Int Orthop. 2026 Mar 16. doi: 10.1007/s00264-025-06720-z. Online ahead of print.

ABSTRACT

PURPOSE: To systematically review the efficacy, safety, and outcomes of limb lengthening procedures in patients with achondroplasia, including effects on quality of life.

METHODS: Following PRISMA guidelines, a systematic review and meta-analysis was performed. Eligible studies included patients with achondroplasia who underwent limb lengthening of the upper and/or lower extremities. Data were extracted on length gain, external fixator index, fixation duration, complications, and quality of life. Pooled means and 95% confidence intervals (CIs) were calculated using single-arm meta-analysis.

RESULTS: Fourteen studies including 1149 patients were analyzed. The mean femoral gain was 8.85 cm (95% CI: 7.42-10.28), tibial gain 7.36 cm (95% CI: 6.21-8.52), and humeral gain 8.38 cm (95% CI: 7.01-9.74). The mean fixator index was 37.1 days/cm (95% CI: 32.37-41.82), with a mean fixation duration of 7.71 months (95% CI: 5.98-9.63). The overall complication rate was 56.1% (95% CI: 26.9-85.2). Importantly, the pooled quality of life score measured by the Paediatric Quality of Life Inventory was 75.69 (95% CI: 65.14-86.23), indicating moderate improvement despite high treatment burden.

CONCLUSION: Limb lengthening in achondroplasia achieves significant stature and proportional gains but requires prolonged treatment and carries a high complication risk. Nevertheless, improvements in functional ability and quality of life are evident, particularly when multi-limb lengthening is performed. Future studies should standardize outcome reporting, assess long-term QoL trajectories, and evaluate newer technologies such as intramedullary nails combined with multidisciplinary support.

PMID:41838116 | DOI:10.1007/s00264-025-06720-z

Int Orthop. 2026 Mar 15. doi: 10.1007/s00264-026-06772-9. Online ahead of print.

ABSTRACT

INTRODUCTION: Osteonecrosis of the femoral head (ONFH) is a progressive condition that often requires surgical intervention. Although treatment strategies have traditionally emphasized joint-preserving procedures in younger patients, advances in implant technology and perioperative management may have altered contemporary surgical decision-making. However, large-scale evidence describing temporal changes in surgical treatment patterns for ONFH is limited.

MATERIALS AND METHODS: Using the Japanese Diagnosis Procedure Combination (DPC) database, we conducted a nationwide retrospective cohort study of patients who underwent surgical treatment for ONFH between December 2012 and March 2023. Surgical procedures were categorized as total hip arthroplasty (THA), bipolar hemiarthroplasty (BHA), proximal femoral osteotomy, pelvic osteotomy, or hip arthroscopy. Temporal trends in procedure selection were evaluated overall and by age group. Postoperative complications, including infection, deep vein thrombosis (DVT), pulmonary embolism, periprosthetic fracture, and in-hospital mortality, were compared between THA and BHA using univariate and multivariable logistic regression analyses.

RESULTS: A total of 36,109 patients were included. THA was the most frequently performed procedure throughout the study period, with its proportion increasing from 72.6% in 2012 to 90.6% in 2022, while the use of BHA and joint-preserving osteotomy steadily declined. Among patients aged ≤ 20 years, proximal femoral osteotomy predominated until 2020; thereafter, arthroplasty procedures accounted for more than half of all surgeries in this age group. Similar shifts toward THA were observed in patients aged 21-40 years. In adjusted analyses, BHA was associated with a higher risk of postoperative infection and DVT, whereas THA was associated with a higher risk of periprosthetic fracture and in-hospital mortality. No significant differences were observed in dislocation or pulmonary embolism rates.

CONCLUSIONS: Nationwide data demonstrate a substantial shift in surgical management of ONFH in Japan, with increasing use of THA and declining reliance on joint-preserving procedures, even among younger patients. While arthroplasty has become the dominant treatment modality, careful consideration of long-term outcomes, complication profiles, and patient age remains essential. Integration of large-scale administrative data with detailed clinical and imaging information may further refine optimal treatment strategies for ONFH.

PMID:41832264 | DOI:10.1007/s00264-026-06772-9

Int Orthop. 2026 Mar 14. doi: 10.1007/s00264-026-06785-4. Online ahead of print.

NO ABSTRACT

PMID:41830987 | DOI:10.1007/s00264-026-06785-4

Int Orthop. 2026 Mar 14. doi: 10.1007/s00264-026-06783-6. Online ahead of print.

NO ABSTRACT

PMID:41830986 | DOI:10.1007/s00264-026-06783-6

J Bone Joint Surg Am. 2026 Mar 13. doi: 10.2106/JBJS.25.00177. Online ahead of print.

ABSTRACT

BACKGROUND: Periprosthetic joint infection (PJI) is the most common reason for revision total knee arthroplasty (TKA). Recent evidence has demonstrated that patients who develop PJI within 1 year following total hip arthroplasty have a significantly elevated risk of mortality within 10 years. Thus, the aim of this study was to compare long-term mortality rates between patients who did and did not develop PJI within 1 year following the index TKA.

METHODS: This was a retrospective population-level database study. All eligible participants interacted with a single-payer public health-care system. The primary outcome measure was mortality at 10 years following index TKA; 1- and 5-year mortality were also compared. Mortality was compared for propensity-score-matched groups.

RESULTS: Of the total of 263,204 patients who underwent primary TKA in the study period (mean age and standard deviation, 67.9 ± 9.3 years), 1,228 (0.5%) subsequently developed PJI within 1 year. Across the entire sample, patients who developed PJI within 1 year following the index TKA were more likely to be male, have frailty, and have a Charlson-Deyo score of >0; they also had significantly higher rates of congestive heart failure and chronic obstructive pulmonary disease compared with those who did not develop PJI within 1 year. A total of 1,202 patients who developed PJI within 1 year of the index TKA were matched to 1,202 patients who did not develop PJI within 1 year of the index TKA, with standardized differences of <0.10 for all covariates, indicating a robust match. After matching, TKA recipients who developed PJI in the first year had a significantly higher 10-year mortality rate (7.2% [86] versus 1.6% [19]; absolute risk difference = 5.45% [95% confidence interval (CI) = 3.41% to 7.74%]; hazard ratio = 4.66 [95% CI = 2.84 to 7.66]).

CONCLUSIONS: Patients who developed PJI within 1 year following TKA were at significantly higher risk for mortality at 10 years post-TKA compared with those who did not develop PJI within 1 year following TKA. The etiological factors leading to this increased risk remain unclear and warrant further investigation alongside efforts to further the prevention, diagnosis, and management of PJI.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:41824557 | DOI:10.2106/JBJS.25.00177

Int Orthop. 2026 Mar 13. doi: 10.1007/s00264-026-06781-8. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the effect of surgical timing and surgical technique on reoperation rates and early clinical outcomes in acute native knee septic arthritis.

METHODS: This retrospective cohort study included adult patients who underwent surgical treatment for acute native knee septic arthritis between 2018 and 2025. Patients were treated with either arthroscopic or open debridement according to the treating surgeon's assessment. Time from symptom onset to surgery was recorded in hours, and an a priori defined 48-h threshold was used to classify early versus delayed lavage. All cases received standardized joint irrigation with nine L of normal saline. The primary outcome was the need for reoperation due to persistent or recurrent infection. Secondary outcomes included knee range of motion at discharge and length of hospital stay. Culture-positive cases were analyzed separately. Multivariable logistic regression analysis was performed to identify independent predictors of reoperation.

RESULTS: A total of 129 patients were included (mean age 58.3 ± 12.3 years; 62.8% male). Baseline demographic and comorbidity characteristics were similar between surgical technique groups; however, early lavage was more frequent in the arthroscopy group (p < 0.001). In early lavage cases, reoperation rates did not differ between arthroscopy and arthrotomy (p = 0.432). In delayed lavage cases, arthroscopy was associated with a significantly higher reoperation rate compared to arthrotomy (p < 0.001). Arthroscopy resulted in greater postoperative range of motion across all subgroups (p < 0.001). Length of hospital stay was shorter with arthroscopy in early lavage but longer in delayed lavage. Early lavage was independently associated with a reduced risk of reoperation (OR 0.02; 95% CI 0.00-0.10; p < 0.001).

CONCLUSION: In acute native knee septic arthritis, our findings suggest that surgical timing may influence the relative outcomes of arthroscopic and open treatment. Early arthroscopic lavage may provide functional advantages without increasing the risk of reoperation, whereas delayed arthroscopy may be associated with higher reoperation rates. Prospective studies are warranted to confirm these observations.

PMID:41824053 | DOI:10.1007/s00264-026-06781-8

Int Orthop. 2026 Mar 12. doi: 10.1007/s00264-026-06774-7. Online ahead of print.

ABSTRACT

PURPOSE: Robotic assistance has recently been introduced for reverse shoulder arthroplasty (RSA) with the goal of improving the accuracy and consistency of implant positioning, but the additional workflow steps required for its use may prolong operative time. Whether operative time returns to a conventional benchmark after an initial learning period remains uncertain. This study sought to characterize the operative time learning curve for robotic-assisted RSA using the Mako robotic system (Stryker, Kalamazoo, MI).

METHODS: We conducted a retrospective observational study of 30 consecutive elective robotic-assisted primary RSA cases performed by a single shoulder fellowship-trained surgeon using the Mako robotic system at an academic ambulatory surgery centre between October 2025 and February 2026. The operative time benchmark was defined a priori as all consecutive conventional primary RSA cases performed at the same surgery centre from its opening in July 2025 through October 2025 (n = 16). Operative time was defined as incision start to incision closure. Learning curve behaviour among robotic cases was assessed using linear regression of operative time on sequential robotic case number. Robotic cases were also grouped into three prespecified 10-case blocks (1-10, 11-20, 21-30).

RESULTS: Mean operative time for conventional RSA was 74.9 min (95% CI, 67.3-82.5; range, 55-105). Across robotic-assisted cases, mean operative time was 88.6 min (95% CI, 79.8-97.4; range, 55-170). Operative time decreased with increasing robotic experience (- 1.85 min per case; p = 0.00010; R2 = 0.42), and the fitted regression reached the conventional benchmark mean at approximately robotic case 23. Mean operative time declined across prespecified adoption phases from 105.5 min (cases 1-10; 95% CI, 89.3-121.7), to 92.6 min (cases 11-20; 95% CI, 79.4-105.8), and to 67.8 min (cases 21-30; 95% CI, 62.6-73.0; p = 0.0034). The final 10 robotic cases had a shorter mean operative time than the conventional benchmark (67.8 vs 74.9 min) but this difference was not statistically significant (p = 0.37).

CONCLUSION: In a single-surgeon ambulatory surgery centre series, robotic-assisted RSA showed a clear learning curve and achieved operative time neutrality relative to conventional RSA after approximately two dozen cases. These findings support the feasibility of integrating robotic workflows into RSA without a persistent operative time penalty after early adoption, and provide practical expectations for surgeons and institutions planning implementation.

PMID:41820603 | DOI:10.1007/s00264-026-06774-7

Injury. 2026 Mar 11;57(4):113096. doi: 10.1016/j.injury.2026.113096. Online ahead of print.

NO ABSTRACT

PMID:41818861 | DOI:10.1016/j.injury.2026.113096

Injury. 2026 Feb 27;57(4):113138. doi: 10.1016/j.injury.2026.113138. Online ahead of print.

ABSTRACT

BACKGROUND: Accurate intraoperative assessment of fracture reduction is essential in trochanteric fracture surgery to prevent mechanical failure. Although restoration of anteromedial cortical support, particularly in the sagittal plane, has been recognized as a critical factor, standard lateral views may fail to detect malreduction because the shadow of the greater trochanter overlaps and obscures the anteromedial cortical line. This study aimed to evaluate the clinical utility of a novel intraoperative anteromedial cortex (AMC) view for assessing fracture reduction.

METHODS: This prospective multicenter observational study included 135 trochanteric fractures (AO/OTA 31A1.2, 31A1.3, and 31A2) surgically treated between June 2022 and December 2023. In addition to standard AP and lateral fluoroscopic views, an AMC view was obtained intraoperatively. Reduction on the lateral and AMC views was categorized as anterior malreduction, anatomic reduction, or posterior malreduction. The primary outcome was the concordance rate between the lateral and AMC views.

RESULTS: Discordances between lateral and AMC views were observed in 26 of 135 cases (19.3%). Notably, among fractures classified as anatomic reduction on the lateral view, 12 cases (19.4%) were reclassified as anterior malreduction on the AMC view, representing "hidden" anterior malreduction. In 7 of these 12 cases (5.2% of the total cohort), the AMC view findings directly led to a change in the surgical strategy, requiring direct reduction through a small incision.

CONCLUSIONS: Approximately one-fifth of trochanteric fractures showed inconsistent reduction patterns between the standard lateral the AMC views. The AMC view provides a more precise intraoperative assessment of the anteromedial cortex and is particularly effective in identifying hidden anterior malreduction that may be overlooked on standard fluoroscopy.

PMID:41818860 | DOI:10.1016/j.injury.2026.113138

Injury. 2026 Mar 11;57(4):113137. doi: 10.1016/j.injury.2026.113137. Online ahead of print.

NO ABSTRACT

PMID:41818859 | DOI:10.1016/j.injury.2026.113137

J Bone Joint Surg Am. 2026 Mar 12. doi: 10.2106/JBJS.25.01315. Online ahead of print.

ABSTRACT

BACKGROUND: The literature regarding optimal autograft choice for anterior cruciate ligament (ACL) reconstruction (ACLR) remains inconclusive. This network meta-analysis (NMA) compares common autografts for primary ACLR.

METHODS: PubMed, Scopus, Web of Science, and Embase were searched up to May 3, 2025, for randomized clinical trials (RCTs) on primary ACLR in adults that compared ≥2 of the following tendon autografts: 4-strand semitendinosus (4SST), 4-strand semitendinosus-gracilis (4SSTG), its 5-strand variant (5SSTG), bone-patellar tendon-bone (BPTB), quadriceps tendon with bone (QTB), and free quadriceps tendon (FQT). Outcomes analyzed in the NMA were the International Knee Documentation Committee (IKDC) subjective score, Lysholm score, Tegner Activity Scale, anteroposterior (instrumented) and rotational (pivot-shift) stability, and rerupture or revision ACLR rate. Autografts were ranked using surface under the cumulative ranking (SUCRA) values.

RESULTS: A total of 44 RCTs with 3,491 patients were included in the NMA. With respect to the IKDC, QTB was statistically superior to BPTB (mean difference = 3.46, 95% credible interval [CrI]: 0.29 to 6.77), although the difference was likely not clinically meaningful. QTB ranked highest for the IKDC (SUCRA = 90.1%) and Tegner (SUCRA = 85.3%), while BPTB ranked lowest for the IKDC and Lysholm. With respect to knee laxity, QTB ranked second in anteroposterior and first in rotational stability, and it carried a significantly lower risk of a 2+ or higher pivot-shift than 4SST (risk ratio = 0.26, 95% CrI: 0.07 to 0.85). QTB was associated with a decreased risk of rerupture/revision compared with other autografts (SUCRA = 83.3%).

CONCLUSIONS: Based on the autograft rankings, QTB was found to lead to improved functional, activity-related, and stability outcomes overall, while also reducing the risk of graft failure.

LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

PMID:41818333 | DOI:10.2106/JBJS.25.01315

J Bone Joint Surg Am. 2026 Mar 12. doi: 10.2106/JBJS.25.01211. Online ahead of print.

ABSTRACT

BACKGROUND: Acute Achilles tendon rupture is a common and serious injury in sports medicine. Clinical studies demonstrate that both surgical and nonsurgical interventions can achieve satisfactory outcomes; however, considerable debate exists regarding the optimal treatment modality for this injury. Currently, most animal experimental studies on acute Achilles tendon rupture lack clinical relevance due to inadequate fixation of the ankle joint.

METHODS: This study involved 162 male C57BL/6 mice and 30 Scx-CreERT2; Rosa26-tdTomato transgenic mice. The injury+repair groups underwent Achilles tenotomy followed by Kessler suture repair, while the injury+no repair groups underwent tenotomy alone. Ankle joints were immobilized at 160° (plantar flexion) or 90° (neutral alignment). Samples were collected at 2 and 4 weeks post-injury for biomechanical, histological, and quantitative real-time PCR (qPCR) analyses, including tracing of Scx+ tendon progenitor stem cells.

RESULTS: Biomechanical analysis was performed 2 and 4 weeks post-injury. At 2 weeks, the injury+repair group immobilized at a maximum plantar flexion angle of 160° showed significantly higher failure force and stiffness compared with the injury+no repair+160° group. However, there was no significant difference between the groups at 4 weeks (p > 0.05). The failure force in each 160° group was significantly higher than in the corresponding 90° group (p < 0.0001). Histological analysis indicated better collagen fiber alignment and higher expression of collagen type I alpha 1 (COL1A1) in the injury+repair groups. qPCR revealed generally higher expression of tendon repair-related genes (Scx, Tnmd, Tgfb1) in the injury+repair groups, while inflammatory factors (Il1b, Il6) were higher in the injury+no repair+90° group. Scx+ tendon progenitor stem cell tracing showed the greatest percentage in the injury+repair+160° group.

CONCLUSIONS: Both surgical and nonsurgical treatments for acute Achilles tendon rupture achieved satisfactory tendon healing results when the ankle joint was maintained in maximum plantar flexion. However, surgical treatment yielded superior histological tendon repair.

CLINICAL RELEVANCE: The results suggest that clinical trials may show immobilization in maximum plantar flexion following surgery to be optimal for tendon healing.

PMID:41818331 | DOI:10.2106/JBJS.25.01211

J Bone Joint Surg Am. 2026 Mar 12. doi: 10.2106/JBJS.25.01375. Online ahead of print.

ABSTRACT

BACKGROUND: Limited vascularization at the tendon-bone interface (TBI) hinders rotator cuff (RC) healing. Although cell sheet technology has shown promise for interfacial repair, prevascularization strategies remain underexplored.

METHODS: Twenty female New Zealand rabbits underwent bilateral infraspinatus tendon repair and were randomized to receive either bone marrow-derived mesenchymal stem cell (BMSC) sheets or prevascularized BMSC sheets generated by coculture with endothelial cells, implanted at the TBI. An age- and weight-matched uninjured group served as a control. Healing at 6 weeks was assessed by gross observation, histology, immunohistochemistry, gene expression, and biomechanical testing.

RESULTS: Prevascularization of the BMSC sheets enhanced TBI vascularization, indicated by greater density of α-smooth muscle actin-positive vessels (16.16 ± 2.81 versus 10.63 ± 2.79/mm2, p = 0.0079). Immunohistochemistry demonstrated greater areas positive for collagen type II alpha 1 (86.96 ± 29.95 versus 40.25 ± 11.96 μm2, p = 0.0079) and interleukin 10 (14.93 ± 4.79 versus 7.43 ± 2.48 μm2, p = 0.0159). Biomechanically, prevascularization of the sheets yielded greater ultimate failure load (156.89 ± 51.92 versus 111.67 ± 27.51 N, p = 0.0364) and stiffness (37.27 ± 12.16 versus 27.16 ± 7.33 N/mm, p = 0.0486).

CONCLUSIONS: Prevascularization of BMSC sheets was able to promote angiogenesis and improve structural and mechanical aspects of tendon-bone healing.

CLINICAL RELEVANCE: Prevascularized BMSC sheets may represent a biologic adjunct to enhance tendon-bone healing in RC repair.

PMID:41818324 | DOI:10.2106/JBJS.25.01375

Int Orthop. 2026 Mar 12. doi: 10.1007/s00264-026-06777-4. Online ahead of print.

NO ABSTRACT

PMID:41817760 | DOI:10.1007/s00264-026-06777-4

Int Orthop. 2026 Mar 12. doi: 10.1007/s00264-026-06776-5. Online ahead of print.

NO ABSTRACT

PMID:41817759 | DOI:10.1007/s00264-026-06776-5

SICOT J. 2026;12:12. doi: 10.1051/sicotj/2025070. Epub 2026 Mar 10.

ABSTRACT

INTRODUCTION: This study aims to assess the functional and radiological outcomes of combining minimally invasive medial displacing calcaneal osteotomy (MDCO) with subtalar arthroereisis (STA) for the treatment of symptomatic planovalgus feet in young adults.

METHODS: A single-centre, prospective cohort study was conducted between November 2015 and February 2022. The study included a total of 32 patients with flexible flatfoot who were treated with subtalar arthroereisis combined with medialising calcaneal osteotomy with at least three years of follow-up. Radiographic evaluation included talar coverage angle, AP talo-first metatarsal (T1MT), AP talo-calcaneal, lateral talo-first metatarsal, and calcaneal pitch angles. Function was assessed by the AOFAS score.

RESULTS: Angles and scores were compared preoperatively and at the third-year follow-up. The mean talo-navicular coverage angle TNCA reduced from 32.72° (±8.33) preoperatively to 8.84° (±5.70) at the last follow-up. The mean AP T1MT improved from 21.59° (±8.47) preoperatively to 7.78° (±4.03) at three years postoperatively. Meary's angle decreased from 20.84° (±7.14) preoperatively to 4.78° (±3.20) following the correction. The mean preoperative AOFAS score was 62.69 (±9.26), and significantly improved to 94.19 (±3.80) at the last follow-up. Four feet experienced sinus tarsi pain (12.5%), and three patients (9.3%) needed removal of the arthroereisis implant.

CONCLUSIONS: The combination of MDCO and STA holds significant promise for treating flexible flatfeet in adolescents and young adults, particularly in cases of moderate to severe deformity. This combination demonstrates a synergistic interaction, with the STA implant providing internal bracing to support MDCO and reducing stresses over the medial arch by preventing hyper-pronation. Simultaneously, the MDCO reinforces the reconstruction, achieving the necessary increased correction in moderate to severe flatfoot cases, while also reducing stresses over the STA implant.

PMID:41805662 | PMC:PMC12975123 | DOI:10.1051/sicotj/2025070

Int Orthop. 2026 Mar 10. doi: 10.1007/s00264-026-06775-6. Online ahead of print.

NO ABSTRACT

PMID:41805855 | DOI:10.1007/s00264-026-06775-6

Int Orthop. 2026 Mar 10. doi: 10.1007/s00264-026-06770-x. Online ahead of print.

NO ABSTRACT

PMID:41805854 | DOI:10.1007/s00264-026-06770-x

Int Orthop. 2026 Mar 9. doi: 10.1007/s00264-026-06771-w. Online ahead of print.

ABSTRACT

BACKGROUND: In an era of healthcare cost containment, this study introduces a novel closed reduction technique using the Ilizarov circular external fixator for comminuted tibial fractures (AO/OTA 42C2-3), minimizing operative interventions and costs compared to internal fixation.

METHODS: We conducted a retrospective analysis of 20 consecutive patients with high-energy tibial fractures managed with a single Ilizarov frame. Postoperative deformities (angulation, translation, rotation) were corrected painlessly in outpatient settings without anaesthesia.

RESULTS: Eighteen patients (90%) achieved union with one frame application; median time to union (injury to frame removal) was 150 days. Two patients had delayed union resolving conservatively. All injuries resulted from road traffic collisions (42C2/42C3). No amputations or compartment syndromes occurred. Pin-tract infections in two patients (10%) required wire exchange. No malunions necessitated reoperation, though two patients (10%) suffered refractures requiring repeat Ilizarov treatment. Per modified ASAMI scores, most achieved excellent/good functional outcomes.

CONCLUSION: This technique delivers reliable union with outpatient, anaesthesia-free deformity correction, avoiding internal fixation's risks (deep infection, compartment syndrome, malrotation) while optimizing cost-effectiveness. Multicenter validation is warranted.

PMID:41801363 | DOI:10.1007/s00264-026-06771-w

Int Orthop. 2026 Mar 9. doi: 10.1007/s00264-026-06769-4. Online ahead of print.

NO ABSTRACT

PMID:41796240 | DOI:10.1007/s00264-026-06769-4