Int Orthop. 2025 Mar 13. doi: 10.1007/s00264-025-06480-w. Online ahead of print.

ABSTRACT

PURPOSE: The prevalence of carpal tunnel syndrome (CTS) as the foremost upper extremity entrapment neuropathy is well-documented. The present study aimed to evaluate the prevalence of anatomical variations in the carpal tunnel and their potential role as risk factors for CTS.

METHODS: Data from 447 CTS patients who underwent median nerve decompression between 2018 and 2019 were retrospectively analyzed. As a control group, 200 hands from 103 age- and sex-matched asymptomatic volunteers were further investigated.

RESULTS: Anatomical variations identified through ultrasound in 19.7% of CTS hands and 16.0% of controls. Specifically, 10.3% of CTS hands had persistent median arteries, while 14.3% had bifid median nerves. Both variations occurred in 4.9% of CTS patients. In the control group, 13.0% had persistent median arteries and 11.0% had bifid median nerves, with both found in 8.0%.

CONCLUSIONS: Anatomical variations were found in both, CTS patients and controls, but their prevalence did not differ significantly between groups, suggesting they are not independent risk factors for CTS.

PMID:40080129 | DOI:10.1007/s00264-025-06480-w

Int Orthop. 2025 Mar 13. doi: 10.1007/s00264-025-06489-1. Online ahead of print.

ABSTRACT

PURPOSE: Total knee arthroplasty (TKA) is a highly effective treatment for osteoarthritis patients unresponsive to conservative therapies. Chronic postsurgical pain (CPSP) following TKA is understudied, with approximately 20% of patients reporting chronic pain. This cross-sectional study conducted in Jordan aims to (1) determine the prevalence of chronic knee pain after TKA in the Jordanian population and (2) identify associations between demographics and rehabilitation factors with chronic pain.

METHODS: Data were collected from 90 Jordanian patients post-TKA. Demographics (age, gender, BMI, and smoking) and rehabilitation factors (pre-operative sessions, post-operative sessions, and duration) were recorded. Statistical analyses included descriptive statistics and 95% confidence intervals. Independent t-tests and Chi-square analyses were used to determine the differences between those with and without chronic pain. Pearson correlations were used to determine the association between demographic and rehabilitation factors with the prevalence of chronic pain.

RESULTS: Ninety patients were included in the study with an average age of 60.3 ± 10.1 years. The prevalence of chronic post-TKA pain in Jordan was 57.8% (52/90), (95% CI: 46.9-68%). No significant differences were found in demographics and pre-operative rehabilitation. Chronic pain was significantly associated with post-operative rehabilitation sessions and duration (r =.349, p =.001) (r =.342, p =.001, respectively. Patients with chronic pain received fewer post-operative rehabilitation sessions (P <.001) and had shorter rehabilitation durations (P <.001) compared to patients without chronic pain.

CONCLUSION: Chronic pain after TKA is highly prevalent in Jordan (57.8%), with reduced rehabilitation engagement strongly linked to its occurrence. Optimizing post-operative rehabilitation protocols may mitigate CPSP risk among Jordanian TKA patients.

PMID:40080128 | DOI:10.1007/s00264-025-06489-1

Int Orthop. 2025 Mar 10. doi: 10.1007/s00264-025-06483-7. Online ahead of print.

NO ABSTRACT

PMID:40063117 | DOI:10.1007/s00264-025-06483-7

Int Orthop. 2025 Mar 10. doi: 10.1007/s00264-025-06479-3. Online ahead of print.

ABSTRACT

PURPOSE: This retrospective cohort study aimed to compare the clinical outcomes of percutaneous transforaminal endoscopic decompression (PTED) with those of posterior lumbar interbody fusion (PLIF) for the treatment of degenerative lumbar scoliosis (DLS) with lumbar spinal stenosis (LSS).

METHODS: In this study, 143 DLS patients who met the inclusion criteria from January 2016 to March 2019 were retrospectively analyzed and divided into the PTED and PLIF groups. The propensity score matching (PSM) method was used to adjust for imbalanced confounding variables between the groups. The visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were then used to compare the clinical outcomes between the two groups. Furthermore, changes in radiological characteristics and surgical complications were assessed.

RESULTS: After PSM, 86 patients were included in the study with a followup duration of at least five years. Postoperative VAS and ODI scores were significantly improved in both groups at all time points compared with preoperative values (p < 0.001). However, the PTED group had higher VAS scores for back pain and ODI scores than the PLIF group at five years postoperatively (p < 0.05). For radiological parameters, the Cobb angle decreased in the PLIF group but increased in the PTED group at the final followup (p < 0.05). A decrease in the adjacent disc height was observed in the PLIF group at the final followup (p < 0.001).

CONCLUSION: Both PTED and PLIF achieved relatively satisfactory outcomes in treating DLS with LSS after a minimum five year followup. However, further studies are required to better determine the characteristics of spinal deformities amenable to each procedure.

PMID:40063116 | DOI:10.1007/s00264-025-06479-3

Int Orthop. 2025 Mar 7. doi: 10.1007/s00264-025-06478-4. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Periprosthetic joint infection (PJI) is a significant and challenging healthcare issues. Accurate diagnosis is essential for effective treatment. The aim of our study is to underscore the usefulness of the new EBJIS definition and criteria when applied in a developing country department.

METHODS: We conducted a retrospective analysis of a single-center cohort of consecutive revision arthroplasties (January 2018-June 2024). This study was carried out at the Department of Orthopedics and Trauma Surgery in the University Hospital Fattouma Bourguiba in Monastir, Tunisia. Were included in our research patients who underwent revision surgery for arthroplasties due to septic failure. Exclusion criteria were: surgery performed within the previous six weeks, antibiotic-loaded bone cement spacer in place, the second step of a two-stage revision and periprosthetic fractures.

RESULTS: A total of 46 patients were included in the study. According to the EBJIS criteria, our cohort was divided into two groups: "likely infection" including 12 patients (26.1%) and "confirmed infection" with 34 patients (73.9%). Clinical signs like inflammation (Se 85.3%, PPV 76.32%) and pain (Se 76.47%, PPV 70.27%) demonstrate higher sensitivity but low specificity. Among paraclinical tests, a CRP level > 10 mg/dL is highly sensitive (97.06%), while PMN > 80% shows perfect specificity (100%). Tissue samples with more than two positives and cultures with the same microorganism exhibit high sensitivity (96.66% and 80%) and PPV (84.85% and 85.71%).

CONCLUSION: Establishing PJI diagnosis is challenging and depends on paraclinical testing. We highlight the lack of important diagnostic instruments in settings with limited resources.

PMID:40053070 | DOI:10.1007/s00264-025-06478-4

Int Orthop. 2025 Mar 7. doi: 10.1007/s00264-025-06467-7. Online ahead of print.

ABSTRACT

BACKGROUND: Meralgia paresthetica (MP) is a compressive neuropathy of the lateral femoral cutaneous nerve (LFCN), characterized by pain, paresthesia, and numbness in the anterolateral thigh. Despite its well-documented etiology, diagnosing MP remains challenging, as complementary tests such as electromyography (EMG) and ultrasound may yield normal results due to anatomical variations and the dynamic nature of nerve compression.

OBJECTIVE: This study introduces the Hip Abduction Maneuver (HAM) as a novel diagnostic tool for LFCN compression and investigates its utility in clinical and intraoperative assessments METHOD: The maneuver, inspired by Hagert's triad, evaluates hip abduction weakness as a functional indicator of LFCN entrapment. MP can result from mechanical, metabolic, iatrogenic, traumatic, or anatomical factors. Compression occurs under the inguinal ligament, where orthogonal taping (OKT) can serve as a mechanical relief test to support diagnosis. HAM exploits afferent inhibitory responses, assessing hip abduction strength before and after decompression maneuvers. The Scratch Collapse Test (SCT) further improves diagnostic accuracy. The Hip Abduction Maneuver (HAM) and Orthogonal KinesioTaping (OKT) enhance the clinical assessment of meralgia paresthetica, particularly in cases with inconclusive imaging.

CONCLUSION: Their integration into preoperative evaluation and intraoperative validation may improve diagnostic precision and optimize surgical outcomes. Further studies are required to validate reproducibility and long-term efficacy.

PMID:40053069 | DOI:10.1007/s00264-025-06467-7

Int Orthop. 2025 Mar 7. doi: 10.1007/s00264-025-06452-0. Online ahead of print.

ABSTRACT

PURPOSE: Peripheral nerve compression syndromes are a common cause of pain, weakness, and functional limitations, yet they often remain underdiagnosed due to the limitations of traditional diagnostic methods such as electromyography and imaging. This article describes the clinical triad-manual muscle testing (MMT), sensory-collapse testing (SCT), and pain evaluation-as a structured, integrative approach to improving the diagnosis of nerve compressions.

METHODS: This narrative review examines the anatomical basis and diagnostic application of the clinical triad across common peripheral nerve compression syndromes. The review focuses on the median, ulnar, and radial nerves in the upper extremity, as well as the peroneal nerve in the lower extremity. Each component of the triad is analyzed for its role in detecting nerve compressions, including the reliability of MMT for identifying muscle weakness patterns, the specificity of SCT as a confirmatory tool, and the role of pain assessment in localizing entrapment sites.

RESULTS: The clinical triad provides a structured and accessible diagnostic framework that enhances the detection of nerve compressions, even in early-stage presentations that may evade standard diagnostic tools. It demonstrates adaptability to complex cases, including double- and multiple-crush syndromes, and offers a non-invasive, cost-effective alternative to traditional diagnostic approaches.

CONCLUSION: The clinical triad enhances diagnostic precision in peripheral nerve compression syndromes by integrating motor, sensory, and pain assessments. Its structured methodology facilitates early detection and targeted interventions, potentially improving patient outcomes while reducing reliance on invasive or resource-intensive diagnostic methods.

PMID:40053068 | DOI:10.1007/s00264-025-06452-0

Int Orthop. 2025 Mar 7. doi: 10.1007/s00264-025-06463-x. Online ahead of print.

ABSTRACT

PURPOSE: Meralgia paraesthetica (MP) is a rare neuropathy of the lateral femoral cutaneous nerve (LFCN), characterized by thigh pain, paraesthesia, or sensory loss. When conservative treatments fail, surgical interventions such as neurolysis or neurectomy are considered. This study aims to evaluate the effectiveness of surgical decompression of the LFCN in alleviating pain, addressing sensory deficits, and improving quality of life.

METHODS: A prospective study was conducted on 26 patients who underwent LFCN decompression surgery between 2015 and 2023, with a minimum follow-up period of one year. Outcomes were assessed using pre- and postoperative questionnaires, including the Brief Pain Inventory (BPI) and the Pain Disability Index (PDI).

RESULTS: The cohort consisted of 15 males and 11 females, with 81% reporting symptom onset following prior surgeries or trauma. Postoperatively, 95.8% of patients experienced pain relief, with 76.9% achieving complete pain resolution (NRS 0). There was a significant reduction in average perceived pain (from 6.6 ± 1.9 to 0.7 ± 1.1; p < 0.001) and maximum perceived pain (8.0 ± 1.54 to 1.0 ± 1.67; p < 0.001). Full sensory function was restored in 61.2% of patients, and quality of life scores improved markedly, with an average increase of 8.4 out of 10 points (± 1.9; p < 0.001).

CONCLUSION: These results demonstrate that neurolysis of the LFCN is highly effective in the treatment of refractory MP, offering substantial pain relief, sensory restoration, and improved quality of life. Furthermore, patients with previous injuries or surgeries benefited most from NL, suggesting that these factors serve as positive prognostic indicators.

PMID:40053067 | DOI:10.1007/s00264-025-06463-x

Int Orthop. 2025 Mar 7. doi: 10.1007/s00264-025-06468-6. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study is to compare the functional outcomes and donor site morbidities after anterior cruciate ligament reconstruction (ACLR) using peroneus longus (PL) tendon versus hamstring (HST) tendon autografts.

METHODS: The PL tendon autograft was used for ACLR in 36 patients, and in another group, ACLR was performed using the HST tendon autograft in 35 patients between September 2022 and April 2023. The knee functional outcomes were evaluated using the International Knee Documentation Committee (IKDC) and the Lysholm scores at preoperative and at 18 months following ACLR. In addition, the autograft diameter was measured intraoperatively in both groups. Ankle joint donor site morbidities were estimated using the American Orthopedic Foot and Ankle Score (AOFAS) in the PL autograft group.

RESULTS: A total of 71 patients, who underwent ACLR, were assessed with a minimum follow-up of 18 months (range 18-20 months). The diameter of the PL tendon autograft was significantly greater than that of the HST tendon autograft (P < 0.001). No significant differences were found in the functional outcomes between both groups at 18 months follow-up. Evaluation of the AOFAS showed no significant ankle joint dysfunction in the PL tendon autograft group.

CONCLUSIONS: PL tendon autograft can be used as a safe and effective autograft choice for ACLR with excellent functional outcomes comparable to HST tendon autograft and minimal donor site morbidity.

LEVEL OF EVIDENCE: Level II, Prospective randomized comparative study.

PMID:40053066 | DOI:10.1007/s00264-025-06468-6

Int Orthop. 2025 Mar 7. doi: 10.1007/s00264-025-06477-5. Online ahead of print.

ABSTRACT

PURPOSE: Rotator cuff tears were a prevalent cause of shoulder pain and impairment, often necessitating arthroscopic rotator cuff repair. The optimal timing of postoperative mobilization initiation remains a subject of debate implicating patient outcomes. Therefore, this study aimed to evaluate the effectiveness of early and delayed mobilization after arthroscopic rotator cuff repair.

METHODS: A total of 84 patients who underwent unilateral arthroscopic rotator cuff repair were included in the study and divided into early and delayed mobility exercise groups. Outcome measures included range of motion, shoulder strength, pain assessment, re-tear rates, return to work and pre-injury activity, as well as patient-reported outcomes at various postoperative time points.

RESULTS: Early mobility exercise after arthroscopic rotator cuff repair led to a significantly greater recovery of range of motion at six weeks postoperatively (P < 0.05) and shoulder strength at 12 weeks postoperatively (P < 0.05), as compared to the delayed mobility exercise group. However, the early mobility exercise resulted in non-significant excess in the pain assessment at the six-month postoperative mark (P > 0.05). Additionally, there were no statistically significant differences between the two groups in several outcome measures, including re-tear rates, return to work and pre-injury activity, and long-term patient-reported outcomes at one year post-operatively (P > 0.05).

CONCLUSION: Both early and delayed mobilization exercises safely improve range of motion, shoulder strength, and pain relief after arthroscopic rotator cuff repair. Early mobilization within six to 12 weeks post-surgery enhances range of motion and strength without increasing re-tear rates.

TRIAL REGISTRATION: Not applicable.

PMID:40053065 | DOI:10.1007/s00264-025-06477-5

Int Orthop. 2025 Mar 7. doi: 10.1007/s00264-025-06407-5. Online ahead of print.

ABSTRACT

PURPOSE: Femoral shaft fractures are significant injuries and if not managed appropriately can result in high complication rates and long-term disability. These complex injuries occur at a higher rate across low and middle income countries and sub-Saharan Africa is thought to have a higher incidence than other regions across the world. This study aims to summarise the most up to date evidence surrounding the treatment and associated outcomes of adult femoral shaft fractures in sub-Saharan Africa - giving a clear understanding of current practices and highlighting potential areas for further research.

METHODS: PubMed, Google Scholar, Africa Journals Online, Cochrane, Clinicaltrial.gov were searched using Boolean search strategies. Data collected included demographics, fracture classification, interventions, union rates, time to union, patient-reported outcomes / functional outcome scores, and secondary outcomes (orthopaedic and medical complications, malunion / non-union, length of admission).

RESULTS: Twenty-three studies reporting 2,180 patients were included-73% (1592/2180) of patients were male, with a mean age of 35 years. Overall, 59% of patients were treated with intramedullary nailing (IMN), 23% with skeletal traction, and 14% with open reduction internal fixation (ORIF). There was a heterogeneity in practice in different regions, with the highest reported rates of IMN in Tanzania (99%), and lowest in Malawi (29.4%). Union rates were highest in IMN (82.4-100%) versus traction (48 - 100%) and ORIF (83.3-87%). Intramedullary nailing demonstrated a super complication profile, with better functional outcomes, shorter hospital stays and time to mobilisation.

CONCLUSION: Intramedullary nailing demonstrated superior clinical and functional outcomes compared to other modalities for the treatment of femur shaft fractures across sub-Saharan Africa. However, there is significant sparsity of research and variable management approaches across the region. Focused research to determine the burden of injury, current healthcare resources and cost-effective and appropriate interventions to improve outcomes are now a public health priority.

PMID:40053064 | DOI:10.1007/s00264-025-06407-5

Int Orthop. 2025 Mar 6. doi: 10.1007/s00264-025-06475-7. Online ahead of print.

NO ABSTRACT

PMID:40047875 | DOI:10.1007/s00264-025-06475-7

Int Orthop. 2025 Mar 6. doi: 10.1007/s00264-025-06485-5. Online ahead of print.

ABSTRACT

PURPOSE: Elbow joint instability results from the disruption of one or more stabilizing anatomical structures. The two most common forms of instability are posterolateral rotatory instability (PLRI) and medial elbow instability (MEI), particularly in athletes. This review aims to explore the anatomical foundations, diagnostic methods, and therapeutic approaches for PLRI and MEI in athletes.

METHODS: A comprehensive literature review was performed to investigate the study objective.

RESULTS: Regarding the anatomical background, the primary stabilizing structures of the elbow joint include the humeroulnar joint (trochlea, olecranon, and coronoid process), the medial collateral ligament (MCL), and the lateral ulnar collateral ligament (LUCL). PLRI is primarily caused by LUCL insufficiency, while MEI results from MCL dysfunction. A thorough clinical evaluation, combined with advanced imaging-magnetic resonance imaging (MRI) or MR arthrography is essential for an accurate diagnosis. For high-level athletes, surgical intervention is often required, with the timing and type of surgery tailored to the athlete's specific needs, expectations, and the chronicity of the injury.

CONCLUSION: PLRI and MEI present diagnostic and therapeutic challenges, especially in athletes. Advanced imaging and clinical evaluation are crucial for the diagnosis. Surgical intervention, particularly arthroscopy, is often required for optimal outcomes.

PMID:40047874 | DOI:10.1007/s00264-025-06485-5

Int Orthop. 2025 Mar 6. doi: 10.1007/s00264-025-06482-8. Online ahead of print.

ABSTRACT

PURPOSE: Hip osteoarthritis is a common chronic condition primarily affecting the elderly, characterised by the presence of pain, joint stiffness, and restricted movement. Ultrasound-guided Pericapsular Nerve Group (PENG) block combined with viscosupplementation may offer symptomatic improvement in patients with hip osteoarthritis unable to undergo total hip arthroplasty. The aim of this study was to evaluate pain and function in patients with hip osteoarthritis following the administration PENG block combined with viscosupplementation.

METHODS: A retrospective study of 17 consecutive patients (12 Female; 5 Male) with hip osteoarthritis who underwent ultrasound-guided PENG block combined with viscosupplementation were included in the study. The primary outcome was pain assessed using the Visual Analogue Scale (VAS), and function measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) before and 12 weeks after the procedure. The secondary outcome was complication rate.

RESULTS: The mean and standard deviation age was 76.5 ± 8.3 years (range 63-93). There was a significant reduction in mean VAS of 3.6 points (p < 0.001) and a reduction in WOMAC score of 29.1 points (p < 0.001). The majority of participants reported being satisfied with the procedure (82.4%). The minor complication rate was 11.8% (ongoing pain requiring analgesia and transient hip flexor weakness). No major complications were observed during the follow-up period.

CONCLUSIONS: The ultrasound-guided PENG block combined with viscosupplementation demonstrated improvement in pain and function without major complications after 12 weeks of follow-up in patients with hip osteoarthritis.

LEVEL OF EVIDENCE: Level IV, case series.

PMID:40047873 | DOI:10.1007/s00264-025-06482-8

Int Orthop. 2025 Mar 6. doi: 10.1007/s00264-025-06476-6. Online ahead of print.

ABSTRACT

We discuss the study by Uğur Bezirgan et al., titled "Comparison of Locking Plate and Conservative Treatment in Elderly Patients with Displaced Proximal Humerus Fractures." The authors are commended for their prospective study, which offers valuable insights into the comparison of locking plate fixation and conservative treatment. The study found no significant difference in functional recovery between the two groups; however, the locking plate group exhibited a higher incidence of complications. We express concerns regarding the potential selection bias arising from the non-randomized allocation of treatments and suggest that not all elderly patients may be suitable candidates for the locking plate fixation approach. Furthermore, the study highlights a lack of patient feedback regarding quality of life, and we recommend that future research incorporate subjective evaluations to provide a more comprehensive understanding of the treatment's effectiveness.

PMID:40044986 | DOI:10.1007/s00264-025-06476-6

Int Orthop. 2025 Mar 5. doi: 10.1007/s00264-025-06469-5. Online ahead of print.

ABSTRACT

PURPOSE: Tunnel syndromes around the foot and ankle are underrecognized and frequently misdiagnosed nerve entrapments that can significantly impact patients' quality of life. This review aims to provide a comprehensive overview of the etiology, clinical presentation, diagnostic challenges, and management strategies for these syndromes, focusing on the sural nerve, deep peroneal nerve, tibial nerve, medial plantar nerve, and inferior calcaneal nerve.

METHODS: A thorough literature review was conducted, examining studies and case reports on nerve entrapments in the foot and ankle. The review covers the clinical assessment, differential diagnosis, and treatment options, including conservative and surgical interventions.

RESULTS: Tunnel syndromes of the foot and ankle can arise from various causes, including trauma, anatomical variations, repetitive strain, and systemic conditions. Clinical manifestations often include burning pain, tingling, and motor weakness, depending on the affected nerve. Accurate diagnosis relies on a detailed patient history, physical examination, and adjunctive tests such as electrodiagnostic and imaging. Conservative treatments, such as physical therapy, orthotics, and corticosteroid injections, are often effective, while surgical decompression is reserved for refractory cases.

CONCLUSIONS: Recognizing and diagnosing tunnel syndromes in the foot and ankle is essential for effective management and preventing permanent nerve damage. A systematic approach that integrates clinical evaluation and appropriate imaging can improve patient outcomes. Timely intervention, whether conservative or surgical, is crucial for alleviating symptoms and restoring function.

PMID:40042611 | DOI:10.1007/s00264-025-06469-5

Int Orthop. 2025 Mar 5. doi: 10.1007/s00264-025-06451-1. Online ahead of print.

ABSTRACT

PURPOSE: While robotic-assisted total knee arthroplasty (RA-TKA) has demonstrated improved surgical precision, its impact on early postoperative pain management remains unclear. This study compared early postoperative pain outcomes between RA-TKA and conventional TKA (C-TKA).

METHODS: In this retrospective study, 230 consecutive patients (309 knees) who underwent primary TKA were analyzed: 143 patients (181 knees) in the C-TKA group and 87 patients (128 knees) in the RA-TKA group. Pain scores at rest and during movement were assessed using the Numerical Pain Rating Scale for 72 h postoperatively. Secondary outcomes included opioid consumption and length of hospital stay.

RESULTS: While pain scores at rest showed no significant differences between groups, RA-TKA patients reported significantly lower pain scores during movement at 24 h post-surgery (p = 0.023). The RA-TKA group demonstrated significantly reduced opioid consumption during the first 48 postoperative hours (p = 0.001 for 0-24 h; p = 0.03 for 24-48 h) and shorter length of hospital stay (p = 0.011). Subgroup analysis of unilateral procedures showed similar advantages in the RA-TKA group.

CONCLUSION: RA-TKA was associated with reduced pain during movement, decreased opioid consumption, and shorter hospital stay in the early postoperative period compared to C-TKA.

PMID:40042610 | DOI:10.1007/s00264-025-06451-1

Int Orthop. 2025 Mar 4. doi: 10.1007/s00264-025-06464-w. Online ahead of print.

ABSTRACT

PURPOSE: Medializing displacement calcaneal osteotomies are part of conservative surgical treatments and represent a reliable option in valgus flatfoot deformities. Favorable short-term results of this procedure is well-known. However, there are few series with follow-up beyond five years. This study reports the clinical outcomes of calcaneal medialization osteotomy with a minimum follow-up of five years. The primary objective was to compare functional scores and radiographic measurements at the preoperative stage, immediately post operative, and at the final follow-up.

MATERIALS AND METHODS: This was a retrospective, single-centre, multi-operator study of 32 patients, who underwent a medialization calcaneal osteotomy for type II flatfoot. Clinical evaluation of the patients was conducted using the American Orthopaedic Foot and Ankle Surgery (AOFAS) score and the European Foot and Ankle Society (EFAS) score. Radiographic evaluation used the plantar arch angle angle, the talus-first metatarsal axis (T-M1) on lateral weight-bearing radiographs, and calcaneal valgus on Meary's angle in a hindfoot alignment view.

RESULTS: Mean follow-up was seven years. AOFAS score improved from 46 to 87 and EFAS score from 11 to 20 (p < 0.05). Each radiographic parameter was significantly modified between the preoperative and immediate postoperative periods.

CONCLUSION: We observed a significant and lasting improvement in functional scores at a mean follow-up of seven years. The correction of the evaluated radiographic parameters was significant and remained stable over time.

PMID:40035852 | DOI:10.1007/s00264-025-06464-w

Int Orthop. 2025 Mar 3. doi: 10.1007/s00264-025-06461-z. Online ahead of print.

ABSTRACT

PURPOSE: Groin pain in athletes, particularly inguinal-related groin pain, remains a diagnostic and therapeutic challenge despite recent consensus on terminology. This study aims to explore nerve disorders as a key contributor to groin pain in athletes, focusing on the anatomy, aetiology, diagnosis, and management options.

METHODS: A comprehensive review of the literature was conducted, focusing on the anatomical variability of the ilioinguinal, iliohypogastric, and genital branch of the genitofemoral nerves, clinical presentations, diagnostic methods, and conservative and surgical treatments for nerve-related inguinal pain. Key studies on nerve entrapment, neuropathic and nociceptive pain mechanisms, and surgical outcomes were analyzed.

RESULTS: Variability in nerve pathways and sensory overlap complicate diagnosis and management. Neuropathic pain often presents with burning or electric sensations due to nerve compression or entrapment, while nociceptive pain manifests as dull or stabbing pain. Conservative treatment, including exercise-based rehabilitation and nerve blocks, offers relief in many cases. For refractory cases, surgical treatment can provide significant pain resolution, with nerve identification and potential neurectomy improving outcomes.

CONCLUSION: Nerve disorders play a critical role in inguinal-related groin pain in athletes. Accurate diagnosis relies on detailed clinical examination and targeted imaging. Conservative treatments are first line, but surgical interventions addressing nerve entrapment or compression are effective for persistent cases. Future research should focus on the role of collagen deficiencies, nerve histopathology, and long-term outcomes of different treatment modalities.

PMID:40032740 | DOI:10.1007/s00264-025-06461-z

Int Orthop. 2025 Mar 1. doi: 10.1007/s00264-025-06458-8. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to evaluate the outcomes of scaphocapitate arthrodesis with lunate excision in patients with stage IIIB and IIIC Kienböck's disease.

METHOD: Between September 2013 and April 2024, 106 consecutive patients were screened, with 64 consenting to participate. Final analysis included 56 patients (32 stage IIIB and 24 stage IIIC) who underwent scaphocapitate arthrodesis with lunate excision, utilizing distal radius bone grafting stabilized by Herbert compression screws. Preoperative and postoperative assessments (6, 18, 36, and 84 months) included VAS score for pain, ROM, grip strength, MMWS, PRWE scores, and radiographic evaluations including RS angle, CHR, CUDR, and ulnar variance.

RESULTS: The mean operative time was 75 ± 11 min, and the average follow-up was 86 ± 2.5 months. The union rate was 91% with a mean time to union of 10 ± 2 weeks. Preoperative mean VAS scores (63 ± 4 mm) significantly decreased to 25 ± 9 mm at 6 months and 12 ± 4 mm at 36 months (p = 0.001), with a slight increase to 22 ± 5 mm at 84 months. ROM improved from 46% ± 9% of the healthy side preoperatively to 59% ± 3.2% at 36 months (p = 0.001) but slightly decreased to 58% ± 3% at 84 months. Grip strength improved from 48% ± 8% preoperatively to 89% ± 6.4% at 36 months (p = 0.001) and remained stable at 88% ± 4% at 84 months. The mean MMWS increased from 46 ± 7 to 75 ± 5 (p = 0.001), while PRWE scores decreased from 68 ± 8 to 23 ± 6 (p = 0.001). The mean RS angle decreased from 59° ± 8° preoperatively to 50° ± 3° at 36 months (p = 0.001). There was no significant change in CHR (0.44 ± 0.04 to 0.46 ± 0.03, p = 0.251), while CUDR decreased from 31 ± 3 mm to 25 ± 2 mm (p = 0.021). Ulnar variance remained stable (p = 0.325). Degenerative changes were noted in 13 patients (23%) at the RS joint, with six showing Grade I, 5 Grade II, and 1 Grade III degeneration. Additionally, 5 patients (9%) exhibited changes at the STT joint, comprising three with Grade I and 2 with Grade II degeneration.

CONCLUSION: Scaphocapitate arthrodesis with lunate excision can improves pain, ROM, grip strength, and functional scores in patients with stage IIIB and IIIC Kienböck's disease. Over time, improvements in VAS scores and functional metrics were notable, though there was a slight decline in pain relief and ROM at 84 months. These changes are critical to understanding the potential degenerative complications, particularly at the RS joint, where some patients developed osteoarthritis.

LEVEL OF EVIDENCE: Level II.

PMID:40024945 | DOI:10.1007/s00264-025-06458-8