Bone quality changes in isthmic spondylolisthesis (IS), especially within the pedicle, remain poorly understood. This study investigated regional bone quality alterations in IS using DXA and CT-derived Hounsfield unit (HU) measurements and evaluated their association with pedicle screw loosening. Adult patients with single-level L5–S1 IS treated with posterior lumbar interbody fusion were retrospectively reviewed. Bone quality was assessed using DXA T-scores and CT-based vertebral body and pedicle HU values. Multivariable logistic regression and ROC analyses were performed to identify factors associated with radiographic screw loosening and assess discriminatory performance. DXA showed no significant difference in bone mineral density between patients with IS and controls. However, CT revealed an inverse regional remodeling pattern at the slipped segment, with increased vertebral body HU values but decreased pedicle HU values. Lower pedicle HU, lower vertebral HU, and older age were independently associated with radiographic screw loosening. Pedicle HU showed a numerically higher discriminatory ability than vertebral HU for radiographic screw loosening, with an exploratory Youden-derived cutoff value of 115.5 HU. IS demonstrates inverse regional bone remodeling characterized by increased vertebral body HU but decreased pedicle HU at the affected segment. Because reduced pedicle bone quality was more closely associated with radiographic screw loosening, pedicle HU may serve as a clinically relevant surrogate marker for preoperative assessment of screw–bone interface risk in patients with IS.
The implementation of simultaneous bilateral unicompartmental knee arthroplasty (SBUKA) across different age groups remains incompletely defined. This study aimed to assess the impact of age on complication rates and implant survivorship in patients undergoing SBUKA. The clinical records of 245 patients (490 knee joints) who received SBUKA at the Affiliated Hospital of Qingdao University and the Third Hospital of Hebei Medical University between January 2010 and December 2020 were retrospectively analyzed. Patients were divided into three groups based on their age at the time of surgery: Group A (age < 60), group B (60 ≤ age < 70), and group C (age ≥ 70). The primary endpoints were complication rates and implant survival. Secondary endpoints included length of stay, length of surgery, and hospitalization costs. Implant survival was assessed by reviewing follow-up clinical records and postoperative radiographs, and compared between groups using Kaplan-Meier survival analysis. All outcomes were compared among different age groups. Patient age ranged from 43 to 78 years (60.62 ± 7.42 years). Compared with other groups, patients with age ≥ 70 had significantly longer hospital stay (10.88 ± 4.74 days vs. 8.55 ± 2.89 days and 8.41 ± 2.46 days, respectively; F = 8.866, p < 0.001), and significantly increased hospitalization costs (11028.83 ± 3392.03 vs. 9832.49 ± 3122.939 and 9535.74 ± 2524.94, respectively; F = 3.285, p = 0.039). There was no significant difference in the incidence of complications after SBUKA among all groups (χ2 = 4.12, p = 0.127). The survival rate of implants in the age group from group A to group C was 95.1
Distal finger defects (DFDs) are common hand injuries that impair both appearance and fine motor function. Because these defects often involve the nail bed, phalanx, and soft tissue, reconstruction remains challenging. This study evaluated the clinical outcomes of Free Hallux Nail Flap combined with Iliac Bone Graft (FHNF) for DFD. We retrospectively reviewed patients with DFD treated with FHNF at Beijing Jishuitan Hospital Guizhou Hospital between January 2020 and December 2023. Pain was assessed using the Visual Analog Scale (VAS), upper limb function using the Disabilities of the Arm, Shoulder and Hand (DASH) score, donor-site foot function using the American Orthopaedic Foot and Ankle Society (AOFAS) score, blood supply using skin temperature, capillary refill time (CRT), and laser Doppler flowmetry, and sensory recovery using the 2-point discrimination (2PD) test. Patient satisfaction was assessed at 12 months by telephone follow-up using a 5-point Likert scale. Twenty-two patients were included, with a minimum follow-up of 12 months. All incisions healed, with a median healing time of 24.50 days (Q1, Q3: 22.00, 29.00), and no flap necrosis or no documented bone nonunion was identified during follow-up. The reconstructed digit length ratio was 97.53
Concerns regarding postoperative complications may delay initiation of anti-osteoporosis treatment after hip fracture. We examined the association between early postoperative Zoledronate administration and acute in-hospital complications, subsequent medical and orthopaedic complications, reoperations, and new fractures within 30 days and one year. In this retrospective observational study, patients aged ≥ 50 years with a new hip fracture were included from two periods: a historical period (HisP) (2012–2013), before implementation of in-patient Zoledronate treatment, and an implementation period (ImpP) (2014–2021), where postoperative Zoledronate was routinely considered. Patients from ImpP not treated with Zoledronate were excluded from comparative analyses. Propensity score matching was used to create comparable treated and untreated groups. Outcomes included acute complications, subsequent medical and orthopaedic complications, reoperations, new fractures, and mortality within 30 days and one year. A total of 1 924 patients were included (68
Pre-existing cervicogenic headache often improves after anterior cervical discectomy and fusion (ACDF); however, new-onset postoperative headache and early aggravation of pre-existing headache remain poorly characterized. This study evaluated these outcomes separately and assessed their clinical phenotypes and associated factors. This single-center retrospective cohort study included 1,993 consecutive patients who underwent ACDF between January 2017 and December 2024 for cervical radiculopathy (n = 866), degenerative cervical myelopathy (n = 806), isolated soft-disc herniation (n = 314), ossification of the posterior longitudinal ligament (n = 5), or revision surgery (n = 2). New-onset headache was assessed through postoperative day 30 in 1,443 patients without active preoperative headache. Early aggravation was assessed at the first postoperative evaluation (24–72 h) in 550 patients with active headache and was defined as an increase of ≥ 2 points in headache visual analog scale (VAS) score. Multivariable logistic regression was performed in each complete risk set. Separate 1:2 Mahalanobis-matched and Firth-penalized models were used as sensitivity analyses. New-onset headache occurred in 112 of 1,443 patients (7.8
Periprosthetic joint infection (PJI) is a serious complication of joint replacement, with limited consensus on optimal treatment, especially in early infections. Debridement, antibiotics, and implant retention (DAIR) is often used, but determining the true duration of symptoms and infection chronicity can be challenging. CRP levels rise in both early and chronic infections, while albumin levels decline more gradually due to increased vascular permeability in chronic cases. The CRP-to-albumin ratio may serve as a useful marker of infection chronicity, potentially aiding in treatment decisions between DAIR and more aggressive options used for chronic infections. A retrospective longitudinal study was performed on 82 patients, involving 91 DAIR procedures, with analysis of hospital admission CRP and albumin levels alongside patient-reported symptom onset. The study assessed the correlation between these variables and 1-year clinical outcomes following the DAIR procedure. In addition, CRP-to-albumin ratios were analyzed in a separate group of patients with chronic infections undergoing resection arthroplasty to identify potential similarities between these treatment groups. Reoperation for infection was used as the primary clinical outcome. Forty-nine DAIR procedures were performed in patients with acute infections (0–28 days of symptoms), and 24 DAIR procedures were performed in patients with chronic infections (≥ 29 days of symptoms). An additional 18 procedures in patients with symptoms lasting more than 3 months who underwent resection arthroplasty were included for comparison. The median (IQR) CRP-to-albumin ratio was 2.5 in the acute group (CRP 8.2 mg/L, albumin 3.2 g/dL), 1.0 in the chronic group (CRP 3.8 mg/L, albumin 3.8 g/dL), and 7.2 in the resection group (CRP 28 mg/L, albumin 3.8 g/dL). Reoperation due to infection occurred in 38.8
“Internal-locking” concepts—deployable talons/claws and tanged anchors, winged/wedge-wing head elements, blade-expandable and wedge-locked distal modules, inside-to-out internal distal locking pins (endopins), and shape-memory (nitinol) wings—aim to streamline intramedullary (IM) fixation by reducing reliance on freehand distal interlocking screws while maintaining stability. A scoping, mechanics-informed review was conducted using PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar (January 1980–October 2025; last search October 25, 2025). Studies evaluating intramedullary systems with internal-locking mechanisms for the humeral shaft/diaphysis, hip (intertrochanteric, basicervical, or subtrochanteric), femoral shaft/distal femur, tibia, fibula, clavicle, and selected pelvic/foot indications were eligible. Bench/FEA, cadaveric, clinical (comparative and single-arm), technique, and health-economic reports were included. For human clinical studies, English-language full texts were eligible; during revision, non-English full texts with an English abstract and extractable outcome data were re-evaluated. Screening was performed by a single reviewer, and data were charted by anatomic pattern, key technique covariates (reduction quality, central–inferior head position, tip–apex distance [TAD]), outcomes, and complications. Sixty-three sources of evidence met eligibility criteria and were charted; details are compiled in Supplementary Table S1 (Master Evidence Table). The remaining 10 references are background/methodological or definitional citations—for example, foundational work informing technique covariates such as tip–apex distance (TAD) and calcar-referenced metrics (e.g., Calcar-TAD)—and therefore are not listed or appraised in the supplementary evidence tables. For the humeral shaft, internal distal-locking strategies reduce the distal-targeting burden of antegrade nailing and may shorten surgery while avoiding an additional distal incision, but outcomes remain strongly technique-dependent. Historical Seidel data and more recent humeral internal-locking series suggest that the main risks are rotational instability, technical locking failure, proximal hardware-related symptoms, and shoulder morbidity rather than the distal mechanism alone. Bench and cadaveric studies indicate that inferior subchondral deployment of talons increases torsional resistance ( 2–3×) and interfragmentary compression ( 2×) versus retracted configurations, providing a plausible basis for reduced lag-element sliding when TAD is 15–25 mm and the head element is central–inferior. Finite-element models suggest that wedge-locked constructs can approximate screw-locked axial/torsional stiffness when deployment torque and friction are adequate, albeit with stress concentrations near the locking windows. Clinically, in geriatric intertrochanteric fractures, union and functional outcomes are generally similar among talon-equipped, helical-blade, and dual-screw cephalomedullary nails when reduction/TAD are optimized; internal-locking designs are often associated with shorter operative and fluoroscopy times, and distal talon locking has been reported to be associated with lower cutout in unstable patterns. In femoral/tibial shafts, internal distal locking shortens procedures and radiation without consistent union penalties, although simple diaphyseal patterns distal to the isthmus show a greater risk of axial shortening/malrotation without adjuncts. In the fibula and clavicle, modern intramedullary systems achieve high union rates ( 98–100
Posterior C1–2 fusion is a standard treatment for atlantoaxial instability. In daily practice, however, follow-up computed tomography (CT) may show no clear posterior graft union even when reduction is maintained and the implants appear stable. Whether this radiographic finding represents true surgical failure remains uncertain. We therefore examined the long-term radiographic and clinical significance of absent posterior graft union after posterior C1–2 fusion. We retrospectively reviewed adult patients who underwent posterior C1–2 fixation and fusion with the Goel–Harms technique and autologous iliac crest bone grafting between May 2012 and May 2021. Posterior graft union was assessed on 12-month postoperative CT. Patients without definite posterior graft union were all included, and comparable patients with posterior graft union were selected using 1:1 propensity score matching. Radiographic stability, implant-related complications, and clinical outcomes were then compared during long-term follow-up. Among 153 screened patients, 112 met the eligibility criteria: 92 had posterior graft union and 20 had no definite posterior graft union on 12-month CT. After matching, the final cohort included 40 patients, with 20 patients in each group. The mean follow-up duration was 67.6 ± 9.7 months. AADI and PADI improved after surgery and remained stable until the final follow-up, without significant between-group differences at any assessed time point. Mean C1–2 ROM decreased from 10.36 ± 3.66° before surgery to 1.16 ± 1.03° at 3 months and remained essentially unchanged at 1.08 ± 1.03° at the final follow-up. No patient developed segmental instability, screw loosening, or implant failure. VAS, JOA, and NDI scores improved in both groups, and the improvements were not significantly different between groups. In this propensity score-matched cohort, absence of definite posterior graft union on follow-up CT was not associated with long-term atlantoaxial instability, implant failure, or inferior clinical outcomes after posterior C1–2 fusion. When reduction is maintained and instrumentation remains stable, posterior graft nonunion on CT should be interpreted cautiously rather than regarded automatically as surgical failure.
Anterior inferior glenoid rim fractures classified as Ideberg type Ia often combine shoulder dislocation, persistent instability and pain, impairing daily shoulder function. Traditional open surgery carries high risks of nerve injury and joint stiffness, while existing arthroscopic fixation methods have limitations for comminuted bone fragments. This study aimed to evaluate the clinical efficacy of arthroscopic reduction and single anchor fixation placed at the two o’clock glenoid position for Ideberg type Ia glenoid fractures, and compare recovery outcomes between patients with isolated fracture repair and those receiving one-stage combined rotator cuff repair. This single-center retrospective observational study enrolled 13 eligible patients treated with the above arthroscopic technique from 2019 to 2021. Preoperative and postoperative computed tomography scans were used to assess fracture reduction and bone healing. All patients completed standardized follow-up with measurements of shoulder active motion, abduction muscle strength and three shoulder functional scoring systems. Patients were divided into two subgroups based on concurrent rotator cuff tears. Paired t-tests analyzed pre- and post-operative indicators, independent samples t-tests compared subgroup outcomes, and intraclass correlation coefficients evaluated measurement reliability. Patients were followed up for (27.77 ± 4.75) months. Postoperative fracture displacement was significantly reduced, and all fractures achieved full healing within six months without major complications. Final follow-up shoulder motion and abduction strength were comparable to the uninjured contralateral shoulder, with all functional scores showing dramatic, statistically significant improvements. Inter-observer reliability of functional assessments was excellent. Subgroup comparison found no meaningful differences in shoulder motion, muscle strength or functional scores between patients with and without simultaneous rotator cuff repair. Arthroscopic two-o’clock single anchor fixation is a safe, minimally invasive treatment for Ideberg type Ia glenoid fractures, especially suitable for comminuted fractures. This technique reduces implant consumption, shortens operation time and lowers surgical costs. Concurrent rotator cuff injuries can be repaired in a single arthroscopic session without sacrificing shoulder strength or functional recovery, supporting wide clinical application of this combined minimally invasive strategy.
Pain and depression frequently co-occur in knee osteoarthritis (OA), traditionally viewed as a vicious cycle in which each worsens the other over time. However, conventional cross-lagged models cannot separate stable differences between individuals from real year-to-year changes within a person. We therefore used a random-intercept cross-lagged panel model (RI-CLPM) in the Osteoarthritis Initiative (OAI). Of 4,796 enrolled OAI participants with, or at risk of, knee OA, 4,638 contributed data across four annual waves from months 12 to 48. The RI-CLPM was applied to knee pain (WOMAC scale, worse knee) and depressive symptoms (CES-D scale), using full-information maximum likelihood. We contrasted it with a traditional model (CLPM), replicated it in a later six-wave window (months 36 to 96), and tested moderation by sex, arthritis severity, baseline pain and baseline depression, alongside covariate-adjusted and sensitivity analyses. Sensitivity analyses used a cognitive–affective CES-D subscale excluding somatic items, alternative model constraints and an alternative standardisation. The RI-CLPM fitted well and the between-person trait correlation was substantial (standardised r = 0.39, p < 0.001), whereas within-person cross-lagged paths were small and non-significant in both directions (pain to depression standardised beta = 0.019, 95
Complex pelvic and spinopelvic injuries present significant surgical challenges, often requiring intricate reduction and stabilization. Minimally invasive techniques reduce soft-tissue complications but are technically demanding. This study evaluates the safety, feasibility, and outcomes of using robotic-assisted navigation for spinopelvic fixation in complex trauma and presents our workflow and technique for these cases. A retrospective review was conducted of patients who underwent robotic-assisted spinopelvic fixation for traumatic pelvic and spinopelvic injuries at a single tertiary center. Outcome measures included reduction adequacy, operative time, radiation exposure, hardware failure, and postoperative complications. Sixteen patients (81
Humeral shaft nonunion is a challenging problem in orthopedic trauma. There is controversy regarding the choice between double-plate fixation and locking plate combined with structural bone grafting in the treatment of humeral shaft nonunion. This study aims to retrospectively compare the clinical advantages of double-plate fixation with autogenous iliac cancellous bone grafting (DPF group) versus locking compression plate anchored monocortical autogenous iliac bone and cancellous bone grafting (LCP + MAI group) in the treatment of humeral shaft nonunion. A total of 27 patients (10 females, 17 males) with closed, aseptic humeral shaft nonunion underwent revision surgery. The patients ranged in age from 29 to 55 years (mean 48 years). Fourteen patients were treated with double-plate fixation combined with autogenous iliac cancellous bone grafting (DPF group), and 13 patients were treated with locking compression plate fixation combined with monocortical autogenous iliac strut and cancellous bone grafting (LCP + MAI group). Operative time, intraoperative fluoroscopy frequency, fracture healing time, full weight-bearing time, and Disabilities of the Arm, Shoulder and Hand (DASH) scores of preoperative, 6-month and 12-month postoperative were collected for both groups. Direct medical costs of the two groups were also extracted from the hospital billing database and analyzed. Fracture healing was achieved in all patients in both groups. Operative time in the LCP + MAI group was 113.0 (IQR, 107.0-128.0) min, significantly shorter than 132.5(IQR,122.0-147.0) min in the DPF group (P<0.01). The number of intraoperative fluoroscopy exposures was 6.0 (IQR,6.0-6.0) in the LCP + MAI group, significantly lower than 8.0 (IQR,6.0-8.0) in the DPF group (P<0.05). No statistically significant differences were observed between the DPF and LCP + MAI groups in full weight-bearing time (p>0.05) or fracture healing time (p>0.05). There were no significant differences in preoperative DASH scores, DASH scores of 6-month and 12-month postoperative between the two groups (p>0.05). In the DPF group, the DASH scores improved significantly from 73.0 (IQR, 72.0-74.0) preoperatively to 30.5 (IQR, 29.0-32.0) at the 6-month follow-up and to 19.0 (IQR,18.0-20.0) at the 12-month follow-up (p<0.001). In the LCP + MAI group, DASH scores improved significantly from 74.0 (IQR,73.0-74.0) preoperatively to 31.0 (IQR,31.0-34.0) at the 6-month follow-up and to 19.0 (IQR, 18.0-20.0) at the 12-month follow-up (p<0.001). Medical costs analysis of the two treatment modalities demonstrated that Hardware costs (USD 3894.79 [2277.31, 4068.27] vs. 1672.62 [1453.20, 2332.89], p < 0.001), In-hospital costs (USD 7283.20±1183.27 vs. 4935.62±821.97, p < 0.001), and Total medical costs (USD 7476.65±1177.86 vs. 5124.50±5523.6, p < 0.001) were significantly higher in DPF group than in LCP + MAI group. The LCP + MAI technique offers comparable clinical efficacy to DPF, while demonstrating advantages in operative efficiency (shorter surgical time and fewer fluoroscopic exposures) and cost-effectiveness (lower total medical costs).
Lateral epicondylitis (LE) is a degenerative tendinopathy of the common extensor origin (CEO). Although local glucocorticoid injections are widely used for symptom relief, concerns exist regarding their potential adverse effects on tendon structure. This study aimed to investigate the association between prior glucocorticoid injection and magnetic resonance imaging (MRI)-based structural CEO damage in patients with chronic LE. In this retrospective, multicenter cross-sectional study, 147 patients with clinically diagnosed LE (symptom duration ≥ 6 months) who underwent elbow MRI between 2015 and 2023 were included. The primary exposure was prior local glucocorticoid injection at the CEO (yes/no and number of injections). Structural tendon damage was assessed using the Walz classification and quantitative lesion size diameters measured in coronal, axial, and sagittal MRI planes. Associations were analyzed using proportional odds ordinal logistic regression and generalized linear models, adjusted for age, sex, occupational workload, study center, and symptom duration. Sixty-three patients (42.9
Sarcopenia is a progressive skeletal muscle disorder characterized by loss of mass, strength, and function. However, reliable molecular biomarkers for early detection remain limited. This study aimed to identify and validate potential biomarkers for sarcopenia through a combination of machine learning analysis and experimental validation. Differential expression analysis between sarcopenia and control samples was performed using the GSE1428 dataset. Three machine learning algorithms were applied to screen candidate hub genes, and the diagnostic performance was evaluated by receiver operating characteristic curve analysis. Candidate gene expression was further validated in independent clinical samples using quantitative real‑time PCR (qRT‑PCR), Western blotting, and immunohistochemistry. Functional analyses were conducted to explore the underlying mechanisms. A total of 39 differentially expressed genes were identified. The intersection of machine learning algorithms identified four hub genes: C1QA, COL21A1, SLC38A1, and HOXB2. All four genes showed good diagnostic accuracy, with COL21A1 achieving an area under the curve value of 0.967. Clinical validation by qRT‑PCR showed that among the four hub genes, only COL21A1 was significantly upregulated at the mRNA level in sarcopenia samples compared with controls. Western blot confirmed that COL21A1 protein expression was significantly increased in sarcopenia. Immunohistochemistry showed enhanced cytoplasmic and extracellular matrix staining in sarcopenic samples. Functional analyses indicated significant associations between COL21A1 expression and immune‑related pathways. This study identified and validated COL21A1 as a potential candidate biomarker for sarcopenia. These findings offer new molecular insights for sarcopenia and may suggest a candidate biomarker for future therapeutic investigation.
The objective of this retrospective study was to evaluate the impact of bone involvement or erosion in localized TGCT of the fingers on local recurrence rates subsequent to surgical excision. The 85 patients who underwent surgical treatment were monitored clinically and radiologically for an average duration of 64.32 ± 53.85 months. Magnetic resonance imaging (MRI) examinations were conducted on patients exhibiting indications of recurrence. Numerical Pain Rating Scale (NPRS) and Michigan Hand Outcome Survey (MHOS) were assessed and statistically analyzed. The mean age was 42.27 ± 15.75. Female patients were predominant (67.1
To investigate whether unilateral cervical facet nerve blockade (FNB) is associated with changes in head repositioning accuracy (HRA), shoulder joint relocation accuracy (JRA), and standing balance in patients with chronic neck pain. This retrospective single-center interventional study included 99 patients treated at the Department of Physical Medicine and Rehabilitation. Cervical proprioception (HRA), shoulder proprioception (JRA), and standing balance (computerized posturography) were assessed before the intervention, immediately after FNB, and at 1-month follow-up. Because normal distribution could not be assumed, non-parametric tests were applied (Mann–Whitney U for independent comparisons and Wilcoxon signed-rank test for paired comparisons). Cervical proprioception during sagittal movements improved significantly after FNB, with effects maintained at 1-month follow-up. The most consistent improvement was observed for HRA during flexion (p < 0.001). Shoulder JRA during abduction also improved significantly after FNB (p = 0.002–0.02), and the improvement persisted at follow-up on the right side. Differences in JRA were observed between patients with upper versus lower cervical dysfunction, with lower cervical dysfunction showing a greater impact on shoulder relocation accuracy. Postural performance improved after FNB, particularly for trace length in the Romberg test (p = 0.02–0.002), and improvements were sustained at follow-up. Patients with higher baseline postural sway demonstrated greater balance improvements than those with low baseline sway. Significant correlations were observed between postural performance and HRA/JRA measures. Secondary outcomes showed significant improvement at 1-month follow-up in neck pain (p < 0.001), health-related quality of life (EQ-5D) (p = 0.005), and disability (Oswestry Disability Index) (< 0.001). Unilateral cervical FNB was associated with improvements in cervical repositioning accuracy, shoulder abduction relocation accuracy, and postural performance, with effects persisting at 1-month follow-up. Improvements were also observed in pain, health-related quality of life, and disability. Given the retrospective single-arm design and single-center setting, these findings should be interpreted as preliminary and require confirmation in prospective controlled studies.
Pin tract infection (PTI) is one of the most frequent complications of external fixation and can lead to pain, osteolysis, loss of fixation, and prolonged treatment. Although several studies have described prognostic variables for PTI, no validated prognostic models or risk scores are currently available to estimate individual patient risk. Socioeconomic and behavioral factors may influence hygiene routines, access to antiseptics, and adherence to care instructions, yet these variables are rarely incorporated into models that may help identify patients at higher risk. This study aimed to develop a preliminary prognostic risk score for PTI in patients treated with external fixation using socioeconomic, behavioral, and clinical prognostic variables. Among 1,220 patients admitted with traumatic limb fractures, 417 required surgical stabilization. External fixation was commonly used for tibial fractures. A total of 119 patients with external fixators attended follow-up visits and agreed to participate in interviews. Four were excluded (one aged < 18 years, one with an upper extremity fixator, and two with congenital deformities), resulting in a final sample of 115 adults treated with standard external fixation for ≥ 2 weeks. Interviews were conducted during routine follow-up visits over a two-year period. The primary outcome was PTI, defined as erythema, secretion, and pain requiring topical or oral antibiotics (Checketts–Otterburn Grade 2). Secondary variables included socioeconomic and behavioral factors such as smoking, alcohol consumption, diet, education level, and hygiene practices. Candidate prognostic variables were evaluated using Cox proportional hazards regression and combined into a preliminary prognostic risk score. Discrimination of the prognostic model was assessed using time-dependent area under the receiver operating characteristic curve (AUC). Among 115 patients (mean age 39 ± 14.5 years; 83
Bilateral medial compartment knee osteoarthritis with varus alignment may be treated with staged or simultaneous medial opening wedge high tibial osteotomy (MOWHTO). Simultaneous bilateral MOWHTO may reduce the overall rehabilitation burden, but concerns remain regarding complications, early mobility, and return to work. This study evaluated adverse events, radiographic correction, functional recovery, and return to work after simultaneous bilateral MOWHTO with early weight bearing. A retrospective case series was performed of 15 patients who underwent simultaneous bilateral MOWHTO between January 2002 and December 2023 at a single specialist sports medicine centre. Demographic, operative, radiographic, complication, mobility, return-to-work, hardware removal, and conversion-to-total-knee-arthroplasty data were extracted from medical records and imaging. Adverse events were classified using the Martin et al. framework (Class I–III). Fifteen patients underwent 30 osteotomies. Mean age was 50 years, and minimum follow-up was 18 months. Mean operative time was 107 min, mean hospital stay was 4.5 days, and mean osteotomy opening was 12.0 mm. Mean hip-knee-ankle angle improved from 169.8° pre-operatively to 180.9° post-operatively. Radiographic union was confirmed at the 6 month radiograph in 28 knees and at the 9 month radiograph in 2 knees. Three undisplaced lateral hinge fractures and 2 delayed unions occurred, all resolving without surgical intervention. Two superficial infections resolved with oral antibiotics and local wound care. There were no Class III adverse events, deep infections, thromboembolic events, cardiac events, hardware failures, losses of correction, or reoperations. All patients discontinued mobility aids by 12 weeks. Among 9 patients employed pre-operatively, 8 returned to work at a mean of 165.1 days. Simultaneous bilateral MOWHTO with early weight bearing was associated with low serious adverse event rates, reliable radiographic union, early functional recovery, and high return to work. These findings support simultaneous bilateral MOWHTO as an effective option for patients seeking a single operative and rehabilitation episode.
Proprioceptive deficits and impaired scapular control are increasingly recognized in adolescents with idiopathic scoliosis (AIS), yet whether targeted sensorimotor interventions provide benefits beyond conventional rehabilitation remains unclear. This study aimed to evaluate the additional effects of proprioceptive neuromuscular facilitation (PNF) on shoulder proprioception, scapular control, and global functional outcomes in AIS. In this assessor-blinded randomized controlled trial, 46 adolescents with AIS were randomly allocated to the PNF plus conventional rehabilitation group or the conventional rehabilitation group. Outcome assessments were conducted at baseline and after an 8-week intervention. Thirty-seven participants (PNF group, n = 19; control group, n = 18) completed the 8-week intervention and post-intervention assessments and were included in the per-protocol analysis. Primary outcomes included shoulder joint position sense assessed by the active reposition test (ART) and scapular postural control measured by scapular balance angle (SBA). Secondary outcomes included lateral scapular slide test (LSST), surface electromyography (sEMG), postural parameters, angle of trunk rotation (ATR), and health-related quality of life (SC-SRS-22). Between-group and within-group differences were analyzed using parametric or non-parametric tests according to data distribution. Both groups demonstrated improvements in selected postural and functional parameters after intervention. However, the PNF group showed significantly greater improvements in ART at medium and high target angles compared with the control group (p < 0.05), along with superior reductions in SBA and LSST (0° position). Significant normalization of sEMG-based muscle activation symmetry was observed in the upper trapezius, lower trapezius, and infraspinatus muscles in the PNF group. In contrast, no between-group differences were found in ATR or SC-SRS-22 scores. Notably, improvements in scapular alignment and trunk rotation were not accompanied by parallel recovery of proprioception in the control group, indicating a dissociation between structural and sensorimotor adaptations. PNF provides additional benefits in shoulder proprioception and scapular neuromuscular control beyond conventional rehabilitation in AIS. However, these improvements do not translate into short-term changes in trunk rotation or health-related quality of life. These findings suggest that scapular proprioception represents a distinct, modifiable neuromuscular domain in AIS that may require targeted intervention independent of global postural correction. ChiCTR2500099252, Date: 2025-03-20.
Three current consensus definitions for sarcopenia—EWGSOP2 (2019), AWGS2 (2019), and SDOC (2020)—differ substantially in their conceptual framework and operational cutoffs. No published meta-analysis has quantitatively pooled prognostic estimates across all three criteria. We aimed to compare pooled prevalence and prognostic associations with all-cause mortality and hospitalisation across these three definitions. We conducted a PRISMA 2020-compliant systematic review with searches in PubMed, Embase, Cochrane CENTRAL, Web of Science, CNKI, and Wanfang from 1 January 2019 to 31 May 2026. Eligible studies enrolled adults in any setting (Population), applied EWGSOP2, AWGS2, or SDOC exactly as published (Index/Comparator constructs), and reported sarcopenia prevalence or adjusted associations with all-cause mortality or hospitalisation (Outcomes). Risk of bias was assessed with the JBI checklist (prevalence studies) and ROBINS-E (cohort studies). Random-effects meta-analysis used Freeman–Tukey transformation for prevalence and generic inverse variance with Hartung–Knapp adjustment for hazard ratios; subgroup, meta-regression, within-cohort indirect comparison, leave-one-out, and Egger publication-bias analyses were pre-specified, whereas meta-regression was exploratory. Pooled prevalence was 11.3
