Search Results (1,140)

Objectives: To evaluate the clinical accuracy and patient-reported outcomes (PROMs) of robotic-assisted full-arch implant rehabilitation performed with an autonomous robotic implant system. Materials and Methods: Six consecutive edentulous patients requiring implant-supported full-arch rehabilitation were treated using the Yakebot task-autonomous robotic implant system following a fully digital workflow. A total of 36 Straumann Bone Level Tapered implants were placed using a flapless approach. Implant placement accuracy was assessed by comparing planned and postoperative CBCT datasets. Coronal, apical, depth, and angular deviations were automatically calculated using dedicated robotic planning software. Patient-reported outcomes were prospectively evaluated through a structured questionnaire assessing preoperative perceptions, postoperative morbidity, and overall treatment satisfaction. Results: All implants were successfully placed according to the robotic-assisted workflow without intraoperative complications or conversion to conventional surgery. Mean three-dimensional coronal and apical deviations were 0.45 ± 0.18 mm and 0.47 ± 0.19 mm, respectively, while mean total angular deviation was 1.30 ± 0.63°. Patients reported low preoperative anxiety (0.5 ± 0.8/10), limited postoperative pain (2.2 ± 3.5/10), swelling (1.3 ± 2.2/10), and interference with daily activities (1.3 ± 2.2/10). Overall surgical experience was highly rated (9.7 ± 0.8/10). Final satisfaction scores were exceptionally high, with all patients indicating they would undergo robotic-assisted surgery again and recommend the procedure to others. Conclusions: Robotic-assisted full-arch implant rehabilitation demonstrated a high level of clinical accuracy, with submillimetric coronal and apical deviations and low angular discrepancies. In addition, treatment was associated with low postoperative morbidity, excellent patient acceptance, and very high satisfaction. These findings support the potential of autonomous robotic implant surgery as a predictable and patient-centered approach for full-arch rehabilitation, although larger controlled studies are required to confirm these results. Full article

Background/Objectives: High tibial osteotomy (HTO) is a joint-preserving procedure for selected patients with medial compartment knee osteoarthritis and varus malalignment. Postoperative pain after HTO may impair early mobilization and increase systemic opioid requirements. Periarticular infiltration analgesia is commonly used as part of multimodal analgesia; however, comparative evidence regarding opioid-containing and opioid-free infiltration protocols in HTO remains limited. This study compared postoperative pain, systemic opioid consumption, PCA demand, rescue analgesic requirement, and analgesia-related adverse events between a modified opioid-containing Ranawat cocktail and an opioid-free dexmedetomidine-based periarticular infiltration protocol. Methods: This single-center retrospective comparative cohort study included 80 patients who underwent medial opening-wedge HTO between March 2021 and March 2025. Patients were categorized according to the documented periarticular infiltration protocol: modified Ranawat cocktail (n = 40) or dexmedetomidine-based cocktail (n = 40). Postoperative VAS scores were recorded at 6, 12, 18, and 24 h and on postoperative days 7 and 14. Secondary outcomes included 24 h systemic opioid consumption expressed as morphine milligram equivalents, PCA demand count, rescue analgesic use, and analgesia-related adverse events. Longitudinal postoperative VAS trajectories were analyzed using unadjusted and adjusted linear mixed-effects models. The adjusted model included the available covariates of age, body mass index, preoperative VAS score, operative time, and tourniquet time. Results: Baseline demographic and perioperative variables were comparable between groups. The dexmedetomidine group demonstrated lower adjusted postoperative VAS scores during the early postoperative period, with statistically significant between-group differences at 12, 18, and 24 h, whereas pain trajectories converged by postoperative day 14. Twenty-four-hour systemic opioid consumption was lower in the dexmedetomidine group than in the modified Ranawat group (9.78 ± 1.99 vs. 13.92 ± 1.79 MME, p < 0.001). PCA demand was also lower in the dexmedetomidine group (6.30 ± 3.16 vs. 9.63 ± 2.92, p < 0.001). No significant between-group differences were observed in rescue NSAID use, rescue tramadol requirement, nausea/vomiting, hypotension, bradycardia, allergic reactions, or other recorded adverse events. Conclusions: In this retrospective cohort, dexmedetomidine-based opioid-free periarticular infiltration was associated with lower adjusted early postoperative VAS scores, reduced 24 h systemic opioid consumption, and fewer PCA demands compared with a modified opioid-containing Ranawat cocktail after medial opening-wedge HTO. However, because treatment allocation was not randomized and several potentially relevant confounders were not available for adjustment, these findings should be interpreted as associative and hypothesis-generating. Prospective adequately powered randomized studies are needed to confirm these findings and evaluate their effects on functional recovery and osteotomy healing. Full article

Background: The Oxford Hip Score (OHS) is a widely used hip-specific patient-reported outcome measure (PROM) following primary total hip arthroplasty (THA). This measure is calculated from answers to a 12-item questionnaire and can provide indices that indicate clinically meaningful success, such as patient acceptable symptom state (PASS). There were three purposes of the present single-cohort retrospective study: first, to determine the threshold PASS; second, to determine the influence of patient characteristics (age, gender, and body mass index (BMI)) and preoperative OHS and other PROMs of patients (namely, EQ-5D-3L, EQ-VAS, and pain VAS) who did not achieve this threshold; and third, to establish whether failure to achieve the PASS could still be associated with meaningful clinical improvement. Methods: This single-centre retrospective cohort study was conducted over 10 years from January 2013 to December 2022, during which 3997 patients completed pre- and postoperative OHS. The mean age was 68.3 years (standard deviation 11.7), and there were 2375 (59.4%) females in the cohort. Patient satisfaction was used as the anchor to define the PASS. Results: An OHS at 12 months postoperative of ≥36 points was identified as the threshold PASS (area under the curve 88.5%, 95% confidence interval [CI] 87.0 to 90.1, p < 0.001). Overall, 3002 (75.1%) achieved the PASS at 12 months. Lower BMI (odds ratio [OR] 0.96, 95% CI 0.95 to 0.98, p < 0.001) and higher preoperative OHS (OR 1.05, 95% CI 1.03 to 1.06, p < 0.001), EQ-5D (OR 1.88, 95% CI 1.33 to 2.65, p < 0.001) and EQ-VAS (OR 1.02, 95% 1.01 to 1.02, p < 0.001) were independently associated with achieving the PASS at 12 months. A total of 995 patients (24.9%) did not achieve this threshold. Patients not achieving the PASS had clinically meaningful worse (p < 0.001) postoperative outcomes and improvement relative to baseline in OHS, EQ-5D and EQ-VAS when compared to those achieving a PASS. Patients achieving the PASS were more likely to be satisfied with their THA (OR 16.8, 95% CI 12.8 to 22.1, p < 0.001); however, patients not achieving the PASS still had significant (p < 0.001) improvements relative to baseline in their OHS (9.6, 95% CI 9.0 to 10.2), EQ-5D (0.254, 95% CI 0.229 to 0.278), EQ-VAS (1.4, 95% CI −0.3 to 3.1) and pain VAS (8.2, 95% CI 6.1 to 10.3) and were more likely to be satisfied (70.8%) than not (29.2%). Conclusions: An OHS of ≥36 at 12 months was defined as the PASS. In total, 995 patients (29.4%) did not achieve this threshold, and in this group, patients were more likely to be female and have a high BMI and low preoperative OHS, EQ-5D, EQ-VAS, and pain VAS. Despite not achieving the PASS, they reported meaningful clinical improvements in OHS, EQ-5D, and pain VAS, and were satisfied with their THA (70.8%). Full article

Background: Outpatient hysteroscopy is the reference standard for the diagnosis and treatment of benign intrauterine pathology. Although several pharmacological and non-pharmacological strategies have been proposed to reduce procedural pain, the clinical and procedural factors primarily determining patient tolerability in a standardized vaginoscopic setting remain incompletely understood. This prospective study aimed to identify the main predictors of pain, procedural tolerability, successful completion, and patient acceptance during outpatient hysteroscopy. Methods: A prospective observational study was conducted between February and June 2026 at a second-level referral hospital. Consecutive women undergoing outpatient hysteroscopy were enrolled. All procedures were performed according to a standardized vaginoscopic “no-touch” protocol using a 15-Fr Bettocchi hysteroscope. Patients completed structured questionnaires before and after the procedure, while physicians recorded procedural findings immediately afterward. Clinical characteristics, psychological variables, procedural factors, pain scores, procedural tolerability, successful completion, and future patient preference were prospectively analyzed. Results: A total of 105 women were included. Diagnostic hysteroscopy was successfully completed in 94 patients (89.5%), and a see-and-treat procedure was performed in 57 (54.3%). Difficult cervical access occurred in 37 cases (35.2%) and emerged as the strongest determinant of poor procedural tolerability. These patients experienced significantly higher maximum pain scores (7.35 ± 2.81 vs. 4.04 ± 2.51; p < 0.001), a higher prevalence of severe pain (67.6% vs. 20.6%; p < 0.001), poorer procedural tolerability, greater preference for future hysteroscopy under anesthesia, and a higher risk of incomplete diagnostic examination. All incomplete hysteroscopies occurred in patients with difficult cervical access. Expected procedural pain was significantly associated with maximum pain (p = 0.0016), whereas pre-procedural anxiety was not. More than half of the patients identified cervical passage as the most painful procedural step. Patients undergoing successful see-and-treat procedures reported the lowest pain scores, suggesting that the operative phase itself was not the principal determinant of procedural discomfort. Conclusions: In a standardized vaginoscopic setting, procedural tolerability during outpatient hysteroscopy appears to depend primarily on difficult cervical access rather than on the operative intervention itself. Pain expectation may influence the hysteroscopic experience more than pre-procedural anxiety, whereas successful see-and-treat procedures remain well tolerated once uncomplicated access to the uterine cavity has been achieved. Early identification of patients at increased risk of difficult cervical access may improve patient counseling, optimize procedural completion, and preserve the benefits of outpatient hysteroscopy. Full article

Perianal fistula, or anal fistula, is an abnormal granulomatous tract connecting the anal canal or rectum to the surrounding skin. It causes perianal pain and fistulous discharge, negatively impacting patients’ quality of life. The mechanism underlying fistula formation remains incompletely understood. Medical imaging is essential for accurate preoperative assessment of the shape, number and branching of fistulous tracts, identification of internal openings and Parks’ classification. This pictorial review provides an image-based overview of the key medical imaging concepts essential for the diagnosis of perianal fistulae and summarises the roles, advantages and limitations of the available imaging modalities for evaluating perianal fistulae. The current evidence on X-ray fistulography, computed tomography (CT) fistulography, transcutaneous ultrasonography (TCUS), endoanal ultrasonography (EAUS) and pelvic magnetic resonance imaging (MRI) was reviewed, emphasising on their diagnostic performance and clinical applications. Conventional X-ray fistulography has progressively been abandoned because it is invasive, is uncomfortable for patients, provides poor soft tissue contrast and inadequately visualises anal sphincters, complex fistulous tracts, secondary branches and abscesses. CT fistulography is useful for evaluating perianal abscesses and fistula when MRI and EAUS are unavailable. TCUS is widely available, non-invasive and radiation-free but is operator-dependent and has limited ability to evaluate high perianal fistulae. EAUS accurately evaluates fistulous tracts, can be performed at the bedside or intraoperatively and is reliable when MRI is contraindicated. However, EAUS is operator-dependent, is contraindicated in patients with severe anal stenosis or acute anal pain, and has a small field of view. Pelvic MRI is the gold standard, providing excellent visualisation of anal canal anatomy, superior soft tissue contrast, accurate mapping of fistulous tracts, localisation of internal openings, assessment of the involvement of anal sphincters and detection of secondary tracts, abscesses and associated complications. Consequently, MRI is a preferred imaging modality, which can guide treatment decisions and monitoring of treatment response. Full article

Background/Objectives: Systemic inflammation may influence postoperative pain, but simple preoperative markers of pain risk are lacking in bariatric surgery. We examined whether the preoperative neutrophil-to-lymphocyte ratio (NLR) and immature granulocyte percentage (IG%) are associated with pain severity after laparoscopic sleeve gastrectomy (LSG). Methods: In this single-center retrospective cohort, records of 81 adults undergoing LSG were reviewed. Pain was rated on the 11-point numeric rating scale (NRS) in the recovery unit, at 24 h, and at 3 months. As NRS is ordinal, associations were assessed with Spearman correlation, covariate-adjusted ordinal logistic (proportional-odds) regression, NLR tertiles with a trend test, and receiver-operating-characteristic (ROC) analysis. Results: Preoperative NLR correlated positively with recovery unit NRS (rho = 0.36), 24 h NRS (rho = 0.37), and 3-month NRS (rho = 0.61; all p ≤ 0.001). After multivariable adjustment, log-NLR remained independently associated with recovery unit pain (odds ratio 6.1) and 24 h pain (odds ratio 8.1; both p < 0.001), with a graded relationship across tertiles (p for trend ≤ 0.020). For moderate-to-severe recovery unit pain, NLR discriminated with an area under the curve of 0.79 (optimal cutoff > 1.73). Neither IG% nor absolute IG was associated with any pain outcome (all p > 0.110). Conclusions: Higher preoperative NLR was independently and dose-dependently associated with greater early postoperative pain after LSG, whereas IG showed no association. NLR is a routinely available, essentially cost-free value that may help flag patients at risk of more severe early postoperative pain; prospective validation is warranted. Full article

Background and Objectives: Hallux rigidus is a degenerative condition of the first metatarsophalangeal joint that causes pain and limitation of motion. The aim of this study was to evaluate the clinical outcomes of a modified interpositional arthroplasty technique using an iliotibial band autograft fixed to the proximal phalanx in patients with advanced hallux rigidus. Materials and Methods: This prospective observational case series included 19 patients with Coughlin–Shurnas Grade III or IV hallux rigidus who underwent surgery between February 2023 and February 2025. Clinical outcomes were assessed using Visual Analog Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS), and range-of-motion (ROM) measurements preoperatively and at postoperative 1, 6, and 12 months. Results: The mean VAS score decreased from 9.0 ± 0.82 preoperatively to 1.58 ± 0.51 at 12 months (p < 0.001). The mean AOFAS score increased from 35.1 ± 2.7 to 74.8 ± 10.9 (p = 0.001). ROM improved significantly at 1 and 6 months; however, the 12-month ROM was not significantly different from the preoperative value (36.3° ± 5.6° vs. 31.0° ± 5.5°, p = 0.082). Conclusions: Interpositional arthroplasty using an iliotibial band autograft fixed to the proximal phalanx was associated with short-term reductions in pain and improvements in functional scores. However, the early increase in range of motion was not maintained to the same extent at 12 months. Full article

Objective: Our objective was to compare clinical safety and postoperative efficacy between transvesicoscopic Politano–Leadbetter (TPL) and laparoscopic Lich–Gregoir (LLG) ureteral reimplantation in infants and toddlers under 36 months diagnosed with primary obstructive megaureter (POM). Methods: This was a single-center retrospective cohort study of pediatric patients with POM who underwent ureteral reimplantation between January 2018 and April 2025. Patients were stratified into TPL and LLG groups by surgical approach. Baseline characteristics, perioperative outcomes, perioperative complications, imaging findings, renal functional outcomes, and long-term complications were collected and analyzed. Primary group comparisons were unadjusted, with additional multivariable linear regression performed for operative duration. Results: We enrolled 65 children: 30 in the TPL group and 35 in the LLG group. Baseline characteristics showed no statistically significant differences across the two study cohorts. There were no open conversions in either group. Total operative duration did not differ significantly between the TPL and LLG groups (145.8 ± 30.6 min vs. 136.9 ± 25.2 min; mean difference, 8.9 min; 95% CI, −4.9 to 22.7; p = 0.210). In multivariable linear regression, TPL showed a non-significant trend toward longer operative time after adjustment for age, preoperative ureteral diameter, and surgery year (B = 10.4 min; 95% CI, −3.7 to 24.4; p = 0.141). Time to postoperative oral intake was slightly shorter in the TPL group (6.1 ± 2.3 h vs. 8.2 ± 2.9 h; mean difference, −2.1 h; 95% CI, −3.4 to −0.8; p = 0.002). No statistically significant differences were detected in estimated blood loss, ureteral tapering rate, double-J stent placement rate, postoperative pain score, acetaminophen use, urinary catheterization duration, or length of hospital stay. Perioperative complications occurred in 3 patients in the TPL group and 5 patients in the LLG group (10.0% vs. 14.3%; risk difference, −4.3%; 95% CI, −20.1% to 11.5%; p = 0.716). No Clavien–Dindo grade III or higher complications occurred in either group. During follow-up, both groups showed reductions in anteroposterior pelvic diameter (APD) and ureteral diameter (UD), with preserved differential renal function (DRF). Low-grade postoperative vesicoureteral reflux (VUR) was detected in two LLG patients, including one grade I case at 4 months and one grade II case at 6 months after surgery; both were managed conservatively. Neither group experienced recurrent ureterovesical junction obstruction (UVJO) nor required reoperation during follow-up. Conclusions: In this single-center retrospective cohort of infants and toddlers with POM, no statistically significant differences were detected in the main perioperative and follow-up outcomes between TPL and LLG. TPL enables intravesical reconstruction and better preserves the natural anatomical course of the ureter and may serve as an alternative minimally invasive option for this patient population. Full article

Background/Objectives: First metatarsophalangeal (MTP) joint arthritis is a debilitating condition often treated with arthrodesis or joint replacement. However, the effectiveness of MTP joint replacement has not been thoroughly researched. This study aimed to evaluate functional outcomes and complication rates following first MTP joint replacement over a maximum seven-year follow-up period. Methods: A retrospective cohort study of 60 patients (68 toes) who underwent MTP joint replacement was performed. Data were extracted from medical records and anonymised prior to analysis. The primary outcomes measured included functional improvement and pain relief (AOFAS). Results: Findings indicate significant improvement in mean active and passive range of motion (ROM), with a mean active ROM of 35 degrees and a mean passive ROM of 45 degrees from a pre-op ROM of 0–10 degrees. The overall complication rate was 20.58%, with 10 cases of persistent stiffness but no pain and four cases of continued post-operative pain that necessitated MTP arthrodesis. Patients reported a mean post-operative AOFAS Hallux MTP-IP score of 88, improving from a pre-op score of 35. Conclusions: Results suggest that first MTP joint replacement is associated with significant pain relief and functional improvement with acceptable complication rates over the study period. Full article

The increasing detection of small, non-palpable testicular lesions has challenged the traditional paradigm that every solid intratesticular mass should be managed by radical orchiectomy. Many incidental lesions, particularly in infertile men and in patients with negative tumour markers, are benign or non-neoplastic, making overtreatment a clinically relevant concern. In this setting, ultrasound has become central to a more conservative and individualised diagnostic strategy. By combining high-resolution grey-scale imaging with Doppler, microvascular imaging, CEUS and elastography, multiparametric ultrasound provides complementary information on lesion morphology, vascularity, stiffness and interval change. When integrated with clinical presentation, tumour markers, fertility status, syndromic background and patient history, these features can help characterise lesions and estimate the likelihood of malignancy in the appropriate clinical context. Although imaging cannot replace histology, it can refine pre-test probability, support active surveillance in selected low-risk lesions, guide testis-sparing surgery, and improve assessment of the operated testis. This review examines the role of multiparametric ultrasound in characterisation of focal testicular lesions across different clinical settings, including incidentalomas, acute scrotal pain, trauma, bilateral disease, heterogeneous parenchyma, genetic and endocrine syndromes, and the postoperative testis. A structured, context-sensitive imaging approach may help reduce unnecessary orchiectomy while preserving timely detection of malignant, persistent, recurrent or metachronous disease. Full article

Background/Objectives: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) can produce comparable short-term clinical outcomes, but their regional effects on cervical muscle morphology are incompletely characterized. This study compared 12-month clinical outcomes and quantitative magnetic resonance imaging (MRI) changes after single-level C6–7 ACDF and CDA. Methods: This retrospective longitudinal cohort included 100 age-, sex-, and body mass index-matched patients (50 ACDF and 50 CDA). Neck and arm pain were assessed on 0–10 scales, and the Neck Disability Index (NDI) was analyzed as a 0–50-point score. Regional muscle cross-sectional area (CSA) and fatty infiltration (FI) were quantified on standardized preoperative and 12-month axial T2-weighted turbo spin-echo images at C6–7. The primary analysis included four posterior muscles. CSA change was expressed relative to baseline, whereas FI change was expressed in percentage points. Results: Clinical outcomes were statistically indistinguishable at 12 months (neck-pain score, 0.50 vs. 0.36, p = 0.318; NDI, 2.6 vs. 2.2 points, p = 0.479; perfect-outcome rate, 68.0% in both groups). Both groups showed significant regional posterior muscle CSA reduction and FI increase; however, the magnitude was greater after ACDF than after CDA (CSA reduction, −15% to −19% vs. −5% to −9%; absolute FI increase, +5.1 to +8.2 vs. +1.1 to +2.3 percentage points; all between-group q < 0.001). Surgical technique was independently associated with both MRI change metrics. Greater regional CSA reduction was modestly associated with higher concurrent 12-month neck-pain scores (β = −0.26, p = 0.022). This concurrent association does not establish causation or predict outcomes beyond 12 months. Conclusions: ACDF and CDA produced equivalent measured clinical outcomes at 12 months, while CDA showed a more favorable regional posterior muscle MRI profile. Differential device-related artifact was not quantitatively assessed and cannot be completely excluded, although concordant findings across four implant-remote posterior muscles make artifact unlikely to be the sole explanation. The functional and longer-term clinical significance of this imaging difference is not established and requires prospective longitudinal study. Full article

Background/Objectives: Chronic lymphocytic leukemia (CLL), the most common leukemia in adults, predominantly affects the aging population. With improved survival from modern targeted therapies, a growing number of CLL patients are living long enough to become candidates for quality-of-life-improving procedures such as elective total knee arthroplasty (TKA). However, the impact of CLL on postoperative outcomes remains poorly understood. Methods: A retrospective cohort analysis was performed using the TriNetX Research Network. Adult patients who underwent primary TKA were identified and divided into two cohorts. CLL and non-CLL control, and 1:1 propensity score matching was performed on demographics and comorbidities. Medical complications were assessed at 30 and 90 days, and implant-related complications at 1 and 3 years postoperatively. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated. Within the CLL cohort, a Cox proportional hazards model was used to identify preoperative laboratory values, medications, and comorbid diagnoses associated with complication development. Results: After matching, 2054 patients, 1027 per cohort, were analyzed. Patients with CLL demonstrated significantly higher risks of postoperative pain at both 30 days (p < 0.001) and 90 days (p < 0.001), as well as transfusion (p = 0.035) and acute kidney injury (p = 0.036) at 90 days. At 1 year, the CLL cohort had elevated risks of periprosthetic joint infection (PJI; p = 0.015) and arthrofibrosis (p = 0.036), and these differences persisted at 3 years (PJI p = 0.033; arthrofibrosis p = 0.006). In the hazards model, preoperative hemoglobin < 8 g/dL (HR: 1.75, 95% CI: 1.27–2.41, p < 0.001), long-term anticoagulant or antiplatelet use (HR: 1.43, 95% CI: 1.13–1.80, p = 0.003), chronic kidney disease (CKD; HR: 1.28, 95% CI: 1.04–1.58, p = 0.021), and overweight/obesity (HR: 1.23, 95% CI: 1.00–1.50, p = 0.047) were independently associated with short-term complications. Chronic opioid use was found to be associated with an increased risk of long-term complications (HR: 2.80, 95% CI: 1.49–5.24, p = 0.001). Conclusions: Patients with CLL undergoing TKA had higher observed risks of both early medical and late implant-related complications. These findings may reflect the combined effects of CLL-related immune dysfunction, cytopenias, and chronic systemic inflammation, which may impair wound healing, reduce physiologic reserve, and blunt infection clearance. Identification of associated, modifiable preoperative risk factors—anemia, anticoagulant exposure, CKD, obesity, and chronic opioid use—may provide actionable targets for optimization and risk stratification. Full article

Background/Objectives: Meniscal tears frequently occur during athletic activities and are often associated with anterior cruciate ligament injuries. The purpose of this study was to compare the posterior tibial slope (PTS) in young adults undergoing arthroscopic surgery for isolated meniscal tears with that of a control group, and to investigate its association with meniscal tears. Methods: This retrospective, single-centre, controlled study included 190 patients aged 18–30 years who presented with unilateral knee pain and underwent knee magnetic resonance imaging (MRI) between 2015 and 2022. Patients with an isolated medial meniscal tear (Group A, n = 67) or an isolated lateral meniscal tear (Group B, n = 31), confirmed on MRI and directly with arthroscopy, were compared with a symptomatic control group who presented with knee pain but had no meniscal or anterior cruciate ligament (ACL) tear on MRI (Group C, n = 92). Medial and lateral PTS angles were measured on pre-existing standing lateral knee radiographs. Interobserver and intraobserver reliability were quantified using intraclass correlation coefficients (ICCs). Group comparisons, receiver operating characteristic (ROC) analysis with the Youden index, and multivariable binary logistic regression adjusted for age, sex and side were performed. Results: Both medial and lateral PTS angles were significantly higher in Groups A and B than in the control group (p < 0.05). ROC analysis identified a cut-off of 9.2° for the medial PTS in the medial-tear group (AUC: 0.756, 95% CI: 0.68–0.83; sensitivity: 64.18%, specificity: 80.43%) and 9.9° for the lateral PTS in the lateral-tear group (AUC: 0.709, 95% CI: 0.60–0.82; sensitivity: 58.06%, specificity: 81.52%). The association persisted after adjustment for age, sex and side (medial slope in medial tears adjusted OR: 1.36 per 1°, 95% CI: 1.19–1.55, p < 0.001; lateral slope in lateral tears adjusted OR: 1.25 per 1°, 95% CI: 1.08–1.44, p = 0.003). Conclusions: In this retrospective cohort of young adults, an increased posterior tibial slope was associated with isolated meniscal tears. A medial PTS greater than 9.2° and a lateral PTS greater than 9.9° were associated with medial and lateral meniscal tears, respectively. Given the modest sensitivity and the observational design, PTS should be regarded as a supportive morphological marker rather than a stand-alone diagnostic metric, and a causal relationship cannot be inferred based on the results of this study. Because discrimination was only fair (AUC 0.693–0.756) and sensitivity limited (54.8–64.2%), these cut-offs are not clinically applicable decision thresholds and should be used only in conjunction with clinical assessment and MRI. Full article

(1) Background/Objectives: Sarcopenia is common in older surgical candidates and may affect perioperative risk and recovery after total hip arthroplasty (THA). Quantifying its burden and severity gradient in THA pathways can inform surgeon-led optimization. (2) Methods: A cross-sectional analysis of baseline preoperative data at a tertiary center (December 2019 to December 2022) was conducted. Consecutive adults with hip osteoarthritis undergoing primary THA were screened. Sarcopenia was staged per EWGSOP2: probable (low handgrip), confirmed (probable and low skeletal muscle index by whole-body DXA), and severe (confirmed and low gait speed). (3) Results: Of 312 screened patients, 203 completed baseline assessment (95 men, 108 women). According to the EWGSOP2 algorithm, 57 patients (28.1%; 95% CI 22.3–34.6%) had low handgrip strength, 30 (14.8%; 95% CI 10.6–20.3%) fulfilled criteria for confirmed sarcopenia, and 21 (10.3%; 95% CI 6.9–15.3%) had severe sarcopenia. No significant association was observed for sex. Sarcopenia diagnosis was associated with older age, lower body mass index (BMI), higher comorbidity burden, lower functional independence, greater cognitive impairment, poorer mental health, and worse hip-related function (all p < 0.05). In multivariable analysis, older age (OR 1.51 per 5-year increase; 95% CI 1.11–2.12), lower BMI (OR 0.88 per kg/m²; 95% CI 0.79–0.98), and lower functional independence (Barthel Index: OR 2.02 per 10-point decrease; 95% CI 1.20–3.60) were independently associated with confirmed sarcopenia. Across EWGSOP2 categories, differences in age, BMI, pain, comorbidity, functional independence, cognition, mental health and hip function showed significant differences (all p < 0.05), with ordered trends in most domains but no uniform monotonic pattern. (4) Conclusions: In THA candidates, sarcopenia is prevalent and is related to older age, lower BMI and lower functional independence. Integrating sarcopenia screening by EWGSOP2 may help to identify THA candidates with greater clinical vulnerability who may warrant further preoperative assessment and targeted optimization strategies. Full article

Angioleiomyoma is a benign soft tissue tumor originating from the smooth muscle of vascular structures. Though relatively uncommon, it frequently occurs in the lower extremities and is often misdiagnosed due to its nonspecific clinical presentation. We report the case of a 54-year-old female with chronic posterolateral heel pain initially attributed to insertional Achilles tendinopathy and Haglund’s deformity. After failure of conservative management, MRI revealed a well-circumscribed subcutaneous lesion with signal characteristics concerning for a soft tissue neoplasm. Surgical excision was performed, and histopathologic analysis confirmed a venous-type angioleiomyoma, characterized by thick-walled vascular channels and smooth muscle proliferation without atypia. Immunohistochemistry was positive for SMA, weakly positive for desmin, and ERG-positive in the vascular endothelium. The patient experienced complete symptom resolution postoperatively. Although not exceedingly rare, angioleiomyomas remain underrecognized in clinical practice, particularly in the foot and ankle, resulting in diagnostic delays averaging over five years. MRI demonstrated characteristic features described in recent literature, validating its utility in preoperative assessment. This case reinforces the importance of maintaining a broad differential when evaluating chronic, focal heel pain and supports the use of advanced imaging and histopathologic confirmation in atypical cases. Greater awareness of angioleiomyomas can help reduce diagnostic delays and improve outcomes in patients with chronic, unexplained soft tissue pain in the foot and ankle. Full article