To investigate changes in MRI-measured Caton–Deschamps index (CDI) at mid- to long-term follow-up following groove-deepening trochleoplasty (TP) combined with medial patellofemoral ligament reconstruction (MPFLR) and to compare these changes between single-bundle quadriceps tendon graft (QTG) and double-bundle hamstring tendon graft (HTG) reconstruction. Seventeen patients who had undergone TP with concomitant MPFLR were analyzed retrospectively. Patellar height was assessed preoperatively and postoperatively on sagittal magnetic resonance images by three independent observers using the CDI. Preoperative and postoperative CDI values were compared using a paired t-test. CDI changes were compared between single-bundle QTG (n = 9) and double-bundle HTG (n = 8) reconstruction using an independent-samples t-test. Interobserver reliability was assessed using the intraclass correlation coefficient (ICC). The mean CDI decreased significantly from 1.06 ± 0.13 preoperatively to 0.95 ± 0.15 postoperatively (Δ = −0.10 ± 0.07; P < 0.001). Significant postoperative reductions in CDI were observed in both subgroups (QTG: P = 0.002; HTG: P = 0.004), with no significant difference in CDI change between the groups (P = 0.77). Interobserver reliability was good for single measurements and excellent for measurements averaged across the three observers. Combined trochleoplasty and MPFL reconstruction was associated with a significant postoperative reduction in MRI-measured CDI at mid- to long-term follow-up, with an average decrease of − 0.10. Whether this finding reflects true anatomical patellar distalization cannot be determined from the present study.
One of the complications of COVID-19 infection is avascular necrosis of the femoral head. To date, various studies have reported a wide range of osteonecrosis of the femoral head in patients with COVID-19. The previous systematic review included only 14 studies. So, this systematic review aims to update the findings of these studies. Databases such as PubMed, Scopus, EMBASE, PsycINFO, Web of Science, and Google Scholar were systematically searched by two independent researchers on April 1st, 2024. A literature search revealed 1229 records, 161 full-texts were evaluated, and finally, 55 studies remained for systematic review. Fifty-five studies were included in this systematic review. Four studies were cross-sectional studies, six were retrospective studies, and the remaining (45studies) were case reports or case-series studies. Totally, 864 cases were included. Except for 12 studies, 43 studies reported the administration of steroid therapy in included cases. The most common underlying conditions were hypertension, followed by diabetes. In 274 (31.7
Kinematic alignment (KA) in total knee arthroplasty (TKA) of the varus knee shows promising clinical outcomes by preserving individual joint anatomy. However, it remains unknown whether this results in knee joint kinematics that more closely resemble the native baseline condition than mechanical alignment (MA). Therefore, this study evaluated the direct influence of KA versus MA on tibiofemoral and patellofemoral kinematics and contact biomechanics in the varus knee during a standardized dynamic muscle-loaded squat. Seven fresh-frozen human cadaveric knee specimens with constitutional varus (-1.4° to -8.3°) were tested in a dynamic knee rig (30° to 130° flexion) under muscle-controlled loading. Kinematics, retropatellar contact area, peak pressure, and quadriceps force were continuously recorded across three successive states within the same specimen: native, KA TKA, and MA TKA using a medial-pivot implant design. Statistical analysis was performed using one-dimensional statistical parametric mapping, including non-parametric SnPM1D ANOVA and pairwise SnPM{F} tests for kinematics, and paired-samples SPM{t} tests for contact mechanics and quadriceps force. Between alignment techniques (KA vs. MA), no statistically significant differences emerged regarding kinematics and patellofemoral biomechanics following Holm-Bonferroni correction (all padj > 0.05). Descriptively, KA displayed a trend toward unphysiological anterior femoral translation in deep flexion (100°–120°, p = 0.028; padj = 0.084) and persistent patellar medialization (delta of up to 5 mm) compared to MA, though these did not retain statistical significance post-adjustment. Both TKA techniques significantly reduced patellar contact area (padj < 0.01), illustrating a general TKA effect rather than an alignment-specific difference. KA was not shown to restore native knee kinematics or patellofemoral mechanics more closely than MA. Descriptive kinematic variations suggest that KA does not automatically optimize functional joint mechanics when using standard implant geometries.
Reported rates of loss of reduction in nonoperatively treated distal radius fractures (DRF) range from 17 to 71
The optimal surgical treatment for cubital tunnel syndrome (CuTS) remains controversial, and comparative evidence regarding endoscopic-assisted anterior transposition is lacking. This study compared the clinical and functional outcomes of open and endoscopic decompression, evaluated open versus endoscopic-assisted anterior transposition, and identified patient-related prognostic factors associated with postoperative outcomes. Fifty-six patients who underwent surgery for CuTS between 2010 and 2023 were retrospectively reviewed. Nineteen patients underwent open in situ decompression and 37 underwent endoscopic decompression. Outcomes were assessed using Quick DASH, VAS, Wilson–Krout grading system, patient satisfaction, and job change. An additional comparative analysis was performed in patients requiring anterior transposition because of intraoperative ulnar nerve instability (open, n = 16; endoscopic-assisted, n = 11). Smoking, body mass index (BMI), occupation, and preoperative McGowan grade were evaluated as prognostic factors. Median follow-up was 138 months (range, 56–180) in the open group and 76 months (range, 27–156) in the endoscopic group. No statistically significant differences were detected between open and endoscopic decompression in postoperative Quick DASH, VAS, Wilson–Krout grades, patient satisfaction, job change, or complication rates. Among patients undergoing anterior transposition, median follow-up was 148 months (range, 60–180) after open transposition and 105 months (range, 50–156) after endoscopic-assisted transposition. No statistically significant differences were detected in postoperative Quick DASH, VAS or Wilson–Krout grades between patients who underwent open anterior transposition and those who underwent endoscopic-assisted anterior transposition. Increasing preoperative McGowan grade was associated with worse postoperative Quick DASH, VAS, and Wilson–Krout outcomes. Smoking and higher BMI were associated with less favorable Wilson–Krout outcomes, whereas occupation had no significant effect on postoperative recovery. No statistically significant differences were detected in long-term clinical and functional outcomes between open and endoscopic decompression for CuTS. Similarly, no statistically significant differences were detected between open and endoscopic-assisted anterior transposition. Greater preoperative disease severity was associated with less favorable postoperative outcomes. Given the retrospective design and limited sample size, these findings should not be interpreted as evidence of equivalence or non-inferiority between the surgical techniques.
