Int Orthop. 2025 Dec 6. doi: 10.1007/s00264-025-06705-y. Online ahead of print.

ABSTRACT

PURPOSE: Periprosthetic joint infection (PJI) after shoulder arthroplasty remains a devastating complication, and the optimal surgical approach is still debated. This study aimed to compare the outcomes of single-stage versus two-stage revision and to identify clinical or demographic factors associated with treatment failure.

METHODS: A retrospective observational study was conducted at a single tertiary hospital including 29 patients treated for shoulder PJI between 2010 and 2023. Patients underwent either one-stage (n = 15) or two-stage (n = 14) revision according to clinical and microbiological criteria, and the final choice of surgical strategy (one-stage vs. two-stage revision) was made at the discretion of the attending surgeon. The primary outcome was treatment success, defined as infection eradication without further surgery or suppressive antibiotics. Secondary outcomes were pain and functional results measured with the Constant-Murley Score (CMS), the Simple Shoulder Test (SST), and the Visual Analog Scale (VAS). A standard statistical analysis was performed comparing baseline data of both groups and finding factors related to the primary outcome.

RESULTS: Baseline characteristics of both groups were comparable. Overall infection control was achieved in 83% of patients, nonetheless, the one-stage group showed a higher success rate compared with the two-stage group (93% vs. 71%), although this difference did not reach statistical significance (p = 0.169; OR:0.19(0.003,2.29)). Functional outcomes assessed by CMS and VAS did not differ significantly between groups, whereas SST scores were significantly better following one-stage revision (p = 0.006). Increased BMI and a higher number of previous surgeries tended to be associated with treatment failure.

CONCLUSION: Single-stage revision achieved comparable infection control and better functional outcomes than two-stage revision, supporting its role as a reliable surgical option for shoulder PJI in appropriately selected patients, although it could be influenced by bias selection.

PMID:41351768 | DOI:10.1007/s00264-025-06705-y

Int Orthop. 2025 Dec 6. doi: 10.1007/s00264-025-06706-x. Online ahead of print.

ABSTRACT

BACKGROUND: The quest for optimal treatment of acute distal tibiofibular syndesmotic disruptions is still in full progress. Using suture-button repair devices is one of the dynamic stabilization options, however, they may not be always appropriate for stabilization, for example in length-unstable syndesmotic injuries. The aim of this biomechanical study was to investigate whether a novel screw-suture implant addresses such issues compared to suture-button implants while preserving dynamic capabilities.

METHODS: Eight pairs of human cadaveric lower legs were injured by complete syndesmosis and deltoid ligaments cuts, and reconstructed using a screw-suture (FIBULINK, Group 1) or a suture-button (TightRope, Group 2) implant for syndesmotic stabilization, placed 20 mm proximal to the tibia plafond. Following, all specimens were biomechanically tested over 5000 cycles under combined 1400 N axial and ± 15° torsional loading. Anteroposterior, axial/vertical, mediolateral and torsional movements at the distal tibiofibular joint level were evaluated biomechanically via optical motion tracking.

RESULTS: Anteroposterior and axial/vertical movements were significantly smaller and maintained over the cycles in Group 1 compared with Group 2 (p < 0.001). No further significant differences were identified between the groups (p ≥ 0.318).

CONCLUSION: Although both implant systems demonstrate ability for stabilization of unstable syndesmotic injuries, the screw-suture reconstruction provides better anteroposterior and axial/vertical stability of the distal tibiofibular joint, and maintains it over time under dynamic loading in a cadaveric study design. Therefore, it could be considered as a valid option for treatment of syndesmotic disruptions with length-unstable fibula.

LEVEL OF EVIDENCE/ STUDY DESIGN: Level V, Controlled Laboratory Study.

PMID:41351767 | DOI:10.1007/s00264-025-06706-x

Int Orthop. 2025 Dec 5. doi: 10.1007/s00264-025-06715-w. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the incidence and risk factors for dressing-induced allergic contact dermatitis (DIACD) following total hip and knee arthroplasty (THA and TKA, respectively) across different dressings and sealants.

METHODS: A retrospective review was conducted of patients who underwent primary, elective THA or TKA between 2019 and 2024 with ≥ 90 days of follow-up. Incidences of DIACD were identified by reviewing medical records for "allergy" diagnoses and use of antihistamines or corticosteroids within 30 days postoperatively. Patient characteristics, prior exposure, treatment, dressing type, and allergy history were analyzed.

RESULTS: A total of 61 (0.3%) of the 23,396 investigated patients developed a DIACD on average 12.2 ± 7.3 days postoperatively. Overall, 41% had a preoperative allergy (excluding seasonal), and 55.7% were treated with topical or low-dose oral antihistamines and corticosteroids. The majority (41%) of the DIACD involved mesh-adhesive dressings, and a liquid skin adhesive (2-octyl cyanoacrylate) was also used in 41% of cases, often in combination with the primary dressing. Of the 61 DIACD patients, 24 (39.3%) had previously undergone THA or TKA, and nearly half of these (n = 11, 45.8%) had been exposed to the same dressing without prior occurrence of DIACD. DIACD patients were significantly more likely to have undergone TKA (73.8 vs. 58.3%, p = 0.015) and to have never smoked (75.4 vs. 58.4%, p = 0.014). The effect sizes of these findings were negligible (Cramer's V = 0.016 and 0.019, respectively).

CONCLUSIONS: The incidence of DIACD following joint arthroplasty is low (0.3%) but remains a frustrating complication, primarily occurring two weeks postoperatively, with mesh-adhesive dressings most frequently implicated. Patients with prior exposure to dressings, those undergoing TKA, and non-smokers are at higher risk. Identifying at-risk patients can guide dressing selection and application.

PMID:41348336 | DOI:10.1007/s00264-025-06715-w

Int Orthop. 2025 Dec 5. doi: 10.1007/s00264-025-06711-0. Online ahead of print.

ABSTRACT

BACKGROUND: Unicompartmental Knee Arthroplasty (UKA) is effective for knee anteromedial osteoarthritis (AMOA), but aseptic prosthetic loosening causes failures. While periprosthetic bone loss links to loosening in Total Knee Arthroplasty (TKA), this association and post-UKA periprosthetic Bone Mineral Density (BMD) changes are understudied. Systematically exploring dynamic post-UKA BMD changes is vital for optimizing management and reducing loosening risk.​.

PATIENTS AND METHODS: This prospective study included 40 patients (40 knees) with knee AMOA who underwent UKA (January 2020-January 2024). All received cemented Oxford unicompartmental prostheses implanted by the same surgeon (standard technique). Dual-Energy X-ray Absorptiometry (DEXA) measured periprosthetic BMD preoperatively, and at one, three, six and 12 months postoperatively to analyze change patterns.​.

RESULTS: Periprosthetic BMD decreased rapidly at one and three months postoperatively, then increased at six and 12 months (p < 0.05). No significant differences were noted in tibial prosthesis BMD changes (ROI 1, ROI 2) or femoral prosthesis stem posterior BMD values (ROI 4) between six and 12 months (p > 0.05).​.

CONCLUSION: Early postoperative (≤ 3 months) rapid periprosthetic BMD decline in UKA suggests potential clinical value of early anti-osteoporotic treatment.

LEVEL OF EVIDENCE: Level 2b - Prospective case-control study.

PMID:41348335 | DOI:10.1007/s00264-025-06711-0

Int Orthop. 2025 Dec 4. doi: 10.1007/s00264-025-06718-7. Online ahead of print.

NO ABSTRACT

PMID:41343083 | DOI:10.1007/s00264-025-06718-7

Int Orthop. 2025 Dec 4. doi: 10.1007/s00264-025-06707-w. Online ahead of print.

ABSTRACT

BACKGROUND: Malunions of tibial pilon fractures pose significant challenges for corrective reconstruction due to the solidly healed displaced fracture fragments and frequently defective articular cartilage. This study aims to introduce a joint-preserving reconstruction strategy for managing tibial pilon fracture malunions in young patients and to evaluate the clinical outcomes.

METHODS: We retrospectively analyzed 39 patients (mean age: 32.7 ± 10.4 years) with malunions of tibial pilon fractures who were treated with corrective reconstruction surgeries from 2013 to 2021. This cohort included 11 patients who underwent corrective intra-articular osteotomy, 17 who received combined osteoperiosteal iliac autograft transplantation, and 11 who underwent combined osteochondral autograft transplantation. The median duration from the initial injury to joint-preserving treatment was 7.4 months (interquartile range [IQR], 4.4-11.1). Radiographic assessments included plain radiographs and computed tomography (CT) scans. Clinical outcomes were evaluated using the visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, the 36-Item Short Form Health Survey (SF-36) score, and ankle range of motion (ROM).

RESULTS: After a median follow-up of 41.5 months, patients showed significant improvements in pain and function. The median VAS score improved from 5 (IQR, 6-7) to 2 (IQR, 1-3), and the median AOFAS score increased from 42 (IQR, 33-58) to 79 (IQR, 73-87) (P < 0.001). The mean SF-36 scores increased from 37.2 ± 12.2 to 71.2 ± 9.6 (P < 0.001), and the median ankle ROM improved from 20 degrees (IQR, 16-30) to 25 degrees (IQR, 20-34) (P = 0.004). Major complications included two patients requiring reoperation, and two patients progressing to radiographic end-stage arthritis; however, the pain remained tolerable, and no secondary arthrodesis or arthroplasty was performed by the final follow-up.

CONCLUSION: Joint-preserving corrective reconstruction surgeries can offer reasonable improvement over a four-year follow-up period, making them a viable alternative for the reconstruction of tibial pilon fractures malunions in young patients.

PMID:41343082 | DOI:10.1007/s00264-025-06707-w

Int Orthop. 2025 Dec 4. doi: 10.1007/s00264-025-06714-x. Online ahead of print.

ABSTRACT

PURPOSE: Rotational instability is a key factor in fixation failure of extracapsular hip fractures. The U-Blade (RC) lag screw was designed to improve rotational stability. This study aimed to compare mechanical complication rates between Gamma3 and Gamma3 RC nails in elderly patients with rotationally unstable extracapsular fractures.

METHODS: We conducted a prospective, single-center randomized controlled trial including 316 patients aged ≥ 65 years with rotationally unstable extracapsular fractures. Patients were randomized to treatment with a Gamma3 nail (n = 169) or a Gamma3 RC nail (n = 147). Mechanical complications were classified as major (rotation and migration of the implant, cut-out, non-union) or minor (back-out, cervicodiaphyseal angle change, excessive sliding).

RESULTS: The overall rate of major complications was 2.9 per 10,000 person-days, being the most frequent the cut out (2.2%), with no significant difference between Gamma3 and Gamma3 RC groups (RR = 1.0; 95% CI: 0.4-2.7). TAD > 25 mm increased the risk of major complications (RT = 3.7; 95% CI: 1.2-11.2), as did superior screw placement (Cleveland zones 1-3: RT = 7.5; 95% CI: 2.7-20.8) and postoperative diastasis (RT = 4.7; 95% CI: 1.4-16.2). Similarly, implant type was not significantly associated with minor complications that were observed in 85 patients (26.9%), most frequently back-out (14.6%).

CONCLUSION: The U-Blade (RC) lag screw did not reduce mechanical complication rates compared with the standard Gamma3. Radiographic parameters, particularly TAD, reduction quality, screw position, and postoperative diastasis, were the main predictors of fixation failure.

PMID:41343081 | DOI:10.1007/s00264-025-06714-x

Int Orthop. 2025 Dec 4. doi: 10.1007/s00264-025-06716-9. Online ahead of print.

ABSTRACT

PURPOSE: Supracondylar humerus fractures are the most common elbow injuries in children, with non-operative management frequently preferred in Gartland type I and selected type II cases. While biomechanical factors affecting outcomes have been well documented, the influence of socioeconomic status (SES) on functional and radiological results remains insufficiently explored.

METHODS: This retrospective cohort study analyzed 237 children (aged 3-13 years) treated non-operatively for supracondylar humerus fractures between February 2019 and February 2024. Socioeconomic status was determined using the Hollingshead Index and categorized as low, middle, or high. Functional outcomes were assessed using Flynn's criteria, while radiological evaluation included Baumann and carrying angle measurements. Subgroup analyses were performed according to fracture type.

RESULTS: There were no significant differences in age, gender, or fracture type between SES groups (p > 0.05). However, Flynn functional scores were significantly lower in the low-SES group compared with middle- and high-SES groups (p = 0.014). Radiological parameters, including Baumann and lateral humerocapitellar angles, did not differ significantly among groups (p = 0.41 and p = 0.37, respectively). Complications were rare (2.3%) and similar between groups.

CONCLUSION: Socioeconomic disadvantage was associated with poorer functional recovery after non-operative management of paediatric supracondylar humerus fractures, despite comparable fracture characteristics and radiological results. Early follow-up and caregiver support may help mitigate these disparities.

LEVEL OF EVIDENCE: Level III (retrospective cohort study).

PMID:41343080 | DOI:10.1007/s00264-025-06716-9

Int Orthop. 2025 Dec 4. doi: 10.1007/s00264-025-06710-1. Online ahead of print.

ABSTRACT

PURPOSE: This study assessed early complications and postoperative blood transfusion rates after simultaneous bilateral prosthetic hip or knee replacement.

MATERIALS AND METHODS: Between 2020 and 2024, 285 patients underwent single-session bilateral total hip arthroplasty (THA), total knee arthroplasty (TKA), or unicompartmental knee arthroplasty (UKA) at a single referral centre. The cohort consisted of 102 patients in the TKA group, 83 in the THA group, and 100 in the UKA group. Patients were 57.2% male, with a mean age of 65.2 years ± 10.9 and a mean BMI of 27.9 ± 4.5. Based on the American Society of Anesthesiologists (ASA) classification, preoperative risk assessment showed a mean score of 1.8 ± 0.5. Early complications occurring within the first two postoperative months and anaemia requiring blood transfusion were recorded.

RESULTS: The early complication rate was 2.5% (7/285), with no complications in the UKA group, 5% (4/83) in the THA group, and 2% (2/100) in the TKA group. No deaths, deep venous thrombosis, pulmonary embolisms, or surgical site infections were reported. Complications included three periprosthetic fractures, one hip dislocation, one early unipolar revision for acetabular migration, and one extensor mechanism rupture. The transfusion rate was 4.6% (13/285), with no transfusions required in the UKA group, which was lower compared to THA (6%; 5/83) and TKA (8%; 8/100) (p = 0.02).

CONCLUSION: Single-stage bilateral hip and knee replacement prove to be a safe procedure with a low complication rate. UKA showed no early complications or transfusion needs, confirming its reliability as a safe option for single-stage bilateral procedures.

PMID:41343079 | DOI:10.1007/s00264-025-06710-1

Int Orthop. 2025 Dec 4. doi: 10.1007/s00264-025-06701-2. Online ahead of print.

ABSTRACT

PURPOSE: Children with chronic diseases are at a significant risk of radiation exposure. This cohort study evaluates the effectiveness and reliability of ultrasonography (US) for detecting femoral head decentration in children with cerebral palsy (CP) and developmental dysplasia of the hip (DDH), comparing it with traditional radiographic techniques to reduce radiation exposure.

METHODS: A total of 169 patients were enrolled in the study. Both hips were evaluated in 158 patients, resulting in a total of 327 hips. Patients underwent clinical and radiological assessments, including standardized US. Parameters measured included the ventral and lateral bony and cartilaginous ultrasonographic migration indices (bUMI and cUMI), which were compared with standardized radiographic indices (Reimers index (RI) and extrusion index (EI)).

RESULTS: The lateral bUMI (17.4%) was significantly lower than the lateral cUMI (25.9%). RI values were lower than EI values (16.8% vs. 27.7%). No significant differences were observed between the bUMI and RI, or between the cUMI and EI, indicating the reliability of US. All lateral parameters correlated well with the lateral centre-edge angle (LCE). Positive correlations were found between the lateral cUMI and the radiological indices, with high inter- and intra-rater reliability (ICC). Significant differences in lateral and ventral UMIs were noted when comparing DDH and CP patients.

CONCLUSION: US is a reliable alternative to radiography for hip surveillance in detecting hip decentration in children with CP and DDH. It reduces radiation exposure while maintaining diagnostic accuracy. The findings support the adoption of US in clinical practice to improve early diagnosis and intervention.

PMID:41343078 | DOI:10.1007/s00264-025-06701-2

Int Orthop. 2025 Dec 2. doi: 10.1007/s00264-025-06695-x. Online ahead of print.

ABSTRACT

PURPOSE: Knee coronal angular deformities are a frequently encountered challenge in paediatric orthopaedic practice. When surgical treatment is indicated, guided growth techniques have many advantages in managing these conditions. The purpose of this study is to evaluate the outcome of a modification of the original Percutaneous Epiphysiodesis using Transphyseal Screw (PETS) technique described by Métaizeau as a minimally invasive surgical approach in the treatment of knee angular deformities.

METHODS: In this prospective study, a total of 14 patients (comprising 25 limbs) with a coronal plane deformity of the knee underwent percutaneous transphyseal screw hemiepiphysiodesis. Operative time is assessed. The patients were subsequently monitored for an average duration of 28 months. The radiological assessment was conducted using the metrics of MAD (mechanical axis deviation), mLDFA (mechanical lateral distal femoral angle), and MPTA (medial proximal tibial angle). Clinical assessment included the intermalleolar distance (IMD) and intercondylar distance (ICD). The functional outcome evaluation was conducted using a modified version of the original Böstman score, taking into account the different age groups of the targeted cases.

RESULTS: In the genu valgum group, the mean preoperative values were: intermalleolar distance (IMD) 16.9 cm, mechanical axis deviation (MAD) 2.6 cm, and mechanical lateral distal femoral angle (mLDFA) 84°. In the genu varum group, the mean preoperative values were: intercondylar distance (ICD) 8.4 cm, mechanical axis deviation (MAD) -3.0 cm, and medial proximal tibial angle (MPTA) 77.8°. The mean operative time was 15 min. All radiological and clinical outcome measures showed significant improvement (P ≤ 0.05). At 24 months, 96% of cases achieved an excellent Böstman knee score. One patient reached skeletal maturity before full correction could be achieved. No other complications were observed.

CONCLUSION: This modification of the Métaizeau technique retains the advantages of PETS and offers a simplified approach that may reduce operative time and fluoroscopy use. Our results suggest that it is a safe and effective option for correcting coronal angular knee deformities in children. Further comparative studies are needed to confirm these potential benefits.

PMID:41329198 | DOI:10.1007/s00264-025-06695-x

Int Orthop. 2025 Nov 27. doi: 10.1007/s00264-025-06709-8. Online ahead of print.

ABSTRACT

PURPOSE: Platelet-rich plasma (PRP) is a promising treatment for enhancing the outcomes of bone marrow stimulation for osteochondral lesions of the talus (OLT) and has demonstrated efficacy in alleviating symptoms due to its biological properties. However, the role of leukocyte concentration in PRP remains unclear, particularly regarding cartilage regeneration. This study aimed to compare the clinical outcomes and time to return to activity between leukocyte-poor PRP (LP-PRP) and leukocyte-rich PRP (LR-PRP) in OLT surgery.

METHODS: Data from 29 patients with ≥ two year follow-up were retrospectively reviewed: 18 who received LP-PRP and 11 who received LR-PRP with OLT surgery. The study assessed the timeline of return to activity and Self-Managed Foot Evaluation Questionnaire (SAFE-Q) scores preoperatively and at three months, six months, and two years postoperatively.

RESULTS: The LP-PRP group resumed jogging and sports significantly earlier than the LR-PRP group (P = 0.03, P < 0.01). No patients in either group experienced complications. Both groups showed improved SAFE-Q scores at six months, but at two years, the LP-PRP group maintained significantly higher scores compared to their preoperative levels, whereas the LR-PRP group showed declines in some domains.

CONCLUSION: LP-PRP enabled an earlier return to sports compared with LR-PRP. Additionally, LP-PRP maintained good clinical scores two years after surgery. In contrast, the LR-PRP group showed some decline from their early postoperative peak, although absolute scores remained above preoperative levels. These findings suggest that LP-PRP may be an effective adjuvant treatment for OLT surgery.

LEVEL OF EVIDENCE: III.

PMID:41307669 | DOI:10.1007/s00264-025-06709-8

Int Orthop. 2025 Nov 27. doi: 10.1007/s00264-025-06708-9. Online ahead of print.

ABSTRACT

INTRODUCTION: Accurate cup sizing is crucial in total hip arthroplasty (THA). Conventional templating and intra-operative head sizing show inconsistent accuracy, whereas CT-based planning in robotic-assisted THA may offer superior precision. We aimed to compare implanted cup size with both CT-based planning and intra-operative native head sizing, hypothesising that CT planning would provides greater accuracy and consistency.

METHODS: This single-centre study included 619 consecutive robot-assisted primary THAs templated with pre-operative CT scans. Implanted cup size was compared with the pre-operative CT-planned size in all hips, and with the intra-operative measurement of the native femoral head in 299 hips.

RESULTS: CT-based planning closely predicted the implanted cup (exact 94.3%; ±1 size 98.7%; mean difference 0.05 ± 0.67 mm; r = 0.984, p < 0.001). Implant-native head comparisons showed larger mismatches (3.14 ± 2.31 mm; exact 9.4%; ±1 size 40.5%; r = 0.817, p < 0.001). Plan-implant agreement was modestly better in females (p = 0.039) and in smaller head categories (< 50 and 50-54 mm) versus > 54 mm (p = 0.007). For implant versus head, mismatch magnitude varied by head size, smaller heads tended toward greater relative oversizing, without a sex effect (p = 0.76).

CONCLUSION: In robotic THA, CT-based 3-D planning provides near-perfect cup-size prediction and substantially outperforms using the native head as a sizing reference. Residual variation reflects patient-specific factors, chiefly native head size and, to a lesser extent, sex, which should be considered alongside the CT plan. Using native head diameter as a complementary check may further refine pre-operative algorithms and guide intra-operative choices, optimizing component selection for long-term stability and function.

PMID:41307668 | DOI:10.1007/s00264-025-06708-9

Int Orthop. 2025 Nov 25. doi: 10.1007/s00264-025-06703-0. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to report the 10-year clinical and radiological outcomes, survivorship, and patient-reported results of the Persona posterior-stabilized (PS) total knee arthroplasty (TKA) performed in a single centre.

METHODS: This retrospective cohort study was based on a prospectively institutional database. A total of 293 primary Persona PS TKAs performed between 2012 and 2015 were identified. After applying inclusion and exclusion criteria, 185 knees (168 patients) were available for analysis at a minimum follow-up of ten years. Clinical evaluation included the Knee injury and Osteoarthritis Outcome Score (KOOS) and the 2011 Knee Society Score (KSS). Radiological assessment consisted of the hip-knee-ankle (HKA) angle. Implant survivorship was analyzed using Kaplan-Meier methods.

RESULTS: At 10 years, Kaplan-Meier survivorship for revision for any reason was 94.1% (95% CI 90.3-97.9%). Four revisions were performed (2 infections, 2 aseptic loosening). Mean KOOS scores improved significantly from preoperative to ten year follow-up (Pain 48→86; Symptoms 45→84; ADL 50→89; Sport 25→72; QoL 30→82; all p < 0.001). The KSS 2011 domains also significantly improved. The mean postoperative HKA angle was 179° ± 2°, with 7.8% of knees outside ± 3° from neutral. No radiographic evidence of radiolucent lines, osteolysis, or loosening was observed.

CONCLUSION: At ten years, the Persona PS knee system demonstrated excellent survivorship and durable functional results comparable to other contemporary TKA designs. Further comparative studies are required to determine whether its morphometric concept provides additional clinical benefit.

LEVEL OF EVIDENCE: IV Retrospective cohort study.

PMID:41288690 | DOI:10.1007/s00264-025-06703-0

Int Orthop. 2025 Nov 24. doi: 10.1007/s00264-025-06696-w. Online ahead of print.

NO ABSTRACT

PMID:41276699 | DOI:10.1007/s00264-025-06696-w

Int Orthop. 2025 Nov 21. doi: 10.1007/s00264-025-06704-z. Online ahead of print.

ABSTRACT

PURPOSE: Platelet-rich plasma (PRP) is a promising orthobiologic therapy for musculoskeletal pathologies. However, its clinical application is influenced by varying legal and regulatory frameworks across regions. This narrative review aims to discuss the regulatory and legal framework for PRP therapy in musculoskeletal pathologies in South America.

METHODS: The authors searched and reviewed contemporary literature on laws and regulations governing platelet-rich plasma use for musculoskeletal pathologies in South America in electronic databases, summarising the findings in a narrative review.

RESULTS: PRP regulation in South America falls into three categories: (1) countries with clear regulatory frameworks (Argentina, Bolivia, Colombia, Peru), where PRP is legally recognised and governed by specific provisions; (2) countries with emerging or developing regulations (Chile, Ecuador, Paraguay, Suriname, Uruguay, Venezuela, Guyana), where PRP is indirectly regulated under broader blood or tissue laws; and (3) countries permitting PRP only for experimental or research purposes (Brazil). Despite regional efforts to align with international standards, significant disparities exist in legal clarity, safety protocols, and clinical guidelines. These inconsistencies pose risks such as unregulated medical tourism and hinder scientific progress.

CONCLUSION: PRP in South America presents three distinct regulatory scenarios: clear, established regulations; emerging or developing frameworks; and use restricted to experimental or research contexts. While most countries align with international safety standards, significant variation persists in how orthobiologics are clinically governed. The future challenge is to unify these regulations and build an international consensus on processing standards that guarantee patient safety and quality, while enabling innovation and legal clarity for clinicians.

PMID:41269299 | DOI:10.1007/s00264-025-06704-z

Int Orthop. 2025 Nov 18. doi: 10.1007/s00264-025-06694-y. Online ahead of print.

NO ABSTRACT

PMID:41251767 | DOI:10.1007/s00264-025-06694-y

Int Orthop. 2025 Nov 17. doi: 10.1007/s00264-025-06674-2. Online ahead of print.

ABSTRACT

BACKGROUND: Dynamic anterior shoulder stabilization (DAS) combined with Bankart repair (BR) has gained attention for treating anterior shoulder instability (ASI) with subcritical anterior glenoid bone loss (GBL). This study aims to evaluate the clinical and biomechanical outcomes of DAS combined with BR for ASI.

METHODS: A comprehensive search of PubMed, Embase, and Scopus through August 2024 identified biomechanical and clinical studies assessing DAS in ASI. Reviews, surgical techniques, case reports, and abstracts were excluded. A meta-analysis was performed using a random-effects model, with using weighted mean differences (WMD) for continuous variables to compare pre-to-post treatment effects. MINORS and QuADS tools were used to assess the quality of the included studies.

RESULTS: Five biomechanical studies (60 cadaveric shoulders, GBL 10%-20%) demonstrated that DAS significantly improved anterior glenohumeral stability and load-to-dislocation compared to isolated BR, particularly in models with < 20% GBL and on-track Hill-Sachs lesions (HSL). Three clinical studies (100 shoulders, mean age ranged from 23.4 to 21, GBL 8.2%-10.5%) revealed significant improvements in Rowe scores (mean difference [WMD] = 58.7; p < 0.001) and forward elevation (WMD = 4.8; p = 0.02), with no significant changes in external or internal rotation. Return-to-sport rates were high (90% at any level, 71% at the same level), with 8% experiencing recurrent instability and 2% requiring reoperation.

CONCLUSION: Available evidence suggests that DAS combined with BR offered significant biomechanical improvements, substantial patient-reported outcome improvements, better forward elevation, high return-to-sport rates, and a low complication profile for ASI with subcritical GBL. However, caution is advised in cases with off-track HSL and GBL of approximately 20%, where DAS offers less stability when compared to Remplissage and Latarjet and increased reoperations rates.

PMID:41247526 | DOI:10.1007/s00264-025-06674-2

Int Orthop. 2025 Nov 14. doi: 10.1007/s00264-025-06699-7. Online ahead of print.

ABSTRACT

BACKGROUND: Essex-Lopresti injuries, defined by a combination of radial head fracture, interosseous membrane (IOM) rupture, and distal radioulnar joint (DRUJ) disruption, result in forearm longitudinal instability, ulnar-positive variance, pain, and loss of rotation. Although radial head replacement (RHR) is commonly performed, the biomechanical contribution of IOM reconstruction remains controversial. This study quantified the relationship between sequential disruption of forearm stabilizers and resultant longitudinal and rotational instability, and evaluated the extent to which RHR with IOM reconstruction restores forearm stability.

METHODS: Ten fresh-frozen cadaveric forearms underwent sequential sectioning of the proximal radioulnar joint (PRUJ), DRUJ, partial and complete IOM, and radial head, followed by anatomic, overstuffed, and understuffed RHR with IOM reconstruction. Rotational motion was assessed using a custom jig and goniometer, while longitudinal displacement under axial load was measured using a materials testing machine. Data were analyzed with paired t-tests and repeated-measures ANOVA.

RESULTS: Sequential sectioning significantly increased both rotation and longitudinal translation. Total forearm rotation expanded from 84° (intact) to 171° (complete injury; p < 0.001), primarily due to increased supination. Longitudinal displacement rose by ~ 30% after PRUJ/DRUJ injury, 100% after partial IOM sectioning, 200% after complete IOM disruption, and 435% following radial head removal (p < 0.001). RHR with IOM reconstruction restored near-normal rotation (90°, p = 0.518 vs. intact) and axial displacement (neutral, 4.37 mm; supination, 6.34 mm; p = 1.000 vs. intact). Overstuffed RHR restricted rotation, while understuffed RHR showed no significant difference from intact.

CONCLUSIONS: RHR combined with IOM reconstruction effectively restores forearm rotational and longitudinal stability in Essex-Lopresti injuries.

PMID:41238929 | DOI:10.1007/s00264-025-06699-7

Int Orthop. 2025 Nov 14. doi: 10.1007/s00264-025-06700-3. Online ahead of print.

ABSTRACT

BACKGROUND: Femoroacetabular impingement affects 14%-17% of young adults; nonoperative physiotherapy has demonstrated outcomes comparable to surgery in selected cohorts. However, age-specific treatment responses remain poorly defined, impeding evidence-based management across age cohorts.

METHODS: We conducted a prospective observational cohort study of 120 participants with femoroacetabular impingement at three specialized centres. Participants were stratified into adolescent (≤ 18 years; n = 60) and adult (19-45 years; n = 60) cohorts, each receiving standardized physiotherapy over six months. The primary outcome was a change in the International Hip Outcome Tool-33 score at six months. Secondary outcomes included Hip Outcome Score subscales, biomechanical measures, and return-to-sport rates assessed at six and 12 months. Statistical analysis employed two-sample t-tests and chi-square tests with a two-sided α = 0.025 for primary outcomes.

RESULTS: At six months, adolescents achieved significantly higher International Hip Outcome Tool-33 scores (72.4 ± 18.3 vs. 61.8 ± 19.7; difference, 10.6 points (95% CI, 3.2-18.0); p = 0.006 and faster time to clinically meaningful improvement (8.2 ± 4.1 vs. 10.7 ± 5.3 weeks; p = 0.012). Adolescents demonstrated superior Hip Outcome Score Activities of Daily Living (88.3 ± 14.2 vs. 82.1 ± 16.8; p = 0.037), modified Harris Hip Scores (85.7 ± 12.8 vs. 79.3 ± 15.2; p = 0.007), and hip range of motion. Return-to-sport rates favored adolescents at 12 months (89.6% vs. 77.6%). Advantages persisted throughout the 12-month follow-up.

CONCLUSIONS: Adolescent femoroacetabular impingement patients demonstrate superior functional recovery trajectories compared to adults following nonoperative physiotherapy management. These findings support age-stratified treatment algorithms and suggest more favorable prognoses for younger patients pursuing conservative management.

PMID:41236571 | DOI:10.1007/s00264-025-06700-3