. The union rate was 91% with a mean time to union of 10 ± 2 weeks. Preoperative mean VAS scores (63 ± 4 mm) significantly decreased to 25 ± 9 mm at 6 months and 12 ± 4 mm at 36 months (p = 0.001), with a slight increase to 22 ± 5 mm at 84 months. ROM improved from 46% ± 9% of the healthy side preoperatively to 59% ± 3.2% at 36 months (p = 0.001) but slightly decreased to 58% ± 3% at 84 months. Grip strength improved from 48% ± 8% preoperatively to 89% ± 6.4% at 36 months (p = 0.001) and remained stable at 88% ± 4% at 84 months. The mean MMWS increased from 46 ± 7 to 75 ± 5 (p = 0.001), while PRWE scores decreased from 68 ± 8 to 23 ± 6 (p = 0.001). The mean RS angle decreased from 59° ± 8° preoperatively to 50° ± 3° at 36 months (p = 0.001). There was no significant change in CHR (0.44 ± 0.04 to 0.46 ± 0.03, p = 0.251), while CUDR decreased from 31 ± 3 mm to 25 ± 2 mm (p = 0.021). Ulnar variance remained stable (p = 0.325). Degenerative changes were noted in 13 patients (23%) at the RS joint, with six showing Grade I, 5 Grade II, and 1 Grade III degeneration. Additionally, 5 patients (9%) exhibited changes at the STT joint, comprising three with Grade I and 2 with Grade II degeneration.

CONCLUSION: Scaphocapitate arthrodesis with lunate excision can improves pain, ROM, grip strength, and functional scores in patients with stage IIIB and IIIC Kienböck's disease. Over time, improvements in VAS scores and functional metrics were notable, though there was a slight decline in pain relief and ROM at 84 months. These changes are critical to understanding the potential degenerative complications, particularly at the RS joint, where some patients developed osteoarthritis.

LEVEL OF EVIDENCE: Level II.

PMID:40024945 | DOI:10.1007/s00264-025-06458-8

Int Orthop. 2025 Mar 1. doi: 10.1007/s00264-025-06454-y. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the impact of implant-associated and radiographic factors on survival rates and revisions of total shoulder arthroplasty (TSA) in patients with primary osteoarthritis (OA).

METHODS: This retrospective study included 68 patients who underwent TSA for primary OA at a single institution between 2008 and 2015, with a minimum follow-up of 60 months. Patients with prior shoulder surgeries, perioperative infections, or revisions within 12 months postoperatively were excluded. Patients were divided into Group A (Survivors) and Group B (Revisions) based on implant survival. Radiographic parameters analyzed included critical shoulder angle (CSA), acromiohumeral distance (AHD), lateral offset (LO), humeral head-stem index (HSI), centre of rotation (COR), and glenoid erosion, categorized using Sirveaux, Lévigne, Franceschi, and Walch classifications. Demographic data were also assessed.

RESULTS: Of 68 patients, 57 were in Group A (mean age: 58.5 ± 10.1 years; follow-up: 115.8 months) and 11 in Group B (mean age: 61.4 ± 8.3 years; follow-up: 113.9 months). Implant survival was 84% after 115.8 ± 34.5 months. Baseline demographics were comparable (e.g., smoking: p = 0.75), as was osteolysis prevalence (Group A: 47%; Group B: 45%; p = 0.91). HSI was significantly higher in Group B (0.5 ± 0.1 vs. 0.4 ± 0.1; p = 0.03). No other radiographic differences were significant.

CONCLUSION: Patients undergoing anatomic total shoulder arthroplasty can expect favourable mid- to long-term outcomes, with implant survival rates of 84% and relatively low complication rates. Although osteolysis is common, it rarely necessitates revision surgery. The role of the humeral head-stem index (HSI) warrants further investigation.

STUDY DESIGN: Level IV; retrospective case study.

PMID:40024944 | DOI:10.1007/s00264-025-06454-y

Int Orthop. 2025 Mar 1. doi: 10.1007/s00264-025-06474-8. Online ahead of print.

ABSTRACT

PURPOSE: In this study, we aimed to evaluate the effectiveness and safety of UBS (Ultrasonic Bone Scalpel) and HSD (High-speed drill) for performing anterior or posterior decompressions in patients with pathologies in cervical and lumbar regions.

METHODS: Between October 2022 and June 2024, 60 patients underwent surgery in which a UBS (Sonopet UST-2001; Stryker Neuro Spine ENT, MI, USA) and High-speed Midas Rex MR8 (Medtronic, Fort Worth, TX, USA) drill was used. Informed consent was obtained from all patients. The study included 27 men and 33 women with a mean age of 59,5 ± 14.6 years (range: 28-85). The following patient data were recorded: preoperative and postoperative JOA scores, intraoperative blood loss, and operative time for decompression in lumbar and cervical region.

RESULTS: In UBS group, the mean intraoperative blood loss was 166.0 ± 64.3 ml. The mean preoperative and postoperative JOA scores were 4.5 ± 1.0 and 8.6 ± 1.8 and the mean postoperative follow-up duration was 6.1 ± 4.4 months in UBS group. The mean intraoperative blood loss was 221.2 ± 93.4 ml in HSD group. The mean preoperative and postoperative JOA scores were 5.2 ± 1.1 and 8.2 ± 1.2 in HSD group. In the HSD group, the blood loss (BL) value was significantly higher (p < 0.05) compared to the UBS group. The preoperative/postoperative JOA score improvement in the UBS group was significantly higher (p < 0.05) than in the HSD group.

CONCLUSIONS: The UBS can be safely used in spinal surgery. It reduces intraoperative blood loss and provide better clinical improvement. Authors would like to emphasize that the UBS resects the bone with oscillatory movements rather than rolling motions and this mechanism of action is important in reducing the risk of dura mater injury.

PMID:40024943 | DOI:10.1007/s00264-025-06474-8

Int Orthop. 2025 Mar 1. doi: 10.1007/s00264-025-06473-9. Online ahead of print.

ABSTRACT

PURPOSE: Athletes face a higher risk of upper limb nerve entrapment due to repetitive stress, trauma, and biomechanics. Diagnosis is challenging, and delayed treatment can impair performance. When conservative care fails, surgery may be needed to restore function and enable return to play (RTP).

METHODS: This systematic review adhered to PRISMA guidelines and evaluated surgical outcomes, RTP rates, and complications in athletes with upper limb nerve entrapment. A comprehensive search was conducted using MeSH terms and keywords for surgical interventions, nerve entrapment syndromes, and sports. Eligible studies included case series, cohort studies, and comparative studies that reported postoperative outcomes in athletes. Data extraction included nerve involvement, surgical techniques, clinical outcomes, and RTP rates.

RESULTS: Thirty-one studies, comprising 1,297 athletes across 23 sports, were included. The most common nerve entrapments involved the ulnar nerve (50.1%), brachial plexus (39.2%), and suprascapular nerve (9.5%). Surgical interventions included ulnar nerve decompression/transposition, first rib resection with scalenectomy for thoracic outlet syndrome (TOS), and suprascapular nerve decompression. RTP rates ranged from 62 to 100%, with an average of 87%. Suprascapular nerve decompression had the highest RTP success (100%), while TOS demonstrated greater variability (62.5-97%). Functional improvements included pain reduction, increased grip strength, and enhanced patient-reported outcomes. The overall complication rate was low, but TOS procedures had the highest reoperation rates (3.8-27%).

CONCLUSION: Surgical treatment of upper limb nerve entrapment in athletes yields high RTP rates and functional recovery. Ulnar and suprascapular nerve decompressions show consistent success, while TOS surgery outcomes vary.

PMID:40021549 | DOI:10.1007/s00264-025-06473-9

Int Orthop. 2025 Feb 28. doi: 10.1007/s00264-025-06459-7. Online ahead of print.

NO ABSTRACT

PMID:40019503 | DOI:10.1007/s00264-025-06459-7

Int Orthop. 2025 Feb 27. doi: 10.1007/s00264-025-06462-y. Online ahead of print.

ABSTRACT

PURPOSE: If the pain persists for a long time in the treatment of plantar fasciitis (PF) or if there is no response to treatment, central sensitization (CS) may develop and the pain may transform into nociplastic pain (NP). This study aimed to evaluate the frequency of CS and NP in patients with PF.

METHODS: This cross-sectional study was undertaken between November 2023 and March 2024. The Foot Function Index (FFI) scale, which evaluates the foot's functionality, was applied to the patient group. The Visual Analog Scale (VAS), which evaluates pain intensity; the Pain-DETECT scale, which evaluates NP; and the Central Sensitization Scale (CSI), which evaluates CS, were applied to patient and control groups.

RESULTS: A total of 206 people were included in the study; 106 were in the patient group with PF, and 100 constituted the control group. While we detected NP in 67 (63.2%) patients according to Pain-DETECT and CS was detected in 91 (85.8%) patients according to CSI among 106 patients with chronic PF; we detected NP in seven (7%) patients according to Pain-DETECT and CS in 44 (44.0%) patients according to CSI among 100 control patients. VAS-score and FFI-pain are moderately and positively correlated with pain-DETECT scores and fairly and positively correlated with CSI scores in the PF group. The pain-DETECT score is moderately and positively correlated with the CSI score in the two groups.

CONCLUSIONS: This is the first study to evaluate the presence of CS and NP in PF patients. We found NP and CS to be common in patients with chronic PF. Effective pain management in patients with PF before it becomes chronic can prevent the development of CS and NP.

PMID:40014141 | DOI:10.1007/s00264-025-06462-y

Int Orthop. 2025 Feb 26. doi: 10.1007/s00264-025-06455-x. Online ahead of print.

ABSTRACT

PURPOSE: The optimal coronal alignment in total knee arthroplasty (TKA) remains debatable, necessitating a clear, simple, and universal classification system. The Coronal Plane Alignment of the Knee (CPAK) classification introduced in 2021 provides a nuanced method for categorizing knee alignment. This study aimed to evaluate the distribution of CPAK types among Chinese patients with osteoarthritis (OA) and clarify the differences in surgical outcomes among different CPAK types.

METHODS: We analyzed the data from 961 patients with OA. All patient information was derived from a single-centre retrospective cohort. Radiological measurements from full-length radiographs were used to classify patients into CPAK types. Propensity score matching was used to compare outcomes among different CPAK types. Demographic and clinical data, information regarding patient satisfaction, and Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Forgotten Joint Score (FJS) scores were also collected.

RESULTS: Among Chinese patients with OA, the most common type was Type I (56.8%), followed by Type II (16.1%). After TKA, CPAK types IV and V, were predominant, accounting for 28% and 31% of patients; CPAK types did not change with OA progression. No significant differences in satisfaction, KSS, or WOMAC scores were observed among patients with CPAK types IV, V, and VII. However, Type V patients had significantly higher FJS scores, potentially due to corrected preoperative varus alignment.

CONCLUSION: This study established the CPAK type distribution among Chinese patients with OA to guide alignment strategies for TKA. Different CPAK types did not significantly affect overall satisfaction but influenced functional recovery, underscoring the need for personalized TKA approaches.

PMID:40009175 | DOI:10.1007/s00264-025-06455-x

Int Orthop. 2025 Feb 26. doi: 10.1007/s00264-025-06466-8. Online ahead of print.

ABSTRACT

BACKGROUND: Total knee arthroplasty (TKA) is a common surgical procedure aimed at relieving pain and restoring function in patients with advanced knee osteoarthritis. However, up to 25% of patients report persistent postoperative pain, which remains a major clinical challenge. While mechanical and biological causes are well-documented, neuropathic pain due to dynamic nerve compression is often overlooked, particularly involving the common peroneal and saphenous nerves.

OBJECTIVE: This study aims to highlight the role of dynamic nerve compressions in persistent post-TKA pain and propose an enhanced diagnostic approach by expanding Hagert's triad into a tetrad (pain, weakness, Scratch Collapse Test + , and orthogonal taping).

METHOD: Dynamic nerve compression differs from static entrapment as it occurs intermittently, often escaping detection in standard electromyography (EMG) or imaging studies. The common peroneal nerve is commonly compressed in the peroneal tunnel, leading to lateral knee pain, ankle weakness, and gait instability. The saphenous nerve, entrapped in Hunter's canal, is associated with medial knee pain, fatigability in standing, and pain while climbing stairs. Incorporating orthogonal taping in the clinical assessment enhances diagnostic sensitivity by providing a reproducible mechanical relief test.

CONCLUSION: Dynamic nerve compression should be systematically considered in cases of persistent post-TKA pain. A thorough clinical examination, including Hagert's tetrad, helps improve early detection. When conservative management fails, surgical nerve release offers a valuable solution, with significant potential for pain relief and functional recovery. Further studies are needed to optimize treatment protocols and validate long-term outcomes.

PMID:40009174 | DOI:10.1007/s00264-025-06466-8

Int Orthop. 2025 Feb 24. doi: 10.1007/s00264-025-06435-1. Online ahead of print.

ABSTRACT

PURPOSE: Complete acromioclavicular (AC) dislocation associated with fracture of the coracoid process (CP) is uncommon. The strong coracoclavicular ligaments, instead of rupture, may avulse the CP near its base, and with disruption of the AC joint may allow complete dislocation of the clavicle. We report ten cases, one of the largest series in literature, and reviewed the findings and treatment previous reported cases, to allow potential readers to establish the most appropriate treatment.

METHODS: We have prospectively collected those cases in which we had identified an association of an AC dislocation with a fracture of the CP, as well as retrospectively reviewed the records that were coded as AC dislocations and CP fracture looking for this association in the senior author institutions. A literature search was completed on PubMed, Web of Science and Scholar Google, using a sensitive search strategy.

RESULTS: We have collected a total of ten patients with the association of a CP fracture to an AC dislocation in a period of twenty-five years. A review of the cases reported in literature shows a great variability in treatment methods from conservative to more surgically in recent years.

CONCLUSIONS: When an AC dislocation is identified by clinical examination and X-rays, one should be aware of a possible fracture of the CP. It is possible this association to be more frequent than shown in literature because of the CP fracture can easily be missed out or mistaken with an unfussed epiphysis in routine anteroposterior radiography. Multiple approaches have been opted for by surgeons to deal with this combined injury and are the basis of this review.

PMID:39992382 | DOI:10.1007/s00264-025-06435-1

Int Orthop. 2025 Feb 21. doi: 10.1007/s00264-025-06438-y. Online ahead of print.

ABSTRACT

PURPOSE: Subtalar arthroereisis (STA) is a clinical intervention used for the correction of flexible flatfoot (FFF) in the paediatric population. This study aims to evaluate the radiographic, clinical, and patient-reported outcomes of STA for symptomatic FFF in paediatric patients with a minimum follow-up period of nine years.

METHODS: A cohort of 19 patients (38 feet) who underwent STA for FFF treatment between 2011 and 2015 was analyzed. This study featured a minimum follow-up period of nine years and involved comprehensive radiographic measurements. Clinical function assessment included footprint analysis classified using the Viladot classification, the Foot and Ankle Outcome Score (FAOS), and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale. We calculated the association between preoperative and postoperative angles and functional results. Receiver operating characteristic (ROC) curve analyses were conducted to establish the optimal threshold to predict good clinical outcomes.

RESULTS: The average age at the time of surgery was 11 ± 1.79 years, and the mean duration of follow-up was ten ± 1.4 years. After the surgical intervention, all foot angles showed statistically significant improvements. Normal foot alignment according to the Viladot classification was noted in 71% of patients. Good to excellent functional outcomes, as measured by both the AOFAS-hindfoot score and FAOS score, were reported in 84.2% of patients. Significant correlations were found between the preoperative and postoperative angles and functional results. Based on ROC curve analysis, the cut-off values were determined to be 28.5 degrees for the talonavicular coverage angle, 19.5 degrees for Meary's angle, and 37.5 degrees for the talar declination angle.

CONCLUSION: Our study indicates that STA is an effective procedure for durable deformity correction in paediatric patients with FFF. Restoring the medial longitudinal arch and correcting forefoot abduction are essential for improving functional outcomes. Both preoperative and postoperative angles were significantly associated with functional results, and the identified preoperative cut-off values are helpful for selecting surgical candidates.

PMID:39982464 | DOI:10.1007/s00264-025-06438-y

Int Orthop. 2025 Feb 20. doi: 10.1007/s00264-025-06457-9. Online ahead of print.

ABSTRACT

PURPOSE: Muscle mass and fatty infiltration can be assessed on computed tomography (CT) images using the cross-sectional area (CSA) and computed tomography attenuation value (CTV). Femoral head collapse in osteonecrosis of the femoral head (ONFH) may affect both values. We investigated factors influencing the CSA and CTV of the periarticular muscles in patients with ONFH.

METHODS: Overall, 101 patients with ONFH with unilateral hip pain (stage 2, 24 patients; stage 3 A, 49 patients; and stage 3B, 28 patients) were included. The CSA and mean CTV of the bilateral gluteus maximus (Gmax), gluteus medius (Gmed), gluteus minimus (Gmin), and iliopsoas (IP) muscles were measured using CT cross-sections. Bilateral comparisons and associations with Japanese Investigation Committee (JIC) stage were analysed. Multiple regression analysis was used to evaluate factors associated with the CSA and CTV.

RESULTS: On the symptomatic side, the CSA was significantly lower for the Gmax, Gmed, and IP, whereas the CTV was significantly lower for all tested muscles (all p < 0.01). The CTV, but not the CSA, of the Gmax, Gmed, and Gmin was significantly associated with the JIC stage severity bilaterally (all p < 0.01). Multiple regression analysis showed significant associations of the CTV with age, sex, and JIC stage (all p < 0.01).

CONCLUSION: Symptomatic ONFH leads to decreased muscle mass and increased fatty infiltration. Femoral head collapse progression is associated with a decrease in the CTV. Periarticular muscle assessment, including on the contralateral side, is important in patients with ONFH, particularly in older women.

PMID:39976738 | DOI:10.1007/s00264-025-06457-9

Int Orthop. 2025 Feb 20. doi: 10.1007/s00264-025-06434-2. Online ahead of print.

ABSTRACT

PURPOSE: Compression neuropathy is a common problem that results in impaired axonal conduction, and with time, numbness, tingling and weakness from muscle atrophy. Supercharge reverse end-to-side (SETS) nerve transfers have emerged as a novel approach to augment function in chronic nerve compression syndromes with minimal donor site morbidity. This review answers the question, "What are the indications, surgical techniques, and nuances of SETS nerve transfers for ulnar, axillary, radial, and femoral compression neuropathies?".

METHODS: This article reviews current literature and technical components of the use of SETS in chronic nerve compression syndromes.

RESULTS: SETS nerve transfers improve functional outcomes and reduce disability in chronic nerve compression syndromes with limited donor site morbidity. SETS nerve transfers for ulnar, axillary, and femoral compressive neuropathy improve muscle strength, as demonstrated by increased MRC scores. It has also been shown that SETS transfers decrease clawing in ulnar nerve compression and pain in axillary nerve compression. More research is needed for SETS transfers for radial nerve compression neuropathies.

CONCLUSION: SETs nerve transfers have emerged as a novel approach to restore function and reduce pain and dysfunction in chronic nerve compression syndromes. SETS nerve transfers have minimal donor site morbidity and improve the strength and function of muscles innervated by the effected "recipient" nerve. This review explores the indications and surgical techniques of SETS nerve transfers for ulnar, axillary, radial, and femoral compression neuropathies as well as their reported outcomes.

PMID:39976737 | DOI:10.1007/s00264-025-06434-2

Int Orthop. 2025 Feb 19. doi: 10.1007/s00264-025-06448-w. Online ahead of print.

ABSTRACT

BACKGROUND: Knee synovial chondromatosis (SC) is a rare joint disorder involving loose cartilaginous bodies, leading to pain, swelling, and impaired function. Arthroscopy has become a primary treatment option, but its efficacy and recurrence rates remain debated. This systematic review evaluates the effectiveness and safety of arthroscopic interventions, focusing on loose body removal, partial synovectomy, and total synovectomy.

METHODS: A systematic search of PubMed and EMBASE (1985-2024) identified studies on arthroscopic treatment of knee SC, adhering to PRISMA guidelines. Inclusion criteria targeted original studies detailing outcomes of loose body removal with or without synovectomy. Data on patient demographics, surgical techniques, and outcomes were extracted, with recurrence as the primary outcome. Qualitative synthesis was conducted due to heterogeneity among studies.

RESULTS: The review included 84 patients (median age: 36 years, range: 7-67). Loose body removal alone was performed in 57.8%, partial synovectomy in 30.9%, and total synovectomy in 13%. Median follow-up was 28 months. Recurrence occurred in 22.6%, predominantly after loose body removal alone. Complication rates were negligible, with only one reported instance unrelated to the arthroscopic procedure.

CONCLUSIONS: Arthroscopic treatment is safe and effective for knee SC. Recurrence rates underscore the importance of synovectomy in preventing disease recurrence. Total synovectomy may offer superior outcomes for advanced cases. Further research with standardized protocols and extended follow-up is needed to optimize treatment strategies.

PMID:39969591 | DOI:10.1007/s00264-025-06448-w

Int Orthop. 2025 Feb 19. doi: 10.1007/s00264-025-06424-4. Online ahead of print.

ABSTRACT

PURPOSE: Implant-associated infections are the most challenging complication in orthopaedics and trauma surgery as they often lead to long courses of illness and are a financial burden for the healthcare system. There is a need for fast, simple, and cheap identification of pathogens but the ideal detection method was not found yet. The work aims to test whether the detection of pathogens culturing the removed implant is more successful than from simultaneously taken tissue samples or punction fluid.

METHODS: Implants were removed due to infection, irritation, or loosening. Tissue samples and joint fluids were processed for bacterial growth in sterile conditions. Samples were incubated and checked for growth. Bacterial identification and antibiotic sensitivity testing were performed. Data were anonymized, and statistical analysis was done using Excel and SAS, employing tests like Shapiro-Wilk, Mann-Whitney-U, and Kruskal-Wallis. Ethical approval was obtained for this study.

RESULTS: Between February 2018 and April 2019, a total of 163 patients (175 cases) underwent orthopaedic implant removal for various reasons. 30 cases were not usable or analyzable due to missing or damaged reference material, so 145 cases could be evaluated due to study protocol. The range of detected bacteria was as expected and included low-virulent bacteria such as Micrococcus luteus and Corynebacteria. Pathogen detection by culture of the the explant´s was more sensitive (84.83%) than pathogen detection from tissue samples and punction fluid (64.14%, p<0.0001). Comorbidities did not play any role in the quality of detection but prior antibiotic treatment did influence the results of tissue diagnostics.

CONCLUSION: This study showed with a higher frequency of bacterial detection of orthopedic explant´s surface compared to tissue samples or punction fluid. This may reduce the number of samples and cost but enhances the quality of orthopaedic implant-related infection diagnostics.

PMID:39969590 | DOI:10.1007/s00264-025-06424-4

Int Orthop. 2025 Feb 18. doi: 10.1007/s00264-025-06443-1. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the effects of adding immediate weight-bearing to tolerance into a post-operative rehabilitation program for surgically treated Tibial Plateau (TP) fractures on clinical and radiological outcomes.

METHODS: A randomized control trial. 106 Patients were recruited following open reduction internal fixation (ORIF) TP fracture, with 54 patients meeting the criteria for inclusion. Patients were assigned randomly into one of two groups: (1) the traditional group (TG) and (2) the weight-bearing group (WG). The TG was given the non-weight-bearing (NWB) rehabilitation protocol for six weeks. The WG was allowed immediate weight-bearing, and the same therapeutic exercise program was given to both groups. The dependent variables, including clinical and radiological measurements, were recorded six weeks, three months, and six months after the surgery.

RESULTS: A total of 45 patients (11 women and 34 men), with a mean age of 43 ± 14 years, completed the study. There were significant differences between groups in favor of the WG at 6-months for the total clinical Rasmussen score (p =.002) as well as for the pain (p =.005), walking capacity (p =.002), and knee ROM (p =.047). We found neither difference between groups regarding radiological CT- Scan and X-ray measures nor Rasmussen's radiological scores (p =.854). Fracture type (Schatzker I-IV) did not affect any radiological measures between the groups. Four of 45 patients had intra-articular collapse, three in TG and one in WG (p =.571).

CONCLUSION: Immediate weight-bearing as tolerated after ORIF of TP fractures (Schatzker I-IV) resulted in better clinical outcomes with no significant differences in the radiological measures.

PMID:39964437 | DOI:10.1007/s00264-025-06443-1

Int Orthop. 2025 Feb 17. doi: 10.1007/s00264-025-06405-7. Online ahead of print.

ABSTRACT

PURPOSE: To examine the effectiveness of a novel bone graft reduction technique with a bone tamp impactor instrument in minimally invasive treatment of tibial plateau collapse fractures through arthroscopic and imaging evaluation.

METHODS: This is a retrospective analysis of prospectively collected data on patients with tibial plateau collapse fracture who received the novel bone graft reduction procedure with a bone tamp impactor instrument for minimally invasive treatment of tibial plateau collapse fractures in a tertiary referral university hospital from February 2021 to March 2023. Patients were classified according to a classification combined with Schatzker classification, AO classification and three-column classification. Arthroscopy evaluation and radiographs were used to measure the reduction effect.

RESULTS: A total of 196 patients were eligible and included. Compared to the preoperative values, post-ADD(c) showed a significant reduction improvement (P = 0.000-0.007), ranging from 87.9 to 96.6% for different classifications. The post-ADD (s) have decreased by 87-96.8% (P = 0.000-0.039), the post-FFG and post-TPW reduced by 87.5-100% (P = 0.000-0.026) and 34.2-63.5% (P = 0.000-0.075) respectively. Additionally, the lower limb alignment have been significantly corrected, with notable changes in post-MPTA (P = 0.000-0.081), post-PTSA (P = 0.000-0.178) and post-FTA (P = 0.000-0.069) for different types of fracture, measured one day after surgery. Arthroscopic evaluation indicated that the average articular surface depression depth was less than 4 mm, and over 60% achieved a depression depth of less than 2 mm. All patient achieved a less than 2 mm of postoperative fracture fragment gap, with over 50% achieving a gap of less than 1 mm. None of patients experienced neurovascular injury or wound infection.

CONCLUSION: The novel bone graft reduction technique utilizing a bone tamp impactor instrument can achieve effective reduction in all types of tibial plateau collapse fractures. This method may prove to be a useful option for minimally invasive treatment of tibial plateau fractures.

PMID:39960508 | DOI:10.1007/s00264-025-06405-7