Int Orthop. 2026 May 8. doi: 10.1007/s00264-026-06831-1. Online ahead of print.

ABSTRACT

BACKGROUND: Magnetic resonance imaging (MRI) is widely used to evaluate meniscal healing after surgical repair; however, the extent to which postoperative MRI findings reflect clinically meaningful recovery remains uncertain. This study aimed to examine the relationship between MRI-based healing appearance and patient-reported functional outcomes after meniscal repair.

METHODS: This retrospective observational study included adult patients who underwent arthroscopic meniscal repair between January 2018 and December 2024 at a tertiary care centre. Patients with at least 12 months of follow-up, available postoperative MRI, and complete clinical outcome data were included. Postoperative MRI was obtained at a mean of 18.6 ± 7.4 months after surgery (range: 12-36 months). Meniscal healing on MRI was classified as complete healing, partial healing, or failed healing/retear. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC), Lysholm, and Tegner scores. Clinical success was defined as IKDC ≥ 80 and Lysholm ≥ 85. The association between MRI healing status and clinical outcomes was evaluated using group comparisons and correlation analyses.

RESULTS: A total of 240 patients (mean age 27.4 ± 6.8 years; 71.7% male) were analyzed. MRI demonstrated complete healing in 40.8% of patients, partial healing in 31.7%, and failed healing or retear in 27.5%. Mean IKDC, Lysholm, and Tegner scores differed significantly across MRI groups (all p ≤ 0.002), with lower scores observed in patients with MRI-defined failure. However, 63.6% of patients classified as having failed healing on MRI met the criteria for clinical success. MRI healing status showed moderate correlations with IKDC (r = 0.42), Lysholm (r = 0.39), and Tegner (r = 0.31) scores (all p < 0.001). The MRI-IKDC correlation was higher in patients who underwent concomitant anterior cruciate ligament reconstruction than in those who underwent isolated meniscal repair.

CONCLUSIONS: Postoperative MRI appearance after meniscal repair is associated with patient-reported and functional outcomes, but the strength of this relationship is limited. MRI-defined structural abnormalities may persist despite satisfactory clinical recovery, indicating that MRI has restricted specificity for identifying clinically meaningful failure. These findings suggest that MRI should be interpreted in conjunction with clinical assessment rather than used as a standalone indicator of postoperative success.

PMID:42103885 | DOI:10.1007/s00264-026-06831-1

Int Orthop. 2026 May 7. doi: 10.1007/s00264-026-06828-w. Online ahead of print.

ABSTRACT

BACKGROUND: Anterior impaction pilon fractures (AIPs) are a distinct subtype of tibial pilon fractures caused by axial loading of the ankle in dorsiflexion and are associated with severe anterior plafond comminution, anterior talar subluxation, and a high risk of post-traumatic osteoarthritis (PTOA). Optimal surgical strategies for AIP remain unclear.

METHODS: This retrospective case series included 23 consecutive patients with AIP treated surgically between 2013 and 2023 with a minimum follow-up of one year. The treatment strategy consisted of anatomical reduction of the impacted anterior tibial plafond and rafting fixation using an anterolateral distal tibial plate, with supplementary fixation and bone grafting as required. Anterior talar subluxation was assessed using the lateral talar station (LTS) as the difference between injured and contralateral ankles immediately postoperatively (ΔLTS-1) and at one year (ΔLTS-2). Clinical outcomes included bone union, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score, ankle range of motion, PTOA graded by the modified Kellgren-Lawrence scale, and complications.

RESULTS: Mean ΔLTS-1 and ΔLTS-2 were 0.77 ± 1.8 mm and 0.5 ± 2.3 mm, respectively, with no significant difference (p = 0.33). Bone union was achieved in all cases. PTOA developed in 9 patients, with a mean modified Kellgren-Lawrence grade of 0.8 ± 1.2. The mean AOFAS score was 91.6 ± 9.6. Deep infection occurred in three patients, and five required soft-tissue reconstruction.

CONCLUSION: Anatomical reduction of the anterior plafond combined with stable anterolateral rafting fixation maintained talar alignment and produced favourable short-term clinical outcomes in patients with AIP.

PMID:42098440 | DOI:10.1007/s00264-026-06828-w

Int Orthop. 2026 May 7. doi: 10.1007/s00264-026-06832-0. Online ahead of print.

NO ABSTRACT

PMID:42096080 | DOI:10.1007/s00264-026-06832-0

Int Orthop. 2026 May 7. doi: 10.1007/s00264-026-06811-5. Online ahead of print.

NO ABSTRACT

PMID:42096079 | DOI:10.1007/s00264-026-06811-5

J Bone Joint Surg Am. 2026 May 7. doi: 10.2106/JBJS.25.01025. Online ahead of print.

ABSTRACT

➢ The sternoclavicular joint (SCJ) serves as the only osseous connection between the axial skeleton and the upper limb and is a synovial, saddle-like joint with robust posterior ligamentous stabilizers and a fibrocartilaginous disc.➢ The brachiocephalic veins and other mediastinal structures are at risk from injury or surgery about the SCJ.➢ SCJ injuries are best imaged with computed tomography (CT). CT angiography is warranted when a vascular injury is suspected, and magnetic resonance imaging (MRI) is useful to define soft-tissue injuries.➢ Acute posterior SCJ dislocations in active, healthy individuals can result in considerable disability if unreduced and an aggressive treatment approach is warranted.➢ Chronic locked posterior dislocations are more challenging to treat, making prompt recognition and referral (if appropriate) important.➢ Reliable surgical techniques including ligament reconstruction and open reduction and internal fixation for SCJ injuries have been well supported in the current orthopaedic literature.➢ Vascular injury is a rare but catastrophic concern when dealing with SCJ pathology and should be considered when determining the venue for planned intervention, as should collaboration with a thoracic or vascular surgeon.

PMID:42096528 | DOI:10.2106/JBJS.25.01025

SICOT J. 2026;12:25. doi: 10.1051/sicotj/2026018. Epub 2026 May 6.

ABSTRACT

INTRODUCTION: The optimal management of the long head of the biceps tendon (LHBT) during rotator cuff repair remains controversial, particularly when the tendon appears normal. This study aims to compare the clinical outcomes of arthroscopic rotator cuff repair with and without routine LHBT release.

METHODS: A retrospective study including patients aged >50 years with a repairable rotator cuff tear and documented normal LHBT who underwent arthroscopic surgery was conducted. Patients were divided into two groups: LHBT preservation group (n = 113) and LHBT release group (n = 110). Postoperative evaluation included the visual analog scale (VAS) for pain, while functional outcomes were assessed by the Constant-Murley score and the American Shoulder and Elbow Surgeons (ASES) scores. Postoperative pain and functional outcomes were compared between the two study groups at 12 and 24 months.

RESULTS: Groups were comparable in terms of age (p = 0.16), sex (p = 0.30), rotator cuff tear size (p = 0.51), and number of anchors used for the repair (p = 0.44). At 24 months, the LHBT release group demonstrated lower VAS score (p < 0.001), higher Constant-Murley score (medians: 86 vs 81, p < 0.001), and higher ASES score (medians: 90 vs 83, p < 0.001). Regression analysis confirmed that LHBT release is independently associated with improved functional outcomes (coefficient = 4.85, p < 0.001 for Constant-Murley score; coefficient = 6.66, p < 0.001 for ASES score).

DISCUSSION: The findings of this study indicate that routine LHBT release during rotator cuff repair, even in the absence of macroscopic pathology, is associated with less postoperative pain and superior functional scores.

PMID:42090591 | PMC:PMC13148789 | DOI:10.1051/sicotj/2026018

Int Orthop. 2026 May 7. doi: 10.1007/s00264-026-06827-x. Online ahead of print.

ABSTRACT

BACKGROUND: Tibial plateau fractures (TPFs) remain challenging injuries due to their complex three-dimensional morphology, frequent posterior column involvement, and high incidence of associated soft-tissue lesions.

PURPOSE: Flexion-type fractures represent a distinct and often under recognized entity that is inadequately addressed using traditional classification systems. Flexion-valgus and flexion-varus mechanisms generate fundamentally different fracture configurations and soft-tissue injury profiles, with important implications for surgical management and prognosis. This narrative review provides a practical, literature- and experience-based overview of the distinguishing features of flexion-valgus and flexion-varus tibial plateau fractures, focusing on fracture morphology, associated ligamentous and meniscal injuries, and key treatment principles.

RESULTS: Flexion-valgus injuries predominantly involve the posterolateral tibial plateau, commonly presenting as split-depression or rim impaction fractures, and are frequently associated with anterior cruciate ligament (ACL) and lateral meniscal pathology. In contrast, flexion-varus injuries typically result in posteromedial shear fractures with metaphyseal comminution, often extending into the posterolateral central segment, demonstrating significantly higher rates of concomitant ligamentous and meniscal injuries, poorer functional outcomes, and increased risk of conversion to total knee arthroplasty (TKA).

CONCLUSION: Accurate recognition of the underlying injury mechanism and fracture morphology, distinguishing flexion-valgus from flexion-varus injuries, is essential to guide preoperative planning, surgical exposure, fixation strategy, and soft-tissue management, with the goal of optimising clinical outcomes.

PMID:42091624 | DOI:10.1007/s00264-026-06827-x

Int Orthop. 2026 May 6. doi: 10.1007/s00264-026-06833-z. Online ahead of print.

NO ABSTRACT

PMID:42089984 | DOI:10.1007/s00264-026-06833-z

Int Orthop. 2026 May 6. doi: 10.1007/s00264-026-06825-z. Online ahead of print.

ABSTRACT

PURPOSE: The representation of anatomical variations in Renaissance art offers a unique opportunity to explore the historical perception of normality and deformity. This study aims to analyse a previously undescribed anatomical feature in the marble statue of Adam (c. 1490-1495) by Tullio Lombardo.

METHODS: A detailed visual and morphological analysis of the statue was performed, focusing on the lateral aspect of the forefoot. The observed features were compared with current clinical descriptions of bunionette deformity and interpreted within the broader context of Renaissance anatomical representation.

RESULTS: The statue shows a prominence of the fifth metatarsal head associated with a varus deviation of the fifth toe, consistent with a bunionette (tailor's bunion). The anatomical precision of Lombardo's work suggests that this feature is unlikely to be accidental or due to technical limitations, but rather represents a deliberate inclusion within an otherwise idealized figure. Comparable variations in foot anatomy have been reported in other Renaissance artworks.

CONCLUSION: Although bunionette deformity is currently associated with mechanical stress and external factors, its presence in an idealized nude figure suggests that such variations may not have been perceived as pathological in their original context. This case highlights the limitations of applying modern diagnostic categories to historical representations and supports the view that minor anatomical variations could be incorporated into Renaissance depictions of the human body without implying disease.

PMID:42089983 | DOI:10.1007/s00264-026-06825-z

J Bone Joint Surg Am. 2026 May 6;108(9):616-617. doi: 10.2106/JBJS.25.01520. Epub 2026 May 6.

NO ABSTRACT

PMID:42089866 | DOI:10.2106/JBJS.25.01520

J Bone Joint Surg Am. 2026 May 6;108(9):615. doi: 10.2106/JBJS.25.01320. Epub 2026 May 6.

NO ABSTRACT

PMID:42089865 | DOI:10.2106/JBJS.25.01320

J Bone Joint Surg Am. 2026 May 6;108(9):613-614. doi: 10.2106/JBJS.25.01358. Epub 2026 May 6.

NO ABSTRACT

PMID:42089864 | DOI:10.2106/JBJS.25.01358

SICOT J. 2026;12:24. doi: 10.1051/sicotj/2026026. Epub 2026 May 5.

ABSTRACT

BACKGROUND: Robotic-assisted systems have been developed to improve the accuracy and reproducibility of total knee arthroplasty (TKA). While outcomes have been widely studied, the effects of these systems on intraoperative workflow and surgical team workload have received less attention. The aim of this study was to compare procedural setup, efficiency, workload, and ergonomics between the VELYS robotic-assisted solution (VRAS) and computer-navigated TKA (NAVI).

METHODS: Twenty patients who underwent primary TKA performed by a single surgeon, using a single implant type, were enrolled in this research (10VRAS, 10NAVI). Procedural efficiency was assessed by reference to an AI-backed process digital twin platform. Workload was evaluated using NASA-TLX questionnaires, objective ergonomic measures (power tool holding times, retractor holding times, and leg holding times), and a tray analysis.

RESULTS: The mean total operating room (OR) time was 69.4 min for the VRAS group and 72.9 min for the NAVI group, with no significant difference. The preparation (22 min) and the breakdown times (12.6 vs.11.7 min) were equivalent. The skin-to-skin times averaged 34.3 min for the VRAS group versus 38.9 min for the NAVI group. NASA-TLX scores revealed significantly lower mental, physical, and temporal demands, reduced effort and frustration, and better perceived performance of the surgeon in the VRAS group (p < 0.05). The instrument burden was similar, 5 trays (21.5 kg) for VRAS and 4 trays (20.9 kg) for NAVI. The objective workload was reduced for the VRAS group, with shorter power tool holding (2.7 vs. 7.7 min, p < 0.001), retractor holding (7.8 vs. 13.0 min, p = 0.01), and leg holding times (3.4 vs. 4.7 min, p = 0.02).

DISCUSSION: Compared with navigated TKA, robotic assistance did not prolong overall OR time and was associated with lower measured NASA-TLX scores. These findings suggest that robotic-assisted TKA may offer workflow and ergonomic advantages, although further studies with larger samples are needed to confirm these preliminary observations.

LEVEL OF EVIDENCE: Level 4, retrospective study.

PMID:42085584 | PMC:PMC13143209 | DOI:10.1051/sicotj/2026026

SICOT J. 2026;12:23. doi: 10.1051/sicotj/2026016. Epub 2026 May 5.

ABSTRACT

INTRODUCTION: Range of Motion (ROM) assessment is a critical baseline metric for diagnosis, treatment monitoring, and rehabilitation goal setting. It significantly impacts patient well-being, aligning with Sustainable Development Goal 3 (SDG 3). However, the universal goniometer (UG), presents limitations regarding accuracy and practical efficiency in clinical settings. Therefore, this study aimed to determine the concurrent validity of an electronic goniometer named Goniwear compared to the UG for measuring elbow and knee angles.

METHODS: The validity of Goniwear involved 40 healthy volunteers stratified by age (20-39 and 40-59 years) and sex. Simultaneous active and passive ROM measurements were conducted three times using both UG and on flexion and extension of the elbow and knee joints. Data were analyzed using the intraclass correlation coefficients (ICC), which were calculated using a two-way random-effects model, and the Bland-Altman method was used to determine the limits of agreement (LoA) between the UG and Goniwear.

RESULTS: Reliability between the two instruments ranged from poor to excellent, depending on the joint and movement type. Elbow flexion and extension demonstrated consistently good to excellent reliability in both active and passive conditions (ICC = 0.84-0.91), with minimal bias and relatively narrow LoA. Knee flexion and extension showed poor to moderate reliability (ICC = 0.44-0.55), particularly for extension, accompanied by a wide LoA.

CONCLUSION: Agreement between the UG and Goniwear varies across joints and movement conditions. While the instruments appear interchangeable for elbow movements, caution is warranted when interpreting knee ROM due to greater measurement variability.

DISCUSSION: The Goniwear demonstrates high validity for single-axis joints with fixed pivot points, suggesting strong potential for clinical application in specific contexts.

TRIAL REGISTRATION: The Thai Clinical Trials Registry is TCTR20251120001.

PMID:42085583 | PMC:PMC13143208 | DOI:10.1051/sicotj/2026016

SICOT J. 2026;12:E3. doi: 10.1051/sicotj/2026019. Epub 2026 May 5.

ABSTRACT

Robotic platforms have revolutionized arthroplasty through precision and patient-specific planning, yet introduce cyber-physical vulnerabilities in interconnected surgical ecosystems. Recent incidents, including the 2026 cyber-attack, highlight operational risks despite low direct intraoperative threats. Proactive cybersecurity, via FDA-aligned secure design, institutional audits, and surgeon vigilance, is imperative to safeguard patient safety and trust in precision orthopedics.

PMID:42085582 | PMC:PMC13143206 | DOI:10.1051/sicotj/2026019

Injury. 2026 Apr 10;57(7):113270. doi: 10.1016/j.injury.2026.113270. Online ahead of print.

ABSTRACT

BACKGROUND: Increased frailty is associated with higher rates of adverse events after hip fracture surgery. Unfortunately, considerable uncertainty remains about which tool or index best quantifies frailty and therefore the associated risk of complications following hip fracture surgery. This study tried to evaluate whether a Comprehensive Geriatric Assessment-Frailty Index could predict in-hospital complications following hip fracture surgery.

METHODS: A retrospective cohort study was conducted among 1469 patients aged 70 years and older with an operatively managed hip fracture. Patients grouped according to their Comprehensive Geriatric Assessment-based Frailty Index: pre-frail to mildly frail and moderately to severely frail. The primary outcome was the occurrence of one or more complications. Secondary outcomes included specific complications, intensive care unit admission, length of stay and in-hospital mortality. Multivariable regression was used to adjust for confounders and presented as adjusted Odds Ratios (aOR).

RESULTS: Moderately to severely frail was independently associated with an increased risk of having one or more complications (aOR 1.70, 95% CI=1.28-2.26, p < 0.001), urinary tract infection (aOR 2.12, 95% CI=1.01-4.47, p < 0.05), delirium (aOR 2.05, 95% CI=1.43-2.93, p < 0.001), in-hospital death (aOR 3.35, 95% CI=1.00-11.26, p = 0.05) and 1-year mortality (aOR 1.75, 95% CI=1.23-2.51, p = 0.002).

CONCLUSION: A Comprehensive Geriatric Assessment-based Frailty Index is a useful tool to predict in-hospital complications, in-hospital mortality and 1-year mortality in geriatric hip fracture patients. This tool provides useful information about a patient's frailty, enables early risk stratification, and has the potential to support physicians, patients and healthcare proxies in shared decision-making and setting individualized postoperative expectations.

LEVEL OF EVIDENCE: Prognostic, level III.

PMID:42085909 | DOI:10.1016/j.injury.2026.113270

J Bone Joint Surg Am. 2026 May 5. doi: 10.2106/JBJS.25.01422. Online ahead of print.

ABSTRACT

BACKGROUND: This observational study systematically used magnetic resonance imaging (MRI) to determine the prevalence of concomitant osteomyelitis and its influence on clinical outcomes in cases of pediatric septic arthritis (SA) of the hip.

METHODS: We retrospectively analyzed the demographic, clinical, microbiological, and radiographic data of 58 children treated for SA of the hip who underwent systematic MRI between 2000 and 2025. Patients were categorized into 2 groups: isolated septic arthritis and septic arthritis with concomitant osteomyelitis. The clinical and laboratory parameters, causative pathogens, and treatments were compared between the groups.

RESULTS: Concomitant osteomyelitis was identified with MRI in 43% (25) of the 58 patients, while radiographs detected it in only 16%. Demographic, clinical, and inflammatory parameters were statistically similar between the groups. Kingella kingae was the most commonly identified pathogen (37.9%), and Staphylococcus aureus and Streptococcus spp. were more frequently associated with repeat surgery. No significant differences in complication rates, treatment duration, or outcomes were found between the groups.

CONCLUSIONS: The systematic use of MRI revealed concomitant osteomyelitis in >40% of cases of pediatric SA. However, the presence of osteomyelitis was not associated with worse outcomes, suggesting that factors related to the microorganism profile or virulence must contribute substantially to disease severity. Nonetheless, MRI should be considered early in any diagnostic work-up of pediatric SA of the hip.

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

PMID:42085536 | DOI:10.2106/JBJS.25.01422

J Bone Joint Surg Am. 2026 May 5. doi: 10.2106/JBJS.25.01681. Online ahead of print.

NO ABSTRACT

PMID:42085535 | DOI:10.2106/JBJS.25.01681

Int Orthop. 2026 May 4. doi: 10.1007/s00264-026-06824-0. Online ahead of print.

ABSTRACT

Morton's neuroma is one of the most common forefoot pathologies. In recent years, radiofrequency ablation has emerged as a minimally invasive alternative to surgical excision, aiming to relieve symptoms while reducing morbidity.

PURPOSE: To compare the efficacy and safety of radiofrequency neurolysis and surgical excision for the treatment of Morton's neuroma at our institution.

METHODS: A single-center, observational, retrospective, and longitudinal study was conducted including patients treated between 2012 and 2022. Clinical data from patients who underwent either surgical excision or radiofrequency ablation were analyzed. Demographic characteristics, pain intensity assessed using the Visual Analog Scale (VAS), complication rates, and reintervention rates were recorded, with a minimum follow-up of two years. Statistical analysis was performed using SPSS version 25.

RESULTS: A total of 192 procedures were identified (110 surgical excisions and 82 radiofrequency ablations). For analyses focused on demographic and baseline characteristics, repeated procedures performed in the same patient were grouped, resulting in 144 unique cases (92 excisions and 52 radiofrequency ablations). Both techniques resulted in significant pain reduction. Surgical excision achieved greater VAS improvement (- 5.57) compared with radiofrequency ablation (- 4.3). Complications were more frequent after surgical excision (13%) than after radiofrequency ablation (3.7%). In the radiofrequency group, 26% of patients required subsequent surgical excision and 33% underwent repeat ablation. The use of radiofrequency increased from 20% during 2012-2017 to 57% during 2018-2022.

CONCLUSIONS: Radiofrequency ablation is a safe and effective treatment for Morton's neuroma, although its analgesic effect appears less durable than surgical excision. Its low complication rate and outpatient applicability make it a valuable alternative, particularly in selected patients.

PMID:42082717 | DOI:10.1007/s00264-026-06824-0

Int Orthop. 2026 May 4. doi: 10.1007/s00264-026-06820-4. Online ahead of print.

ABSTRACT

BACKGROUND: Evaluate the association between preoperative SIRI and early postoperative SSI and to assess its diagnostic performance.

METHODS: Retrospective cohort study was conducted including 500 consecutive adult patients who underwent posterior fusion lumbar spine surgery for degenerative pathology. Preoperative neutrophil, lymphocyte, and monocyte counts were used to calculate SIRI. The primary outcome was early acute deep postoperative SSI. Associations were analyzed using univariate and penalized multivariate logistic regression. Discriminatory performance was assessed using receiver operating characteristic curve analysis.

RESULTS: Early postoperative SSI occurred in 27 patients (5.4%). Patients who developed infection had significantly higher preoperative SIRI values than those without infection (median 1.78 [IQR, 1.02-3.41] vs. 1.12 [IQR, 0.62-2.04]; p = 0.031). In the multivariate logistic regression model, log-transformed SIRI remained independently associated with infection (adjusted OR 1.93; 95% CI 1.02-3.67; p = 0.044). Preoperative SIRI demonstrated moderate discriminatory ability for early SSI, with an AUC of 0.66 (95% CI, 0.54-0.77; p = 0.03). The optimal cutoff value of 1.29 yielded a sensitivity of 63.0% and a specificity of 68.3%.

CONCLUSIONS: Preoperative SIRI is independently associated with early postoperative SSI following instrumented lumbar spine surgery for degenerative pathology. Although its discriminatory performance is moderate, SIRI represents a simple, inexpensive, and readily available adjunctive marker for preoperative risk stratification, particularly useful for identifying patients at low risk of postoperative infection.

PMID:42080946 | DOI:10.1007/s00264-026-06820-4