Objectives:To evaluate the associations between magnetic resonance imaging (MRI) findings of the anterolateral ligament (ALL) and clinical variables in patients undergoing anterior cruciate ligament (ACL) reconstruction. Methods:This retrospective multicenter study included patients with clinically confirmed ACL tears scheduled for reconstruction between January and August 2024 at three orthopedic centers in Mashhad. MRI examinations were performed using a 1.5-T scanner and interpreted by two to three experienced radiologists. Associations between MRI-detected ALL injuries and clinical variables were analyzed statistically. Results:Eighty-three patients (mean age, 29 years; 90.6% male) were included. MRI identified ALL injuries in 34 patients (41.0%), while 45 patients (54.2%) had no detectable ALL injury; four cases were unclassified. Concomitant ACL and ALL injuries were present in 41.7% of patients. A high-grade pivot shift test was positive in 54.2% of cases. Medial and lateral meniscal injuries were observed in 53.0% and 13.3% of patients, respectively, and joint effusion was present in 60.2%. Significant associations were found between ALL injury and MRI-detected effusion (P = 0.035) as well as a positive pivot shift test (P < 0.001). No significant relationships were observed between ALL injury and age, sex, or anterior drawer test findings. Conclusion:ALL injuries were significantly associated with joint effusion and positive pivot shift test results in patients undergoing ACL reconstruction. Although a possible association with posterior cruciate ligament buckling was observed, larger studies are needed to confirm this finding.
Objectives:The Merle d'Aubigné--Postel (MDP) score is a widely used patient-reported outcome measure (PROM) for assessing hip function for pain, walking ability, and mobility. Despite its widespread international use, no validated Persian version has been available to date. This study aimed to translate and culturally adapt the MDP score into Persian and evaluate its reliability and validity in Persian-speaking patients undergoing total hip arthroplasty (THA). Methods:Following Guillemin et al. guidelines, Persian translation was done using a forward--backward process, followed by expert review and pretesting with 20 patients to ensure clarity and cultural relevance. The adapted instrument was validated in 103 Persian-speaking patients who had undergone THA with at least one year of follow-up. Internal consistency (Cronbach's alpha), test--retest reliability (intraclass correlation coefficient [ICC]), construct validity (correlation with the Harris Hip Score [HHS]), criterion validity (correlation with HHS and the Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), and content validity (floor and ceiling effects) were evaluated. Inter-rater reliability for mobility was assessed by three orthopedic residents. Results:The Persian MDP score demonstrated high internal consistency (α= 0.74) and excellent test--retest reliability (ICC= 0.95; 95%CI: 0.91--0.98). Inter-rater reliability for mobility was excellent (ICC= 0.89; 95%CI: 0.82--0.94). Construct validity was supported by strong domain-specific correlations (e.g., MDP pain vs. HHS pain: r= 0.73; 95%CI: 0.62--0.81). Criterion validity was confirmed by strong correlations with WOMAC (r= 0.745; 95%CI: 0.65--0.82) and HHS (r= 0.753; 95%CI: 0.66--0.83). Content validity showed no floor effect (0%) and an acceptable ceiling effect (14.5%). Conclusion:The Persian MDP score is a valid and reliable instrument for assessing outcomes after THA in Persian-speaking patients. Its simplicity and strong psychometric properties support its use in clinical and research settings. However, the observed ceiling effect should be considered for excellent postoperative outcomes.
Objectives:Distal humerus fractures require stable fixation to restore elbow function, yet conventional plates often exhibit a geometric mismatch with bone morphology, potentially compromising biomechanical performance. Our finite element analysis (FEA) compared a novel anatomical plate designed to conform to native humeral geometry with a conventional plate for treating type B1 distal humerus fractures. The influence of meshing strategy on the outcomes was also evaluated. Both adaptive and uniform approaches were considered. Methods:A CT-based three-dimensional humerus model with heterogeneous bone properties was reconstructed from scans of a 37-year-old woman. An anatomically contoured plate was compared with a conventional locking plate. Adaptive and uniform meshing were applied separately to each model, and each construct was subsequently tested under 100 N tensile and compressive loads. Results:The anatomical plate showed higher stiffness (up to 13%), a broader contact pressure distribution (23--28 MPa vs. conventional: 12--18 MPa), and a larger area of sticking contact, whereas the conventional plate produced higher shear stresses (p=0.113). Uniform meshing generated significantly greater interfragmentary motion than adaptive meshing (p=0.008) but caused unrealistically high screw stresses (up to 1526 MPa). Adaptive meshing predicted higher bone stresses, whereas uniform meshing concentrated stresses in the screws. Although meshing affected the absolute stress and strain magnitudes, the comparative differences between plate designs remained consistent. Conclusion:The anatomically contoured plate offers greater biomechanical stability than conventional designs for distal humerus fractures, as evidenced by reduced displacement and maintained fragment positioning conducive to healing. An adaptive meshing strategy appears more suitable for FEA of complex fixation components because it yields more reliable stress distributions without altering the primary comparative conclusions. Further experimental validation is warranted before clinical application.
Postoperative infection is a rare but serious complication following anterior cruciate ligament reconstruction (ACLR). This review integrates current epidemiological trends, risk factors, and novel diagnostic and therapeutic approaches reported in the existing literature. The estimated incidence of septic arthritis (SA) after ACLR typically ranges from 0.14% to 2.6%. Male sex, smoking, hamstring autograft use, diabetes mellitus, and elevated body mass index (BMI) were identified as risk factors in earlier studies. Intraoperative presoaking of the graft in vancomycin, known as the 'vancomycin wrap' technique, has reduced infection rates and improved prophylactic practice. Diagnosis relies on patient history, physical assessment, and laboratory findings, including synovial fluid analysis and C-reactive protein (CRP). Management often involves urgent arthroscopic debridement and individualized antibiotic treatment, with the primary aim of preserving the ACL graft. Although graft retention is successful in many cases, persistent infection may require graft removal, which is associated with poorer outcomes.
Objectives:The accurate quantification of hip deformities in medical images presented a significant challenge for radiologists. Inaccurate quantifications can lead to misclassification of diseases and improper treatment. This study introduced two-stage deep learning (DL) models designed for the detection of landmarks in hip X-ray images, aiming to improve the accuracy of deformity quantification. Methods:This study employed two two-stage deep learning (DL) models based on VGG16 and ResNet50. The first stage aimed to detect the bounding box for each landmark, while the second stage focused on pinpointing the exact location of the landmark within the magnified box. The model automatically identified 16 hip landmarks and measures 12 specific dimensions on each side. Training, validation, and testing were conducted on a dataset comprising 854 3-joint lower limb X-ray images depicting various anomalies. Results:The model's measurements were compared with those obtained manually to evaluate performance. The resulting average error ranged from 0.56 to 2.33 mm for different landmarks in the ResNet50-based model. The most accurate measurements were obtained for the femoral head radius and shaft width, with average errors of 0.49 mm and 0.64 mm, respectively. Conversely, the least accurate results were observed for the alpha angle, with an error of 7.37°. Conclusion:This dataset can be valuable for diverse research endeavors related to the hip region. The 2-stage model demonstrated a brief learning time due to the small image size loaded in both steps, while also offering high precision through the use of a bounding box.
Objectives:To evaluate the outcomes of open reduction and internal fixation (ORIF) in older adults with acetabular fractures, with a focus on postoperative complications, mortality, and conversion to total hip arthroplasty (THA). Methods:We systematically reviewed studies published between September 2013 and February 2025 in Web of Science, PubMed, Embase, Scopus, and the Cochrane Library. Studies reporting postoperative outcomes of ORIF in elderly patients aged ≥65 years were included. Data extraction and quality assessment were performed independently by two reviewers. Statistical analyses were conducted using Comprehensive Meta-Analysis software, version 3.0. Results:Twenty-one studies involving 2,410 patients were included in the analysis. Follow-up duration ranged from 12 to 96 months. The pooled mortality rate after ORIF was 11.0% (95% CI: 7.0%--16.7%). The pooled complication rate was 26.5% (95% CI: 21.3%--32.4%), and the pooled rate of conversion to THA was 20.0% (95% CI: 15.2%--26.0%). The pooled infection rate was 5.8% (95% CI: 4.2%--7.9%). Fixation failure occurred in 12.6% of patients (95% CI: 9.8%--15.9%) and was primarily attributed to secondary loss of reduction, implant loosening, or hardware breakage, often requiring revision surgery or conversion to THA. Conclusion:ORIF in elderly patients with acetabular fractures is associated with substantial risks, including a high complication rate and a notable likelihood of conversion to THA. Alternative treatment strategies, such as primary THA or nonoperative management, should be considered in selected patients.
Pectoralis major tendon (PMT) ruptures are increasingly seen in athletes, particularly weightlifters, often requiring surgical repair to restore function. Current surgical techniques may be limited by poor tendon quality or significant retraction. We present a novel approach combining unicortical button fixation with DX Reinforcement Matrix augmentation in a competitive weightlifter with a complete PMT rupture and contralateral pectoralis dysfunction. Intraoperatively, the tendon was augmented with a DX Matrix and fixed using a unicortical button to restore the anatomic footprint and reduce repair tension. The patient underwent structured rehabilitation and returned to full activity within six months. MRI at 12 months showed intact tendon healing at the anatomical footprint without graft failure or retraction. The Oxford Shoulder Score was 48 at six months, indicating high patient satisfaction. This technique is designed to provide a biomechanically robust and biologically supportive solution for complex PMT repairs and may improve outcomes, particularly in high-demand individuals. Further evaluation in larger cohorts is needed.
Objectives:The use of antibiotic-loaded bone cement (ALBC) is a common strategy for preventing periprosthetic joint infection (PJI) after total knee arthroplasty (TKA); however, its effectiveness remains controversial. This study aimed to provide a clear, evidence-based recommendation regarding the use of ALBC versus plain bone cement (PBC) for the prevention of PJI after TKA. Methods:This systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 reporting guidelines. PubMed, Embase, and Scopus were searched to identify relevant studies evaluating PJI in patients who received ALBC versus PBC. Eligible studies were screened, selected, and assessed for risk of bias using appropriate checklists. Random-effects meta-analyses were performed to calculate odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the I² statistic. The effects of antibiotic type and dose were examined through subgroup analyses. Meta-regression was performed to evaluate the effects of age, sex, follow-up duration, and diabetes mellitus on the occurrence of PJI. Results:Eighteen studies including 72,928 TKAs (20,201 in the ALBC group and 52,727 in the PBC group) were included. The overall analysis showed no significant difference in PJI rates between the ALBC and PBC groups (OR, 0.92; 95% CI, 0.67-1.27; p = 0.6). However, cefuroxime-loaded cement was associated with a significantly lower risk of PJI (p = 0.01). In contrast, cement containing gentamicin (p = 0.08), vancomycin (p = 0.3), or tobramycin (p = 0.6) did not show a similar protective effect. Antibiotic dose, age, sex, diabetes mellitus, and follow-up duration did not appear to influence the results. Conclusion:Most ALBC formulations were not associated with a significant reduction in the risk of PJI. Larger, dedicated trials are needed to further evaluate the effect of ALBC on PJI risk in selected patient populations.
Objectives:Two frequently used surgical interventions for knee joint osteoarthritis include closing wedge high tibial osteotomy (CW-HTO) and opening wedge high tibial osteotomy (OW-HTO). Studies showed that, most to near all cases lead to failure, requiring a total knee arthroplasty (TKA). This systematic review aimed at answering this question: What are the outcomes of TKA following CW-HTO and OW-HTO? Methods:The main electronic databases were searched up to November 2025. Only studies that included comparative arms for both closing-wedge high tibial osteotomy (CW-HTO) and opening-wedge high tibial osteotomy (OW-HTO) were considered for further assessment. The primary outcomes included knee joint function scores, such as the International Knee Society (IKS) score and the Knee Society Score (KSS). A meta-analysis was not feasible because of heterogeneity in the reported data and follow-up periods. The Joanna Briggs Institute (JBI) critical appraisal tool was used to assess the methodological quality of each included study. Results:Of the 6,756 records identified and screened, three comparative clinical studies, including a total of 541 TKA cases, were included in this systematic review. Two studies reported no significant difference in KSS or range of motion after TKA between patients who had previously undergone CW-HTO and those who had undergone OW-HTO. However, one study reported improvements in walking ability in both groups after 80-90 months of follow-up. Post-operative complication rates were comparable between groups (OW-HTO: 12.3% vs. CW-HTO: 8.3%); however, one study noted a significantly higher incidence of specific complications, such as skin necrosis and nerve injury, in the CW-HTO cohort (12% vs. 6%, P<0.05). Intra-operative complications were rare, affecting 2.8% of cases with no significant between-group difference. Conclusion:The limited available evidence precludes definitive conclusions. Current data suggest potential benefits after TKA following either CW-HTO or OW-HTO, including earlier relief of joint loading, shorter recovery time, and improved clinical outcomes, with no significant differences in clinical outcomes and complications between the two HTO techniques.
Bone is a mineralized connective tissue composed of osteoblasts, osteocytes, and osteoclasts, and its integrity is essential for structural and physiological function. Defects arising from trauma, tumors, or developmental abnormalities often require surgical reconstruction to restore normal performance. Autografts and allografts have long served as standard treatments for bone repair, however, their usefulness is restricted by limited availability, donor‑site complications, and the potential transmission of underlying diseases. These challenges have accelerated interest in bone tissue engineering (BTE) as an alternative strategy capable of enhancing regeneration while reducing postoperative risks. Advances in three‑dimensional (3D) printing have introduced powerful technique for fabrication of scaffolds with precisely controlled architectures and tunable mechanical and biological characteristics. This technology enables the creation of porous constructs that mimic the structural complexity of native bone, supporting cell infiltration, nutrient transport, and vascularization. Effective scaffolds for BTE must demonstrate biocompatibility, biodegradability, appropriate strength and stiffness, and the ability to promote osteogenesis and angiogenesis. Among natural polymers, alginate (Alg) has become a prominent candidate due to its inherent biocompatibility, degradability, abundance, low cost, and non‑immunogenic nature. Its versatility makes it suitable for developing customized 3D‑printed scaffolds. Additionally, bioactive glasses (BGs) are widely incorporated into composite scaffolds because their composition closely resembles the mineral phase of bone. BGs significantly enhance osteoconductivity, support mineral deposition, and can improve the mechanical resilience of polymer-based constructs. This review highlights recent progress in 3D‑printed Alg-based scaffolds for BTE, emphasizing how advanced fabrication techniques and BGs incorporation contribute to improved biological performance and structural reinforcement.
Objectives:Fast-track or enhanced recovery after surgery (ERAS) pathways have been increasingly adopted in total knee arthroplasty (TKA) to optimize perioperative care, yet their comparative effectiveness and safety relative to routine pathways remain incompletely defined. This systematic review and meta-analysis compared the effects of fast-track versus routine perioperative care on length of hospital stay (LOS), postoperative pain, complications, and readmissions in patients undergoing primary TKA. Methods:A systematic search of PubMed, Embase, Cochrane Library, Scopus, and Web of Science was performed from inception to January 2025 using MeSH terms. Primary outcomes were LOS and postoperative pain, with complications and readmissions assessed as secondary outcomes. Risk of bias was assessed using Cochrane RoB 2 for RCTs and ROBINS-I for non-randomized studies. A random-effects meta-analysis was conducted due to anticipated heterogeneity. Results:Nine studies (total 2607 patients) met inclusion criteria. Fast-track care significantly reduced LOS (WMD: -2.41 days, 95% CI: -3.18 to -1.64). Postoperative pain was slightly higher in the fast-track group at 24h (MD: 0.98, 95% CI: -0.1 to 2.05) and at 2 weeks (MD: 0.33, 95% CI: -0.04 to 0.7), neither reaching statistical significance. Methodological quality was limited, with moderate to serious risk of bias in non-randomized studies and high risk of bias in all randomized trials. Conclusion:Overall, the available evidence suggests that fast-track rehabilitation following TKA substantially reduces hospitalization without clinically meaningful or sustained increases in postoperative pain. These findings support the use of fast-track pathways to enhance perioperative efficiency in TKA, while highlighting the need for higher-quality randomized studies to better define their effects on pain and safety outcomes.
Objectives:This study hypothesizes that, in patients undergoing four-corner fusion (4CF) surgery, the choice of fixation method-either headless compression screw (HCS) or staples (ST)-will not significantly impact postoperative complication rates, union rate, and functional outcomes. Methods:A retrospective chart review was conducted on patients who underwent 4CF for scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC) wrist at a single institution over thirteen years. Functional outcomes included postoperative complications, nonunion, subsequent surgery, wrist flexion-extension range of motion (ROM), Quick Disabilities of Arm, Shoulder & Hand (QuickDASH) score, and the 12-Item Short Form Survey (SF-12). Results:Thirty-seven patients were identified with an average follow-up of 9.1 months (range: 3-24 months). Nineteen patients were treated with HCS, and 18 were treated with ST. There were no significant differences in the complication rates between the HCS and ST groups (P=0.73). In the HCS group, the main complications were pain (n=4), subsequent surgeries for revision or hardware removal (n=3), and nonunion (n=2). For the ST group, these were pain (n=5), subsequent surgeries for revision or hardware removal (n=5), and hardware loosening (n=4). Postoperatively, wrist flexion and extension ROM did not significantly change in either group. QuickDASH improved postoperatively in both groups (P<0.005). Only the ST group improved in the SF-12 physical component postoperatively (P=0.01). Conclusion:In this small, retrospective case series with short follow-up, fixation choice between HCS and ST in 4CF for SLAC or SNAC did not significantly impact complication rates or functional recovery. Postoperative complications occurred at similar rates, with pain and the need for subsequent surgery being the most common.
Objectives:This study investigated the relationship between knee pain severity and functional performance, as well as hip and knee muscle strength and trunk endurance, in individuals with patellofemoral pain syndrome (PFPS). Methods:This cross-sectional study included 50 participants diagnosed with PFPS. An 11-point visual analog scale (VAS) was used to assess the severity of knee pain, and the Anterior Knee Pain Scale (AKPS) was used to quantify functional ability. Hip extensors, abductors, medial and lateral rotators, and knee extensors were tested for strength using a handheld dynamometer. Trunk endurance was assessed through plank tests in anterior, posterior, and lateral positions. Results:A significant inverse relationship was identified between pain intensity and functional performance (r = -0.504, p < 0.001). Body mass index (BMI) exhibited a negative relationship with performance (B = -7.459, p = 0.021). Knee extensor strength (B = 0.156, p < 0.0001) and lateral plank endurance (B = 1.457, p = 0.002) showed a positive relationship with functional performance. Conclusion:Higher pain levels and BMI were related to poorer function in individuals with PFPS. In contrast, greater quadriceps strength and increased lateral core endurance were correlated with better functional outcomes.
The simultaneous double dislocation of the distal interphalangeal joint (DIPJ) and proximal interphalangeal joint (PIPJ) in one finger is a rare injury. We present the case of a right-hand dominant male in his late teens who sustained a hyperextension injury to the tip of his left ring finger while playing football. A physical examination followed by anteroposterior and lateral radiographs confirmed dorsal dislocations at both the PIPJ and DIPJ in a "stepladder" deformity. His finger was subsequently splinted for 1 week after which hand physiotherapy was initiated. At 6 weeks follow-up, the patient demonstrated full functional recovery with a full range of motion in both DIPJ and PIPJ with no pain or stiffness. We also provide an up-to-date review of PubMed-indexed case reports regarding simultaneous double dislocations of the DIPJ and PIPJ.
The existing literature on bone fractures in people with hemophilia (PWH) states that they should be treated in the same way as in healthy individuals but with perioperative hemostasis control through intravenous infusion of the deficient coagulation factor (factor VIII in hemophilia A, factor IX in hemophilia B) at appropriate doses and for the necessary duration. It has also been found that fractures in PWH are more frequent than in normal individuals, probably due to suffering from osteoporosis. The healing time for fractures in PWH is similar to that of the general population. It should be noted that some fractures in PWH are pathological due to the presence of hemophilic pseudotumors that cause erosion of the affected bone. These fractures should also be treated as pathological fractures of any other etiology. Finally, the risk of acute compartment syndrome associated with bone fractures in PWH should never be forgotten.
Objectives:This study aimed to evaluate the Pelvico-Sacro-L1 angle (PSLA) as a direct parameter for assessing PI-LL mismatch as a key determinant of sagittal balance. Methods:In this retrospective study, adult patients scheduled for total hip arthroplasty (THA) underwent spinopelvic lateral radiography. The pelvic sagittal line angle (PSLA) was defined as the angle between a line drawn from the center of the femoral head to the center of the superior endplate of S1 and the superior endplate of L1. The deviation from 90° was termed the modified PSLA, proposed as an alternative to the pelvic incidence-lumbar lordosis (PI-LL) mismatch. Two independent orthopaedic surgeons measured the spinopelvic parameters and repeated the assessments four weeks later to evaluate intraobserver reliability. Results:A total of 92 patients (average age: 57.4 ± 9.9 years, 50 females) were included. The Bland-Altman plot indicated no significant systematic difference between the two measurement sets, suggesting good agreement between methods. The intraclass correlation coefficient (ICC) for PSLA in both inter- and intraobserver reliability was greater than 0.9, indicating excellent agreement. Conclusion:The PSLA demonstrated a strong agreement with the PI-LL mismatch, confirming the reliability of this approach, which provides a more straightforward and easily interpretable measurement.
Objectives:This approaches, for inducing knee osteoarthritis (KOA) in rabbit and rodent models. It also summarizes data study evaluates surgical, mechanical, chemical, genetic, and diet-induced methods, as well as combination-based on post-intervention time points for KOA development, the duration required for osteophyte formation, KOA scoring systems, and relevant histopathological findings. Methods:A systematic search of PubMed, Scopus, and Web of Science (from 1970 to February 2025) was conducted using the PICO framework, focusing on animal models (rabbits and rodents), osteoarthritis induction methods, comparative efficacy, and relevant outcomes. Extracted variables included model characteristics, interventions, and KOA-related findings. The risk of bias was assessed using the Cochrane risk-of-bias tool and the ROBINS-I tool. Results:After screening 5,702 records, 98 studies met the inclusion criteria. Surgical (n = 34), chemical (n = 15), genetic (n = 13), mechanical (n = 19), and high-fat diet-induced (n = 6) models, as well as combination approaches, were reviewed. Among surgical techniques, anterior cruciate ligament transection (ACLT) and medial meniscus destabilization (DMM) were the most frequently used, whereas monosodium iodoacetate (MIA) was the predominant chemical inducer. Genetic models primarily involved gene deletions or mutations in C57BL/6 mice. Mechanical induction methods included joint loading, treadmill running, and immobilization. Histological evaluation-most commonly using the Mankin and Osteoarthritis Research Society International (OARSI) scoring systems-was the predominant approach for KOA assessment, while micro-computed tomography (micro-CT) was employed in selected studies. Osteophyte formation was prominent in surgical and specific chemical models and was typically observed within 8 weeks post-intervention. Additionally, each induction method exhibited a distinct time course for osteophyte development and the establishment of KOA. Conclusion:Each approach offers distinct advantages for replicating KOA pathology and for facilitating research into disease mechanisms and therapeutic interventions.
Medial meniscus ramp lesions have emerged as a critical but frequently overlooked contributor to knee instability, particularly in the context of anterior cruciate ligament (ACL) injuries. Recent advances in imaging and arthroscopic techniques have improved their detection and classification, enhancing our understanding of their anatomical and functional significance. Evidence indicates that untreated ramp lesions may perpetuate instability and alter knee biomechanics, underscoring the need for structured, individualized treatment. Although multiple arthroscopic repair strategies have been proposed, the optimal technique remains debated. The posterior portals approach offers superior visualization and reliable repair, and has gained increasing adoption. This review synthesizes current insights into ramp lesion pathophysiology, classification, diagnostic advances, and evolving management strategies, emphasizing the importance of accurate identification and tailored intervention to optimize patient outcomes.
