The latest medical research on Orthopaedic Surgery

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about orthopaedic surgery gathered by our medical AI research bot.

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Integrity of the hip capsule measured with magnetic resonance imaging after capsular repair or unrepaired capsulotomy in hip arthroscopy.


Current literature shows no clear answer on the question how to manage the capsule after hip arthroscopy. Regarding patient reported outcome measures there seems to be no difference between capsular repair or unrepaired capsulotomy.

To evaluate and compare the integrity of the hip capsule measured on a magnetic resonance imaging (MRI) scan after capsular repair or unrepaired capsulotomy.

A case series study was performed; a random sample of patients included in a trial comparing capsular repair vs unrepaired capsulotomy had a postoperative MRI scan. The presence of a capsular defect and gap size were independently evaluated on MRI.

A total of 28 patients (29 hips) were included. Patient demographics were comparable between treatment groups. There were 2 capsular defects in the capsular repair group and 7 capsular defects in the unrepaired capsulotomy group (P = 0.13). In the group of patients with a defect, median gap sizes at the acetabular side were 5.9 mm (range: 2.7-9.0) in the repaired and 8.0 mm (range: 4.5-18.0) in the unrepaired group (P = 0.462). At the muscular side gap sizes were 6.6 mm (range: 4.1-9.0) in the repaired group and 11.5 mm (range: 3.0-18.0) in the unrepaired group (P = 0.857). The calculated Odds ratio (OR) for having a capsular defect with an increasing lateral center-edge (CE) angle was 1.12 (P = 0.06). The OR for having a capsular defect is lower in the group of patients that underwent a labral repair with an OR of 0.1 (P = 0.05).

There is no significant difference in capsular defects between capsular repair or unrepaired capsulotomy. Regarding clinical characteristics our case series shows that a larger CE angle increases the likelihood of a capsular defect and the presence of a labral repair decreases the likelihood of a capsular defect.

SABER-Bupivacaine Reduces Postoperative Pain and Opioid Consumption After Arthroscopic Subacromial Decompression: A Randomized, Placebo-Controlled Trial.


Shoulder arthroscopy can result in substantial postoperative pain. Sucrose acetate isobutyrate extended-release bupivacaine (SABER-Bupivacaine; trade name Posimir) is a novel depot formulation of bupivacaine designed to provide analgesia at the surgical site for up to 72 hours. The objective of this study was to evaluate the effect of SABER-Bupivacaine on pain and opioid consumption after arthroscopic subacromial decompression and to assess short-term and long-term safety.

In this double-blind, placebo-controlled trial, 78 subjects were randomized in a 2:1 ratio to SABER-Bupivacaine 5 mL or SABER-placebo 5 mL injected into the subacromial space just before skin closure. Twenty-nine additional subjects were randomized on an exploratory basis to bupivacaine hydrochloride 20 mL, also injected subacromially. Subjects rated pain intensity on a 0 to 10 scale over the first 3 postoperative days and received intravenous or oral morphine for breakthrough pain. The coprimary efficacy end points were pain intensity on 90° shoulder flexion and cumulative morphine intake from 0 to 72 hours after surgery. The time to first use of opioid rescue analgesia was a secondary end point.

The mean (SD) pain intensity was 5.16 (1.94) for SABER-Bupivacaine and 6.43 (1.77) for placebo (P = 0.012). The median consumption of intravenous morphine equivalents was 4.0 mg for SABER-Bupivacaine and 12.0 mg for placebo (P = 0.010). The median time to first use of morphine rescue was 12.4 hours for SABER-Bupivacaine and 1.2 hours for placebo (P = 0.014). The corresponding values for bupivacaine hydrochloride were 5.16 (2.38), 8.0 mg, and 1.4 hours. The incidence and severity of treatment-emergent adverse events were similar for all treatment groups, and no functional or radiographic differences were noted at the 6-month follow-up.

Compared with placebo, SABER-Bupivacaine reduced pain and opioid analgesic consumption over 72 hours after arthroscopic subacromial decompression and prolonged the time to first use of opioid rescue analgesia. No safety signals were noted during the immediate postoperative period or at 6-month follow-up.

Does Preoperative Neutrophil-Lymphocyte Ratio Predict Patient-Reported Pain and Functional Outcomes at 12 Months After Lumbar Fusion?

International Journal of Spine Surgery

Preoperative neutrophil-lymphocyte ratio (NLR) has been described in various fields to predict pain outcomes, but its prognostic utility for pain/functional outcomes after spine surgery is unclear.

To determine the relationship between preoperative NLR and pain/functional outcomes at 12 months after lumbar fusion.

We performed a single-center retrospective study of 53 patients who underwent lumbar fusion and collected demographic data including age, sex, body mass index, smoking status, spinal levels operated, and preoperative NLR. Visual analog scale (VAS) for back and leg pain and Oswestry Disability Index (ODI) at baseline and 12 months after lumbar fusion were also collected. The outcome measures were the occurrence of a clinically important improvement in VAS and ODI scores at 12 months. Binary logistic regression was used to estimate the associations of demographic factors and NLR with improvement in VAS and ODI scores. A P value of <0.05 was considered statistically significant.

There were no statistically significant associations between preoperative NLR and improvement in VAS or ODI scores. A unit increase in baseline VAS back pain score was associated with a 56% increase in the odds of improvement in back pain (OR: 1.56, 95% CI: 1.04-2.35, P = 0.03). Compared to male patients, female patients had 12 times greater odds of an improvement in leg pain (OR: 12.0, 95% CI: 1.3-110, P = 0.03).

Preoperative NLR does not predict patient-reported pain/functional outcomes at 12 months after lumbar fusion. Large-scale prospective multicenter studies are warranted to confirm our findings.

The thumb ossification composite index is the optimal intersection between Sanders and low-dose scoliosis sterioradiography.

Spine Deformity

Skeletal maturity assessment may be performed using low-dose scoliosis radiographs (LDSS) with simultaneous imaging of the hand or proximal humerus. We sought to compare the practicality, reliability and validity of the Sanders skeletal maturity staging (SMSS), proximal humerus ossification system (PHOS) and the thumb ossification composite index (TOCI) as skeletal maturity assessment tools using LDSS.

Diagnostic-Level III.

472 TOCI measurements, 288 SMSS measurements, and 340 measurements were collected. Kappa interobserver reliability for TOCI was 0.79 (strong) using hand radiographs and 0.74 (strong) using LDSS. Kappa for SMSS was 0.66 (strong) using hand radiographs and 0.45 (moderate) using LDSS. Kappa for PHOS was 0.51 (moderate) using LDSS. Intraobserver agreement between LDSS and hand imaging averaged 0.78 (strong) for TOCI and 0.34 (weak) for SMSS.

Skeletal maturity assessment with TOCI using LDSS demonstrates strong interobserver reliability when hands are placed at the patient's side and correlates well with assessment on hand radiographs. TOCI achieved better inter- and intraobserver reliability compared to SMSS and PHOS, likely because the thumb readily assumes a good position in standing scoliosis sterioradiographs.

Rod Link Reducer system in adolescent idiopathic scoliosis: a retrospective observational trial.

Int Orthop

The Rod Link Reducer (RLR) (Globus Medical, PA, USA) allows direct three-dimensional correction of the spine deformity follows the direct vertebral rotation (DVR) theories. The purpose of this retrospective study is to compare RLR with traditional correction technique (TCT) in two cohorts of patients with adolescent idiopathic scoliosis (AIS).

Fifty-four patients (M:F = 1:8) between 2018 and 2020 were included. The first group (n = 22) was treated by RLR while the second one (n = 32) by TCT. All spines were classified as per the Lenke system. Length of hospitalization, days in intensive care unit (ICU), operative time, and blood loss were recorded. SRS-30 and SF-36 questionnaires were administered pre-operative and post-operative. We collected radiological data: pre-operative and post-operative Cobb angles, coronal and sagittal balance, trunk and thoracic height.

RLR and TCT groups are homogeneous in age (p = 0.317), sex ratio (p = 0.347), and Risser stage (p = 0.222). Between both groups there was no significant statistical difference in haemoglobin value, hospitalization length, days in ICU, operative times, SF-36, SRS-30, NRS, and perceived satisfaction. RLR group shows a better improvement of correction of main thoracic (MT) curve (RLR 54.2% ± 15.9%/TCT 38.1% ± 20.4%, p = 0.031). Nevertheless, RLR group shows a worse thoracic kyphosis correction (RLR 16.82° ± 9.13°/27.12° ± 12.13°, p = 0.015).

RLR system allows a more effective MT curve correction than TCT systems, but it seems to give a hypokyphosis effect.

Does spiked tibial cement spacer reduce spacer-related problems in two-stage revision total knee arthroplasty for infection?

Int Orthop

Articulating cement spacers are frequently used in staged approaches for infected total knee arthroplasty (TKA). This study investigated whether a tibial cement spacer (TCS) with spikes could reduce spacer-related problems in two-stage revision TKA (R-TKA).

A total of 27 patients (27 knees; 10 men and 17 women) who underwent two-stage R-TKA for infected TKA were retrospectively analyzed. Group A comprised 12 patients who used TCS with spikes added to the bottom surface, whereas group B consisted of 15 patients who used conventional TCS with a flat bottom. For each group, plain radiographs were obtained after cement spacer implantation and before R-TKA to measure mediolateral (ML) translation and TCS's tilting angle. Patients' demographic data, ML translation of the TCS, and changes in the TCS's tilting angle between the groups were analyzed.

The mean ML translation was significantly lower in group A than that in group B (1.7 mm vs. 5.4 mm, p = 0.04). The mean change in the tilting angle was significantly lower in group A than that in group B (4.5° vs. 19.4°, p = 0.047).

The spiked TCS in two-stage R-TKA provides superior stability compared to the TCS with a conventional design.

The effects of adding splint use to corticosteroid injection for the treatment of trigger finger: A randomized controlled trial.

Musculoskeletal care

Trigger finger is the most common flexor tendinopathy affecting the general population. We evaluated the effects of adding a static metacarpophalangeal joint splint to corticosteroid injection for the management of trigger finger in the short term.

We carried out a randomized controlled trial with two parallel arms in Department of Physical Medicine and Rehabilitation at a university hospital. We randomly allocated 60 participants (34 women) with trigger fingers other than the thumb to two groups (both n = 30). The mean (SD) age was 41.5 (7.6) years. All participants received a single injection of 40 mg methylprednisolone plus 0.5 ml of lidocaine at the A1 pulley. Patients in the splint group wore a full time static splint for blocking the metacarpophalangeal joint for 3 months. The primary outcome was the Numerical Pain Rating Scale and the secondary outcomes were Boston questionnaire scores for symptom severity and functional status, grip strength, and the stages of stenosing tenosynovitis. We measured the outcomes at baseline, and in 1 and 3 months post-intervention.

Both interventions were effective; however, the splint group showed more reductions in pain (p = 0.013) and symptom severity (p = 0.047) and a larger decrease in the stages of tenosynovitis (p = 0.004) after 3 months. There was no significant difference in decreasing functional scores between the groups (p = 0.162). The splint group had a better (but not statistically significant) restoring grip strength (p = 0.056).

Wearing of a static metacarpophalangeal joint splint for 3 months following a single injection of corticosteroid increases and stabilises the benefits of the treatment for trigger finger.

Maternal vitamin D deficiency affects the morphology and function of glycolytic muscle in adult offspring rats.

Journal of Cachexia, Sarcopenia and Muscle

Fetal stage is a critical developmental window for the skeletal muscle, but little information is available about the impact of maternal vitamin D (Vit. D) deficiency (VDD) on offspring lean mass development in the adult life of male and female animals.

Female rats (Wistar Hannover) were fed either a control (1000 IU Vit. D3/kg) or a VDD diet (0 IU Vit. D3/kg) for 6 weeks and during gestation and lactation. At weaning, male and female offspring were randomly separated and received a standard diet up to 180 days old.

Vitamin D deficiency induced muscle atrophy in the male (M-VDD) offspring at the end of weaning, an effect that was reverted along the time. Following 180 days, fast-twitch skeletal muscles [extensor digitorum longus (EDL)] from the M-VDD showed a decrease (20%; P < 0.05) in the number of total fibres but an increase in the cross-sectional area of IIB (17%; P < 0.05), IIA (19%; P < 0.05) and IIAX (21%; P < 0.05) fibres. The fibre hypertrophy was associated with the higher protein levels of MyoD (73%; P < 0.05) and myogenin (55% %; P < 0.05) and in the number of satellite cells (128.8 ± 14 vs. 91 ± 7.6 nuclei Pax7 + in the M-CTRL; P < 0.05). M-VDD increased time to fatigue during ex vivo contractions of EDL muscles and showed an increase in the phosphorylation levels of IGF-1/insulin receptor and their downstream targets related to anabolic processes and myogenic activation, including Ser 473 Akt and Ser 21/9 GSK-3β. In such muscles, maternal VDD induced a compensatory increase in the content of calcitriol (two-fold; P < 0.05) and CYP27B1 (58%; P < 0.05), a metabolizing enzyme that converts calcidiol to calcitriol. Interestingly, most morphological and biochemical changes found in EDL were not observed in slow-twitch skeletal muscles (soleus) from the M-VDD group as well as in both EDL and soleus muscles from the female offspring.

These data show that maternal VDD selectively affects the development of type-II muscle fibres in male offspring rats but not in female offspring rats and suggest that the enhancement of their size and fatigue resistance in fast-twitch skeletal muscle (EDL) is probably due to a compensatory increase in the muscle content of Vit. D in the adult age.

Posterior shoulder stiffness was associated with shoulder pain during throwing in college baseball players: assessment of shear wave elastography.

Euro Journal of OrthoSurgery and Trauma

To investigate shoulder stiffness on the throwing and non-throwing sides in college baseball players using ultrasound shear wave elastography (SWE), and investigate the relationship between stiffness and shoulder pain during throwing.

Forty-nine college baseball players (98 shoulders) were recruited. Shoulder range of motion was evaluated. SWE was used to measure stiffness of the bilateral supraspinatus tendons, infraspinatus tendons, subscapularis tendons, supraspinatus muscles, infraspinatus muscles (ISPM), and posterior capsules. Participants were divided into pain and no pain groups based on the presence or absence of shoulder pain during throwing within 1 month before measurements on the throwing side. Items were compared between the throwing and non-throwing sides, and between the pain and no pain groups. Factors affecting shoulder pain during throwing were also investigated via multiple logistic regression analysis.

Compared with the non-throwing side, the throwing side had significantly greater external rotation at 90° abduction, significantly lesser internal rotation at 0° abduction and internal rotation at 90° abduction (AbdIR), significantly higher SWE values of the infraspinatus tendon, ISPM, and posterior capsule, and significantly lower SWE values of the subscapularis tendon. Compared with the no pain group, the pain group had a significantly higher SWE value of the ISPM, and significantly lesser AbdIR. Increased ISPM SWE values and decreased AbdIR were significantly correlated with shoulder pain during throwing.

The posterior tissue was stiffer than the anterior tissue on the throwing side. Decreased AbdIR and increased ISPM stiffness may be correlated with shoulder pain during throwing.

Technology-assisted reading fluency interventions for students with reading difficulties: evidence from a meta-analytic approach of single case design studies.

Disability and rehab Assistive technology

The purpose of this article was to provide a quantitative review of technology-assisted reading fluency interventions for students with disabilities and select moderator variables that may modify the effects of the interventions.

All reviewed 13 studies employed a single-case research design, targeting technology-assisted reading fluency interventions for students with learning disabilities (LDs) or learning difficulties. Studies were descriptively analysed and evaluated for methodological quality. Additionally, to examine the level and trend of reading fluency outcomes, Tau-U was calculated across the studies by measuring the impact of various moderator variables on the intervention effects.

Overall, studies showed a moderate to strong effect on reading fluency and there was a significant difference in moderator variables such as student status, type of technology, and features of technology. While the current study found positive outcomes from technology-based fluency interventions for struggling readers suggesting the effectiveness of using technology for the improvement of reading fluency, educators should consider using a rubric when utilising tablets because of the limited instructional components. Possible explanations about intervention effects, moderator effects, and study qualities along with limitations and future research were discussed. Implications for rehabilitationThis article examined a quantitative review of technology-assisted reading fluency interventions for students with disabilities and those considered at-risk. From this examination, we suggest the following implications:More research is needed to explore the effectiveness of technology-assisted reading fluency interventions. Some studies exist exploring the effect of overall reading interventions, but more specific analyses are needed related specifically to fluency and technology-assisted fluency interventions.Due to continuous advancements in technology, more research is also needed related to the integration of tablets and applications (or apps) on reading fluency.The use of technology to teach fluency has a general positive outcome for at-risk students. However, these types of interventions are more effective if they also provide vocabulary support.

Smartphone-based gait and balance assessment in survivors of stroke: a systematic review.

Disability and rehab Assistive technology

Gait and balance impairments are associated with falls and reduced quality of life among survivors of stroke (SS). Effective methods to assess these impairments at-home and in-clinic can help reduce fall risks and improve functional outcomes. Smartphone technology may be able to evaluate these impairments. This review aims to summarize the validity, reliability, sensitivity, and specificity of smartphone applications for determining gait and balance disorders in SS.

Database search through PubMed, Web of Science, Scopus, CINAHL, and SportDiscuss was conducted to retrieve studies that explored the use of smartphone-based applications for assessing gait and balance disorders in SS. Two independent reviewers screened potential articles to determine eligibility for inclusion. Eligible studies were summarized for participant and study characteristics, validity, reliability, sensitivity, and specificity of smartphone assessments. Methodological quality assessment of studies was performed using the NIH Quality Assessment Tool.

Seven cross-sectional studies were included in the review. Quality assessment revealed all studies had low risk of bias. Three of the included studies examined the validity, four examined the reliability, and two examined the specificity and sensitivity of smartphone-based application assessments of gait and balance in SS. Studies revealed that smartphones were valid, reliable, specific, and sensitive. Six of the seven included studies intended their use for SS and one study for clinicians.

Preliminary evidence supports that smartphone-based gait and balance assessments are valid, reliable, sensitive, and specific in SS in laboratory settings. Future research is needed to test smartphone-based gait and balance assessments in home settings and determine optimal wear sites for assessments.IMPLICATIONS FOR REHABILITATIONSmartphone-based gait and balance assessments are feasible, valid and reliable for survivors of strokeThe findings may guide future research to standardize the use of smartphone to assess gait and balance in this population.The remote use of smartphone-based assessments to predict fall risk in survivors of stroke needs to be explored.

Study on the validity of the theoretical paradigm of art therapy for vulnerable children.

Disability and rehab Assistive technology

The vulnerable children refer to the special group of children with deviation in the process of children's psychological development and personality formation due to growth dilemmas.

This may incur a series of serious social and family problems. The vulnerable children mainly cover the children suffering from children's psychological problems, such as childhood autism, autism, social anxiety and hypersensitivity, fear, depression, and PTSD arising from other factors. At present, the research results at home and abroad mainly focus on the psychological dynamic correlation investigation and solution discussion of a certain kind of difficult factor in the children's psychological development based on statistical data by the experimental methods, such as scale and model, and there is a blind spot in the humanistic orientation theory construction of psychological treatment for vulnerable children, causing the social reflection on children's psychological predicament from the humanistic perspective cannot be performed in related researches and going against searching for universal and integral theoretical paradigm for solving related problems.

Sophisticated technologies for the observations have emerged increasingly for enabling the psychological features of vulnerable children through developmental cognitive neuroscience experiments.

This paper introduces humanistic art therapy theory, focuses on the construction of a theoretical paradigm, and verifies its effectiveness based on the experimental results on the psychological development of vulnerable children, with an efficient performance.IMPLICATIONS FOR REHABILITATIONThis study mainly refers to children with difficulty in social inclusion and psychological development.The results showed that two kinds of art therapy can obviously improve the psychological disorders of vulnerable children.The goal was to enhance self-cognition, strengthen emotional interaction, and implement positive motivation.