BACKGROUND:Patient comorbidities and medication intake impact on the mortality rate in revision surgery for periprosthetic joint infection (PJI) of the lower limb. The present study collected data from patients who underwent revision surgery for PJI of total hip arthroplasty (THA) or total knee arthroplasty (TKA). Data regarding comorbidities and medication intake for each patient were collected to investigate whether comorbidities and medication intake influence in-hospital mortality in patients who underwent revision surgery for PJI of a THA or TKA. METHODS:The present study follows the STROBE Statement. Our institutional databases were searched using the OPS (operation and procedure codes) 5-823 and 5-821 in combination with the ICD (International Statistical Classification of Diseases and Related Health Problems) codes T84.5, T84.7 or T84.8. All patients with hip or knee implant infections who underwent revision surgery were retrospectively retrieved and included in the present study. RESULTS:Data from 346 patients were collected (181 THAs and 165 TKAs). Patients with renal insufficiency demonstrated a statistically significant greater risk of in-hospital mortality (95% CI 0.0131 to 0.1132), as did patients with a history of malignancy (95% CI 0.1478 to 0.7497), and patients with dementia (95% CI 0.0398 to 0.3791). Nicotine and alcohol abuse, diabetes mellitus, arterial hypertension, hereditary thrombophilia, hereditary haemorrhages, cerebrovascular diseases, coronary heart diseases, chronic obstructive pulmonary disease osteoporosis, liver cirrhosis, rheumatoid arthritis, acute dental infection did not influence in the in-hospital mortality rate in patients who underwent revision surgery for PJI of a THA or TKA. Patient medication therapy did not impact the risk of in-hospital mortality in PJI. CONCLUSION:Patients undergoing revision surgery for PJI after total hip and knee arthroplasty show an increased in-hospital mortality in the presence of the following comorbidities: dementia, renal insufficiency, and history of malignancy. Based on the present results, further infection prevention and geriatric co-management strategies should be evaluated for patients undergoing revision arthroplasty of the hip and knee for PJI.

BACKGROUND:Age-related varus remodeling of the proximal femur is well recognized, but its anatomical center of rotation remains unclear. Varus proximal femoral morphology plays a relevant role in fracture patterns, implant positioning, and surgical exposure in geriatric trauma surgery. We investigated whether correlations between the caput-collum-diaphyseal angle (CCD) and trochanteric rotation/offset parameters indicate a subtrochanteric origin of femoral varisation. METHODS:100 CT angiographies of the pelvis-leg axis from patients of different ages were analyzed. CCD and the critical trochanter angle (CTA) were assessed in their conventional and modified forms (mCCD/mCTA). Additional parameters included greater (OGT/OGTI) and lesser trochanter offsets (OST/OSTI), femoral antetorsion, and trochanteric anteversion/retroversion. Bone quality was classified according to Dorr. RESULTS:mCCD showed a significant negative correlation with age, confirming increasing varus alignment in older individuals. CTA and mCTA positively correlated significantly with both CCD and mCCD (CTA/CCD: p = 0.005 and CTA/mCCD p < 0.001; mCTA: with both CCD & mCCD p < 0.001), indicating that increased medial trochanteric overhang is strongly associated with varus morphology. OGT and OGTI demonstrated strong positive correlations with CCD and mCCD (OGT: with both p < 0.001, OGTI: with both p = 0.001), whereas OST and OSTI correlated negatively with CCD (p = 0.032 and p = 0.02), reflecting a decrease in greater trochanter offset and an increase in lesser trochanter offset with progressive varisation. Posterior trochanteric orientation (PTO) of the greater trochanter correlated positively with CCD/mCCD, indicating reduced retroversion in varus hips. In contrast, femoral neck anteversion and anterior trochanteric anteversion showed no significant correlation with CCD parameters (p = 0.889 and p = 0.125). Lower CCD values were significantly associated with more osteoporotic Dorr types (Kendall's Tau: -0.212 for CCD, p = 0.008; -0.197 for mCCD, p = 0.014). CONCLUSION:Correlation patterns suggest that age-dependent varisation occurs predominantly in the subtrochanteric region. This morphology may complicate exposure and stem alignment in total hip arthroplasty in varus hips and should influence implant selection, stem design and fracture-related implant strategies in elderly patients.

Introduction: We aimed to identify and explore the psychological and physical strains that caregivers of patients suffering from a periprosthetic joint infection (PJI) experience. Methods: Twenty-four qualitative semi-structured interviews with people giving care to patients suffering from a PJI were conducted by a single trained interviewer. The interviews were used to identify physical and emotional challenges that caregivers were confronted with. Results: The psychological and physical strains caregivers reported were wide-ranging and included suffering from stress and anxieties, and feelings of hopelessness and helplessness while having to function all the time to the point where, subjectively, caregivers felt as if they gave themselves up. Caregivers were suffering from mental and physical exhaustion as mainly family members and close ones provided the caregiving. Oftentimes an elaborate team effort approach was needed to lighten the caregiving burden. Conclusions: This study shows that caregivers are willing to go above and beyond for their loved ones, while exhausting and exceeding their individual resources. Caregivers of PJI patients deal with major issues. Specifically, we identified (1) conflicts regarding the hospital stay, (2) novel personal challenges, (3) nursing, (4) emotional and psychological consequences, and (5) effects on the relationship. Our research shows that there is a profound need for support during and after hospitalisation, and caring for a PJI patient seems surprisingly similar to caring for a cancer patient. We recommend including the caregivers of PJI patients, and how to better support them, into the PJI treatment guidelines.

Abstract Background Bibliometric analyses are increasingly used to explore how scientific knowledge is created, disseminated, and perceived. In orthopaedics, research output has expanded rapidly over the past decade, yet the factors determining whether an article achieves wide visibility and scholarly impact remain poorly understood. Beyond the inherent quality of a study, elements such as authorship patterns, title construction, and open access (OA) availability may play an essential role in shaping citation performance. However, evidence in this field is still limited and sometimes contradictory, highlighting the need for large-scale, field-specific analyses. Methods Orthopaedic publications from 2010 to 2020 were identified in Scopus using the keyword ‘orthopaedic’. After duplicate removal, 97,806 unique articles were included with complete data on authorship, titles, citation counts, study design, and OA status. Citation rates were normalised per year since publication. Associations between bibliographic features and citation performance were assessed using multiple linear regression, while differences across title styles and study designs were evaluated with comparative statistical testing. Exploratory modelling was performed to identify combinations of authorship and title characteristics linked to the highest predicted citation rates. Results Larger author teams were associated with higher citation rates (β = 0.108 citations/year per additional author, 95% confidence interval [CI] 0.103–0.114, p < 0.001). OA articles achieved a mean increase of 0.175 citations/year compared with non-OA (p = 0.001). Title length in characters correlated positively with citation rate (β = 0.023 per character, p < 0.001), whereas title length in words showed a negative association (β = −0.183 per word, p < 0.001). The presence of a colon (+0.314 citations/year, p < 0.001) or dash (+0.187, p = 0.001) increased citation performance, while question marks (−0.476, p < 0.001) and all-capital titles (mean 0.71 citations/year) reduced it. Regarding study design, network meta-analyses achieved the highest citation rate (mean 6.64 citations/year), followed by systematic reviews (5.66), meta-analyses (5.08) and narrative reviews (4.81). Randomised controlled trials (3.90) and clinical trials (3.86) performed at an intermediate level, whereas observational studies (2.40), case series (1.79), technical notes (1.33), case reports (0.77), editorials (0.51) and commentaries (0.25) showed consistently lower citation performance (p < 0.0001). Conclusions In orthopaedic research, collaboration, OA availability and concise, well-structured titles with selected punctuation contribute to higher citation performance, while unconventional title formatting reduces visibility. Although useful for optimising dissemination, ethical authorship practices and rigorous scientific standards remain more critical than citation metrics.

Abstract The macroscopic biomechanical characteristics of soft and ultrasoft tissues, such as articular cartilage and vocal folds, significantly determine their physiological function. Treatments of widespread tissue degradations due to osteoarthritis in the knee or vocal fold impairment remain an unresolved challenge. For the design of implants for tissue repair after injury or disease, it is key to thoroughly understand the unique biomechanical properties of native tissues and potential substitute materials. We use multimodal mechanical testing methods combined with hyperelastic nonlinear continuum mechanics modeling, and finite element simulations to determine the macroscopic behavior of surrogate materials for human articular cartilage in the knee and human vocal folds. Our cyclic loading experiments reveal qualitative similarities for both tissues and their surrogates, including a nonlinear stress-strain behavior, hysteresis, and conditioning. We demonstrate the tunability of biomimetic and biosimilar stiffnesses of synthetic articular cartilage and vocal fold surrogates through tissue-specific process-material combinations. Our results demonstrate the feasibility of synthetic metamaterials in replicating essential passive biomechanical functions with great potential for future treatment options.

Background:Anterior cruciate ligament (ACL) injuries are among the most common knee injuries. Treatment options include conservative management as well as surgical repair and reconstruction. Given the well-documented risk of secondary joint damage, such as meniscal injury, cartilage degeneration, and the progression to osteoarthritis in persistently unstable knees, ACL reconstruction has become a widely accepted standard of care. Various surgical techniques have been developed. Among these, anteromedial femoral tunnel drilling has gained increasing attention as a more anatomic alternative to the transtibial technique, with the potential to overcome its limitations and improve clinical outcomes. Methods:An umbrella review of meta-analyses was conducted in accordance with established methodological standards. Meta-analyses of randomised controlled trials (RCTs) directly comparing anteromedial (transportal) and transtibial femoral tunnel drilling techniques in primary ACL reconstruction were included. Quantitative data were extracted for patient-reported outcome measures (PROMs) and consistently reported clinical endpoints, including subjective and objective International Knee Documentation Committee (IKDC) scores, Lysholm and Tegner scores, graft failure rates, instrumented laxity, and clinical stability tests (Lachman and pivot-shift tests). Pooled effect estimates with corresponding confidence intervals were calculated using random-effects models. Between-study heterogeneity was assessed using the I2 statistic, and the robustness of the findings was evaluated through sensitivity analyses. Results:Four level I meta-analyses were included. Graft failure rates did not differ significantly between anteromedial and transtibial drilling techniques (RR 0.67, 95% CI 0.42-1.09). Functional outcomes were largely comparable, with no significant differences observed in objective IKDC, Lysholm, or Tegner scores; subjective IKDC scores demonstrated only a small advantage for the anteromedial technique (MD 1.02, 95% CI 0.04-2.00). In contrast, anteromedial drilling was consistently associated with improved clinical stability, reflected by higher rates of negative Lachman (RR 1.12, 95% CI 1.05-1.19) and pivot-shift tests (RR 1.17, 95% CI 1.10-1.24). Sensitivity analyses confirmed the robustness of the stability outcomes, whereas functional measures appeared more susceptible to heterogeneity. Conclusions:Anteromedial femoral tunnel drilling in ACL reconstruction confers superior rotational knee stability compared with the transtibial technique; however, this biomechanical advantage fails to translate into clinically meaningful improvements in functional outcomes or patient-reported measures.

Abstract Background Orthopaedics, as a surgical speciality with a structurally narrower citing audience and lower citation density than general medicine, is systematically disadvantaged in any cross-disciplinary comparison relying on absolute citation counts. Whether this disadvantage is stable or has changed over time has not been previously quantified. Methods The 100 most-cited articles indexed in the Web of Science Core Collection were identified for medicine and orthopaedics in 2014 and 2024. Citation data were extracted from a single snapshot taken on 19 January 2026. Total citations and citation velocity, defined as citations per year since publication, were compared between fields and across time points using Mann-Whitney U tests. Ratio-based analyses and distributional characteristics were also assessed. Results Median citation counts were substantially higher in medicine than in orthopaedics in both years, reaching 5055 versus 288 in 2014 and 720.5 versus 34.0 in 2024, corresponding to 17.6- and 21.2-fold differences, respectively. Citation velocity followed the same pattern, with medicine maintaining an approximately 17- to 21-fold advantage at both time points. Within-field temporal analysis showed that citation velocity remained broadly stable in medicine between cohorts, whilst orthopaedics demonstrated reduced early citation accrual in the more recent cohort. Citation distributions were more right-skewed in medicine, with a small number of articles accounting for a disproportionate share of total citations, whereas orthopaedic citations were more evenly distributed across the top 100. Conclusions Orthopaedics demonstrated substantially lower citation performance than general medicine articles, and this gap appeared to persist over time.

Abstract Background: Anatomical characteristics and landmarks are of overarching importance for many surgical procedures. The anatomical characteristics of the medial femoral condyle are of great clinical relevance, since they include the origin and attachment surfaces of many knee joint stabilizing structures. The surgical repair technique of the medial patellofemoral ligament (MPFL) with X-ray assistance has been described as a difficult method due to uncertain femoral placement. This study aimed to determine the diagnostic value and applicability of ultrasound for the femoral origin and landmark definition of the MPFL. Methods: To evaluate anatomical landmarks of the MPFL attachment area, a linear ultrasound probe with musculoskeletal pre-set was used to determine the identifiability, size, and special relationship of the adductor tubercle and the medial femoral epicondyle (ME). Measurements were carried out in 30 knee joints of healthy adult participants ( n participants = 15). Intra- and interobserver reliability were assessed within three different measurement time points and between two investigators . Results: The ME could be visualized in 94.5% and the tuberculum adductorium in 99.4% of all cases. Intrarater reliability was assessed with an intraclass correlation coefficient (ICC) score of 0.96. Interrater reliability demonstrated an ICC score of 0.94 for the measured mean values. Conclusion: Ultrasound seems to be an applicable and useful noninvasive tool to reliably identify the MPFL attachment area using the adductor tubercle and the ME as bony landmarks. Our findings emphasize the potential role of ultrasound in the assessment of bony anatomical landmarks, offering implications for MPFL reconstruction techniques.

Hip arthroscopy has been established as a successful management for femoroacetabular impingement (FAI) syndrome. Patient-reported outcome measures (PROMs) are frequently used to assess treatment results in patients. However, clinically important outcome values have recently been calculated to better understand and interpret PROMs and define successful treatment. This systematic review aimed to investigate the minimal clinically important difference (MCID), patient-acceptable state (PASS), substantial clinical benefit (SCB), and minimally detectable change (MIC) of the most commonly used PROMs for assessing patients who have undergone arthroscopic surgery for FAI. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the 2020 PRISMA statement. In October 2025, the following databases were accessed: PubMed, Web of Science, and Embase. All clinical studies investigating tools to assess the clinical relevance of PROMs used to evaluate patients who have undergone arthroscopic surgery for FAI were accessed. Only studies that assessed the minimal MCID, PASS, SCB, and/or MIC were considered. The methodological quality of the 21 included studies was assessed, and the overall risk of bias was found to be low-to-moderate. The main characteristics of the included studies were analyzed and summarized. In addition, we determined the MCID, PASS, SCB, and MIC of the hip injury and osteoarthritis outcome score (HOOS), short form 36 (SF-36), modified Harris hip score (mHHS), nonarthritic hip score (NASH), Copenhagen hip and groin outcome score (HAGOS), hip outcome score (HOS), international hip outcome tool-12 (iHOT-12), international hip outcome tool-33 (iHOT-33), University of California, Los Angeles Score (UCLA), visual analogue scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores for arthroscopic hip surgery. This systematic review provides clinically important outcome values, such as the MCID, PASS, SCB, and MIC, for the most commonly used PROMs in arthroscopic hip surgery, based on data from 21 studies involving 5687 patients. The calculated values for the MCID, PASS, SCB, and MIC could be helpful for future clinical trials investigating the outcomes of hip arthroscopy in patients with FAI. However, given the heterogeneity of the included studies, their predominantly nonrandomized designs, and differences in PROMs, follow-up intervals, and calculation methods, these findings should be interpreted with caution. Level of evidence Level IV, systematic review.

Background: Postoperative pain management after total knee arthroplasty (TKA) is crucial for promoting early recovery. Advances in pain management techniques have significantly improved outcomes after TKA. Recently, multimodal analgesia has emerged as a key concept in pain management following TKA, using regional anaesthesia to reduce narcotic use and minimise narcotic-related side effects. This Bayesian network meta-analysis compared different treatment options for the management of postoperative pain following primary TKA. Methods: This study was conducted following the 2020 PRISMA statement. In January 2025, all randomised controlled trials (RCTs) related to postoperative pain management following TKA were accessed. Pain reported on postoperative days (PODs) 1–3 was evaluated. Results: Data from 7199 patients were retrieved. Of these, 63.2% (4232 of 6691) were women, and the mean age was 66.7 ± 3.1 years. The mean length of follow-up was 10.2 ± 18.3 weeks. At baseline, comparability was confirmed for age (p = 0.1), BMI (p = 0.8), and visual analogue scale (VAS, p = 0.1). On POD 1, single-shot SNB/three-in-one block was associated with a lower VAS, followed by continuous intra-articular analgesia/local infiltration analgesia (LIA)/posterior capsule infiltration (PCI) and continuous femoral nerve block (FNB)/intermittent SNB. On POD 2, continuous intra-articular analgesia/LIA/PCI was associated with a lower VAS, followed by continuous FNB/PCI and single-shot femoral triangle block (FTB)/single-shot infiltration between the popliteal artery and capsule of the knee (IPACK). On POD 3, continuous ACB was associated with a lower VAS, followed by continuous intra-articular analgesia/LIA/PCI and continuous FNB/PCI. Conclusions: Continuous intra-articular analgesia/LIA/PCI was associated with the best pain control following primary TKA. Multimodal analgesia, which incorporates peripheral nerve blockade and periarticular injections, has become a key concept in contemporary pain management following TKA.

BACKGROUND:This systematic review and meta-analysis was performed to evaluate the impact of reduction mammaplasty (RM) on back pain and postural changes in patients with macromastia. METHODS:A comprehensive literature search (using PubMed, Google Scholar, Embase, and Scopus) was conducted in November of 2024 according to the 2020 PRISMA statement. Both prospective and retrospective studies examining the effects of RM on back pain and posture were included. Primary outcomes were changes in back pain, spinal alignment (thoracic kyphosis and lumbar lordosis), and postural control. RESULTS:A total of 47 studies met the inclusion criteria for systematic review, with 25 contributing to different meta-analyses ( n = 4677). The mean age was 38.6 ± 3.0 years, the mean body mass index was 27.57 ± 2.06 kg/m 2 , and the mean follow-up was 27.4 ± 25.5 months. All studies assessing back pain reported relief after RM. A meta-analysis of 7 studies ( n = 393) using the visual analog scale showed a significant reduction in back pain (mean difference, 5.01 [95% CI, 3.11 to 6.91]; P < 0.01). A separate quantitative analysis of 12 studies ( n = 1380) using a dichotomous end point (improvement in back pain versus no improvement) found that 90% of patients experienced significant back pain relief (95% CI, 86% to 93%). Thoracic kyphosis, assessed in 4 studies ( n = 126), improved significantly (mean difference, 1.5 degrees [95% CI, 0.23 to 2.76 degrees]; P = 0.02), whereas changes in lumbar lordosis ( n = 126) were less consistent (mean difference, 0.26 degrees [95% CI, -0.07 to 0.60 degrees]; P = 0.13). Postural control data are exploratory due to the limited number of comparable studies. CONCLUSIONS:RM appears to be an effective intervention for alleviating chronic back pain and improving thoracic kyphosis in patients with macromastia. Further research is needed to clarify its effects on postural control.

Articular cartilage serves an important mechanical function in the human body. For the design of implants for cartilage repair after injury or disease, it is key to thoroughly understand the unique mechanical properties of the native tissue. Here, we use multimodal mechanical testing combined with poro-viscoelastic modeling, finite element simulations, and histology to characterize the region-specific macroscopic large-strain mechanical properties of healthy and osteoarthritic human articular cartilage as well as their relation to the underlying microanatomy. We individually characterize tissue from medial and lateral sides, respectively, of the human femoral condyle and tibial plateau. Our results show that there are no significant differences between the medial and lateral sides, but tissue from the tibial plateau is slightly softer than tissue from the femoral condyle. Osteoarthritis leads to a significantly softened mechanical response, which correlates with corresponding microstructural changes. Through the presented combination of experiments and poro-viscoelastic material parameter identification for healthy and osteoarthritic cartilage, we confirm a reduction in stiffness and an increase in permeability due to the disease. The parameters can be valuable for future finite element simulations of the knee joint The presented results will help guide the design of implants that are able to restore cartilage structure and function, bridging biomechanics and regenerative medicine for osteoarthritis treatment.

Identifying syndesmotic instability in ankle fractures using conventional radiographs is still a major challenge. In this study we trained a convolutional neural network (CNN) to classify the fracture utilizing the AO-classification (AO-44 A/B/C) and to simultaneously detect syndesmosis instability in the conventional radiograph by leveraging the intraoperative stress testing as the gold standard. In this retrospective exploratory study we identified 700 patients with rotational ankle fractures at a university hospital from 2019 to 2024, from whom 1588 digital radiographs were extracted to train, validate, and test a CNN. Radiographs were classified based on the therapy-decisive gold standard of the intraoperative hook-test and the preoperatively determined AO-classification from the surgical report. To perform internal validation and quality control, the algorithm results were visualized using Guided Score Class activation maps (GSCAM).The AO44-classification sensitivity over all subclasses was 91%. Furthermore, the syndesmosis instability could be identified with a sensitivity of 0.84 (95% confidence interval (CI) 0.78, 0.92) and specificity 0.8 (95% CI 0.67, 0.9). Consistent visualization results were obtained from the GSCAMs. The integration of an explainable deep-learning algorithm, trained on an intraoperative gold standard showed a 0.84 sensitivity for syndesmotic stability testing. Thus, providing clinically interpretable outputs, suggesting potential for enhanced preoperative decision-making in complex ankle trauma.

Background:Conventional orthotic insoles demonstrate limited accommodation for individual foot morphology and plantar pressure distribution patterns, resulting in biomechanical inefficiencies and patient discomfort. Computational approaches integrating artificial intelligence with additive manufacturing technologies offer promising solutions for personalized orthotic design. This study investigates the clinical efficacy of AI-driven 3D-printed meshed-silicone orthotics through comprehensive biomechanical assessment. Methods:A prospective cohort study (n = 21; 8 females, 13 males; age 25.6 ± 3.68 years; BMI 25.48 ± 3.46) evaluated custom orthotics fabricated using machine learning algorithms applied to individual foot and gait data. Pre- and post-intervention assessments included Visual Analog Scale (VAS), Foot Function Index (FFI), Foot Posture Index (FPI), plantar pressure distribution analysis, and 3-dimensional gait analysis over a 4-week period. Results:FFI scores showed minimal variation (pre-intervention: 13.48 ± 13.14; post-intervention: 14.10 ± 12.96). Significant biomechanical modifications were observed: multi-planar lower extremity alignment correction at hip, knee, and ankle joints. Plantar pressure redistribution demonstrated decreased heel loading with unchanged forefoot pressure distribution, accompanied by significant maximum metatarsal pressure elevation (P < .05). Conclusions:II. AI-integrated 3D-printed meshed-silicone orthotics demonstrated measurable biomechanical improvements including lower extremity alignment optimization and plantar pressure redistribution. These computational design methodologies combined with advanced manufacturing technologies establish a foundation for personalized orthotic interventions in clinical biomechanics applications.

Introduction: Periprosthetic joint infections (PJIs) have a severe physical impact and impose a significant psychological burden. This study aimed to compare patient-reported outcome measures (PROMs) and qualitative interview data within the same study cohort. Methods: A total of 28 PJI patients were identified after completing treatment for hip or knee PJIs. Qualitative interviews were conducted, and PROMs - such as the hip disability and osteoarthritis outcome score (HOOS), knee injury and osteoarthritis outcome score (KOOS), hospital anxiety and depression scale - total (HADS-T) score, and brief pain inventory (BPI) score - were assessed. The data were then evaluated for correlations between the PROMs and the qualitative interview findings. Results: A total of 20 out of 28 (71.4 %) patients scored above the accepted threshold of  ≥ 10 on the HADS-T. A total of 8 out of 28 (28.6 %) patients scored low on the HADS-T. Through semi-structured interviews, we further evaluated the two groups: a high-HADS-T-scoring group and a low-HADS-T-scoring group. PJI patients scoring high on the HADS-T experienced a heavier psychological burden than those scoring low on the HADS-T. Our qualitative data show that the high-HADS-T-scoring group perceived their PJI experience as troubling and psychologically distressing; moreover patients in the high-HADS-T-scoring group did not deal with the PJI as well as those in the low-HADS-T-scoring group. Conclusions: This study provides valuable information regarding the screening of PJI patients who are at risk of psychological disorders using the HADS-T. Following screening, it also provides insight into which patients should be closely monitored and which patients should be offered professional psychological support, as the latter resource is limited and needs to be distributed sensibly. PJI patients scoring above  ≥ 10 on the HADS-T are high-risk patients and should be offered professional psychological support.

Femoroacetabular impingement (FAI) syndrome is a condition characterised by irregularities in the femur or acetabular rim, leading to hip pain, increased risk of osteoarthritis (OA), and potential need for total hip arthroplasty (THA). Non-surgical treatments are the first-line approach. However, arthroscopic surgery has become more prevalent due to its promising short- and medium-term outcomes. Recent meta-analyses suggest that hip arthroscopy may offer superior results compared to non-operative treatments, though follow-up periods in these studies have been limited to 12 months. This systematic review aims to evaluate the long-term effectiveness of arthroscopic management for FAI syndrome, hypothesising that it will significantly improve patient-reported outcomes (PROMs) over a follow-up period exceeding ten years. The review focused on studies published in peer-reviewed journals with a minimum follow-up of 120 months and assessed outcomes such as PROMs and complication rates. It adhered to PRISMA guidelines and used the PICOT algorithm to evaluate the literature. Data extraction covered study characteristics, PROMs, and complications. Statistical analyses were conducted using IBM SPSS software to summarise continuous and dichotomous data. Of 1,245 identified articles, 7 were included after rigorous screening. Risk of bias assessment with the ROBINS-I tool revealed a serious or moderate risk of bias due to confounding, although overall methodological quality was acceptable. Data from 478 patients showed significant improvements in PROMs from baseline to follow-up. This systematic review indicates that arthroscopic management for FAI syndrome significantly improves PROMs with a mean follow-up of approximately 130 months. Nevertheless, 32

Rationale and objectives:To date, no study has investigated the comparability between point shear wave elastography (pSWE) and 2D-shear wave elastography (2D-SWE) in assessing patellar tendon (PT) stiffness. In addition to comparing shear wave velocities, this study also evaluated intra- and interrater reliability, as well as measurement time. Materials and methods:Forty healthy subjects (20 females, 20 males; age: 23.3 ± 2.4 years, BMI: 22.46 ± 2.23 kg/m2) were recruited as participants. Each participant underwent a standardized multimodal ultrasound protocol that included B-mode ultrasound (B-US), Color Doppler ultrasound (CD-US), and a shear wave elastography (SWE) examination of the bilateral patellar tendon using both pSWE and 2D-SWE. Stiffness values and examination times were recorded. Intra- and interrater reliability were assessed across two different measurement time points with two investigators for both pSWE and 2D-SWE. Results:Elastography values were slightly higher for pSWE compared to 2D-SWE (pSWE: 4.02 ± 1.07 m/s, 2D-SWE: 3.82 ± 0.73 m/s; p < 0.001). 2D-SWE10 measurements took significantly more time than pSWE (2D-SWE10: 69.89 ± 13.46 s vs. pSWE: 54.85 ± 8.34 s, p < 0.001). However, the time required for 2D-SWE1 was significantly shorter than for pSWE (2D-SWE1: 47.20 ± 8.23 s vs. pSWE: 54.85 ± 8.34 s, p < 0.001). Both interrater and intrarater reliability reached excellent levels for all SWE measurements, with the highest interrater and intrarater ICC values obtained for 2D-SWE1. Conclusion:This is the first study to evaluate and compare pSWE and 2D-SWE in the assessment of patellar tendon stiffness. These findings could have important implications for the clinical use of musculoskeletal SWE, providing insights into measurement time, reliability, and the potential benefits of using 2D-SWE in clinical practice.

Background Neurological gait disorders are mainly classified based on clinical observation, and therefore difficult to objectify or quantify. Movement analysis systems provide objective parameters, which may increase diagnostic accuracy and may aid in monitoring the disease course. Despite the increasing wealth of kinematic movement and balance parameter data, the discriminative value for the differentiation of neurological gait disorders is still unclear. We hypothesized that kinematic motion and balance parameter metrics would be differently altered across neurological gait disorders when compared to healthy controls. Methods Thirty one patients (9 normal pressure hydrocephalus < NPH > , 16 cervical myelopathy < CM > , 6 lumbar stenosis < LST >) and 14 healthy participants were investigated preoperatively in an outpatient setting using an inertial measurement system (MyoMotion) during 3 different walking tasks (normal walking, dual-task walking with simultaneous backward counting, fast walking). In addition, the natural postural sway of participants was measured by pedobarography, with the eyes opened and closed. The range of motion (ROM) in different joint angles, stride time, as well as sway were compared between different groups (between-subject factor), and different task conditions (within-subject factor) by a mixed model ANOVA. Results Kinematic metrics and balance parameters were differently altered across different gait disorders compared to healthy controls. Overall, NPH patients significantly differed from controls in all movement parameters except for stride time, while they differed in balance parameters only with regard to AP movement. LST patients had significantly reduced ROMs of the shoulders, hips, and ankles, with significantly altered balance parameters regarding AP movement and passed center-of-pressure (COP) distance. CM patients differed from controls only in the ROM of the hip and ankle, but were affected in nearly all balance parameters, except for force distribution. Conclusion The application of inertial measurement systems and pedobarography is feasible in an outpatient setting in patients with different neurological gait disorders. Rather than defining singular discriminative values, kinematic gait and balance metrics may provide characteristic profiles of movement parameter alterations in the sense of specific ´gait signatures´ for different pathologies, which could improve diagnostic accuracy by defining objective and quantifiable measures for the discrimination of different neurological gait disorders. Trial registration The study was retrospectively registered on the 27th of March 2023 in the ‘Deutsches Register für Klinische Studien’ under the number DRKS00031555.

Background Recent studies have suggested that psychological factors are important components of a successful return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to survey physicians with respect to their criteria used to determine readiness to RTS after ACLR and to understand the significance of psychological factors on RTS. Methods A survey was designed to understand the practices of clinicians managing rehabilitation after ACLR, consisting of 25 questions divided into 3 different sections, including one section about psychological scores and factors affecting RTS. The survey was delivered to three North American organizations for orthopedic sports medicine. Results The total number of respondents was 113. Of the respondents, 95% considered psychological tests at least "somewhat important" (33% "important", 23% selected "very important"). Routine use of psychological tests in practice was only reported by 35% of respondents. The ACL-Return to Sport after Injury Scale was the most frequently used psychological test (23%). Fear of reinjury was considered the most common patient-cited psychological factor affecting RTS. Psychological factors ranked 8th out of 9 outcomes measures in determining readiness to RTS. Conclusion This study demonstrates a discrepancy between the importance of psychological tests and the frequency of use in practice. Additional education on this topic, web-based applications, and a multidisciplinary approach may increase the usage of psychological tests to determine RTS after ACLR.