Search Results (118)

Whole-leg radiographs (WLRs) are widely used to assess coronal alignment before total knee arthroplasty (TKA), but may be inaccurate in patients with atypical morphotypes or malrotation. This study evaluated the discrepancy between WLR and 3D computed tomography (CT) scans across coronal plane alignment of the knee (CPAK) morphotypes and introduced a novel projection index—the femoral notch projection ratio (FNPR). In CPAK III knees, 19% of cases exceeded a clinically relevant threshold (>3° difference), prompting investigation of underlying projection factors. In 187 knees, coronal angles—including the medial distal femoral angle (MDFA°), medial proximal tibial angle (MPTA°), femoral mechanical angle (FMA°), and arithmetic hip–knee–ankle angle (aHKA°)—were measured using WLR and CT. Rotational positioning on WLR was assessed using FNPR and the patellar projection ratio (PPR). CPAK classification was applied. WLR systematically underestimated alignment, with the greatest bias in CPAK III (MDFA° + 1.5° ± 2.0°, p < 0.001). FNPR was significantly higher in CPAK III and VI (+1.9° vs. −0.3°, p < 0.001), indicating a tendency toward internally rotated limb positioning during imaging. The PPR–FNPR mismatch peaked in CPAK III (4.1°, p < 0.001), suggesting patellar-based centering may mask rotational malprojection. Projection artifacts from anterior osteophytes contributed to outlier measurements but were correctable. Valgus morphotypes with oblique joint lines (CPAK III) were especially prone to projection error. FNPR more accurately reflected rotational malposition than PPR in morphotypes prone to patellar subluxation. A 3D method (e.g., CT) or repeated imaging may be considered in CPAK III to improve surgical planning. Full article

Introduction: Synovitis and damage to natural stabilizers of many axial and peripheral joints make patients with rheumatoid arthritis particularly susceptible to sagittal balance disorders of the axial skeleton. This may determine the high individual variability of cervical spine deformities as well as differences in the rate of development of disease symptoms in these patients, such as radiculopathy and myelopathy. Methods: In the scientific literature, in addition to systemic factors, more and more attention is paid to work on biomechanical factors in the development of cervical spine instability. One of the methods for assessing the influence of biomechanical factors, which can also be used in everyday practice, is the analysis of radiological parameters of sagittal balance. Results: Among the selected sagittal balance parameters studied, a statistical relationship between C4 and C5 distance and the OI parameter has been found, indicating a relationship to a parameter that remains constant throughout an individual’s life in the group of patients with disease duration over 20 years. Conclusions: The development of instability and deformity in the subaxial segment of the cervical spine in patients with rheumatoid arthritis may be the result of insufficiently understood components of biomechanical factors; hence, further research in this field is necessary. Full article

Background: Acromioclavicular (AC) joint dislocations are frequent, especially kocsisamong young male athletes. While over 150 surgical techniques exist, consensus on optimal treatment—particularly for Rockwood type III injuries—remains elusive. This study evaluates the Lockdown procedure’s efficacy, safety, and patient satisfaction, a synthetic ligament technique for AC joint stabilization. Methods: A multicenter prospective study was conducted on 39 patients across three Hungarian hospitals (2018–2023). Outcomes included shoulder function, pain levels, and complication rates, with subgroup analysis of acute (≤3 weeks) versus chronic (>3 weeks) cases. A systematic review of nine studies (205 cases) was also performed to assess broader outcomes and complications. Results: Significant improvements were observed in functional scores (OSS, Constant, DASH, SST, ASES, Nottingham, Imitani) and pain reduction, especially in acute cases with no prior shoulder surgery. The mean patient age was 38.9 ± 12.68 years, with a 24.5-month average follow-up. OSS improvement between acute and chronic cases was 14.96 (95% CI: 6.45–23.47; p = 0.0017). Complications (30.8%) occurred in eleven patients, mainly minor infections; implant failure necessitated revision in 5.1%. The systematic review reported a 34.6% complication rate (predominantly minor complications, like asymptomatic subluxation −16%) and 5.4% implant removal due to failure. A meta-analysis was not feasible due to data heterogeneity. Conclusions: The Lockdown procedure significantly enhances shoulder function and reduces pain, particularly in acute dislocations. However, the procedure showed a moderate complication rate, underscoring the need for careful patient selection and postoperative management. Full article

Numerous studies exist on medial opening wedge supramalleolar osteotomy (SMO), ever since its introduction by Takakura et al., as a joint-preserving surgical option for treating varus ankle osteoarthritis (OA). Although SMO can induce lateral translation of the talus—which is medially translated in varus ankle OA—it has only minimal effects on the correction of the varus tilt of the talus. Particularly, SMO alone does not effectively neutralize the talar position. The primary reason for this limitation is that varus tilting of the talus is not merely a two-dimensional deformity in the coronal plane, but rather a three-dimensional deformity involving internal rotation and anterior subluxation. Therefore, this study aimed to explore the key considerations for achieving effective correction of varus talar tilt in joint-preserving surgery for treating degenerative varus ankle OA with large talar tilting. Further, we have discussed the relevant studies and included the lessons learned from our clinical experience, categorizing the key surgical considerations into preoperative, intraoperative, and postoperative phases. Full article

Background/Objectives: Hindfoot valgus malalignment, characterized by the lateral deviation of the calcaneus and medial tilting of the talus, disrupts hindfoot biomechanics and increases strain on subtalar joint. This study evaluates weightbearing and non-weightbearing imaging modalities to identify dynamic alignment changes and their diagnostic implications. This study aims to (1) quantify changes in subtalar joint parameters between non-weightbearing computed tomography (NWBCT) and weightbearing computed tomography (WBCT) in patients with hindfoot valgus; (2) evaluate correlations between WBCT and standard radiographic parameters; and (3) identify radiographic predictors of subtalar joint status during weightbearing. Methods: We reviewed 70 patients with confirmed hindfoot valgus malalignment (hindfoot valgus angle >5°), identified through radiographic measurements. Of these, 32 underwent both NWBCT and WBCT, while 38 underwent WBCT alone. Hindfoot alignment angle (HAA) and hindfoot alignment ratio (HAR) were measured on hindfoot alignment radiographs, while heel valgus angle (HVA), talocalcaneal distance (TCD), subtalar joint subluxation (SL) and calcaneofibular distance (CF) were assessed on CT. Results: WBCT revealed significant increases in HVA and SL (both, p < 0.001) and decreases in TCD and CF (p < 0.001 and p = 0.002, respectively) compared to NWBCT, reflecting dynamic subtalar joint changes under weightbearing conditions. Receiver operating characteristic (ROC) analysis identified hindfoot alignment angle (HAA) as the most reliable predictor of talocalcaneal osseous contact, with a cutoff value of >9.25° based on Youden’s index, yielding a sensitivity of 73% and specificity of 81.8%. Inter- and intra-observer reliabilities for all parameters were excellent (ICC > 0.81). Conclusions: WBCT provides critical insights into subtalar joint dynamics under physiological loads, surpassing NWBCT in assessing weightbearing-induced alignment changes. Although standard radiographic parameters, particularly HAA, can serve as reliable, cost-effective predictors of subtalar joint pathology in resource-limited settings, WBCT should still be preferred when available, especially in patients with significant malalignment or when detailed dynamic evaluation is needed to guide clinical decision-making. Full article

Background/Objectives: We report a consecutive prospective case series to obtain prospective safety and performance data of a low-energy femtosecond (FS)-laser for cataract surgery in children and to evaluate the applicability of the Bochum formula for capsulotomy diameter calculation. Methods: In pediatric lens surgery with implantation of a bag-in-the-lens intraocular lens (BIL IOL), anterior capsulotomies were performed using the FS-laser. Regression analysis was used to develop an age-dependent correction formula, and the Pearson correlation was used to evaluate the applicability of the Bochum formula. Surgery-related and ocular adverse events (AE) were recorded at 1 day, 1 week, 1 month, and 6 months postoperatively. Results: Thirteen eyes of 10 patients were included in the analysis, among them three cases of subluxated lenses. The mean age was 3.10 ± 2.38 years (range: 4 months to 8 years). The linear bivalent regression yielded the following formula: 1.27 − 0.014 × patient age. Age-related formulas, such as the Bochum formula, are required to calculate the programmed capsulotomy diameter. No complications related to the FS-laser or ocular AEs were observed up to six months; in particular, no excessive shrinkage, retinal detachment, or unusual inflammation were identified. Conclusions: This study indicates that the use of the low-energy femtosecond laser for anterior capsulotomy in pediatric lens surgery is safe and contributes to improved reliability and feasibility. The confirmed age dependence of the enlargement factor of the capsulotomy diameter might be related to the higher capsular elasticity in pediatric eyes. Full article

Background and Objectives: Hemiplegic shoulder pain (HSP) is a common and disabling complication in stroke patients, yet its pathogenesis remains unclear. This longitudinal study aimed to investigate the clinical and ultrasound characteristics of HSP emerging within the first 72 h (T0) post-stroke, with follow-ups at one month (T1) and three months (T2). Materials and Methods: A total of 28 stroke patients with hemiparesis were assessed for HSP. Evaluations included pain severity during passive shoulder mobilization, passive and active range of motion, muscle strength, spasticity, and functional disability. Ultrasound examinations were conducted to assess tendon disorders, bursitis, effusion, glenohumeral subluxation, and adhesive capsulitis. Results: HSP prevalence increased over time, affecting 11% of patients at T0, 32% at T1, and 57% at T2. Higher baseline scores on the National Institutes of Health Stroke Scale (NIHSS), an established marker of stroke severity, were significantly associated with HSP (p < 0.05). At T2, patients with HSP exhibited greater impairment, including restricted passive and active range of movement, pronounced muscle weakness, and increased spasticity (p < 0.05). Ultrasound findings at T2 revealed that adhesive capsulitis and glenohumeral subluxation were significantly more frequent in HSP patients (p < 0.05). Adhesive capsulitis showed a significant increase from 0% at T0 to 21% at T2 (p = 0.031), while glenohumeral subluxation exhibited a non-significant rise from 4% to 21% (p = 0.063). Patients with these conditions experienced significantly greater pain progression (p < 0.001). Conclusions: These findings suggest that capsular pathology plays a key role in the development of HSP within the first three months after stroke. The results highlight the need for targeted interventions addressing glenohumeral subluxation and adhesive capsulitis to alleviate pain and improve rehabilitation outcomes. Full article

Atlantoaxial subluxation (AAS) is a neurosurgical condition caused by joint hyperflexion and is characterized by the development of compressive cervical myelopathy. Various ventral fixation techniques have been described to permanently reduce the subluxation by long-term stabilization of the atlantoaxial joint. However, the rate of complications related to implant failure with these techniques remains high. The aim of this study was to describe a cervical distraction–stabilization technique using screws and PMMA to treat AAS and evaluate the clinical outcomes based on neurological and radiographic follow-up. Magnetic resonance imaging (MRI) was performed to confirm the diagnosis of AAS and identify any associated intraparenchymal lesions. Computed tomography (CT) scans were performed for surgical planning. No complications resulting in irreversible damage, surgical revision, or euthanasia protocol were observed. In the immediate postoperative period, the neurological scores showed an improvement of approximately two points from the preoperative values in all subjects. At the 6-month neurological examination (medium-term follow-up), 93% (13/14) of the dogs showed normal neurological function with no signs of pain. Based on clinical follow-up data, the cervical distraction–stabilization technique described in this study appears to be a valuable surgical alternative to treat AAS in toy-breed dogs. Full article

Background: Patellofemoral instability is a pathological condition that is characterized by altered joint congruence, which manifests as episodes of subluxation or dislocation of the patella. The aim of this study was to systematically review the literature on this condition by comparing the results of various studies evaluating the effectiveness of surgical versus conservative treatment approaches for patellar instability, particularly in patients experiencing a first episode of patellar dislocation. Methods: The research was conducted using three different databases: PubMed, Cochrane Library, and PEDro. Both randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) with full text availability were included. All articles were in English, and no temporal limits were imposed during the search. Results: In total, 10 articles met the inclusion criteria and were included in the systematic review. The standard for statistical significance was p < 0.05. The statistical analysis of re-dislocation rates indicated a statistically significant difference between the conservative and surgical groups (p = 0.023). The statistical analysis also showed that the mean Kujala score was significantly lower in the non-operative group (80.94) than the surgical group (89.83) (p = 0.017). These results indicate that surgical treatment is significantly more effective in reducing re-dislocation rates than conservative treatment and has better Kujala scores than conservative treatment. Conclusions: A reduction in the re-dislocation rate and improved scores on subjective tests related to pain and quality of life were observed with surgical treatment. Nevertheless, a higher level of evidence is needed to more clearly and accurately determine the most effective treatment approach. Full article

The increasing interest in complementary and alternative medicines (CAMs) for musculoskeletal care has sparked significant debate, particularly regarding their biological plausibility and clinical effectiveness. This comprehensive review critically examines the use of two of the most widely utilized CAMs—osteopathy and chiropractic care—over the past 25 years, focusing on their biological plausibility, clinical effectiveness, and potential mechanisms of action. Our analysis of current research and clinical studies reveals that osteopathy and chiropractic are based on concepts such as “somatic dysfunction” and “vertebral subluxation”, which lack robust empirical validation. While these therapies are often presented as credible treatment options, studies evaluating their effectiveness frequently exhibit serious methodological flaws, providing insufficient empirical support for their recommendation as first-line treatments for musculoskeletal conditions. The effects and mechanisms underlying osteopathy and chiropractic remain poorly understood. However, placebo responses—mediated by the interaction of contextual, psychological, and non-specific factors—appear to play a significant role in observed outcomes. The integration of therapies with limited biological plausibility, whose effects may primarily rely on placebo effects, into healthcare systems raises important ethical dilemmas. This review highlights the need for rigorous adherence to scientific principles and calls for a more comprehensive investigation into biobehavioral, contextual, and psychosocial factors that interact with the specific effects of these interventions. Such efforts are essential to advancing our understanding of CAMs, enhancing clinical decision-making, promoting ethical practices, and guiding future research aimed at improving patient care in musculoskeletal disorders. Full article

Since its introduction, weight-bearing computed tomography (WBCT) has gained prominence due to its ability to produce accurate three-dimensional images under natural loading conditions, making it particularly useful for assessing complex foot deformities. This review aimed to focus on the diseases of the foot and categorized the pathological conditions into forefoot disease (hallux valgus), midfoot disease (Lisfranc injuries and midfoot osteoarthritis), and progressive collapsing foot deformity. For each category, the authors detail how WBCT enhances diagnostic accuracy and informs treatment strategies. In hallux valgus, WBCT allows for more precise measurement of established parameters and reveals crucial information about metatarsal pronation and ray instability. For midfoot pathologies, WBCT’s superiority in detecting subtle Lisfranc injuries and characterizing midfoot osteoarthritis is emphasized, highlighting the development of novel measurement techniques. The review extensively covers the application of WBCT in assessing the complex three-dimensional features of PCFD, including hindfoot valgus, midfoot/forefoot abduction, medial column instability, peritalar subluxation, and valgus tilting, presenting several WBCT-specific measurements and the use of distance mapping to quantify joint surface interaction. The authors conclude that WBCT, potentially enhanced through integration with artificial intelligence (AI), represents a significant advancement in foot and ankle care, promising improved diagnostic accuracy, streamlined treatment planning, and, ultimately, better patient outcomes. Full article

Cervical spine injuries that impact young horses and foals can result in mild to severe neurological signs or even result in sudden death. There are only a few reports on conservative treatment options for this condition in the scientific literature. If the condition is left untreated, it can lead to the development of degenerative joint disease, resulting in chronic neurological symptoms and discomfort. We present the case of a two-day-old Arabian foal that showed signs of ataxia following a neck injury, being the result of cervical spine subluxation. Radiological examination revealed a dislocation between the second and third cervical vertebrae. At admission to the clinic on the seventh day of life, the foal’s clinical examination parameters were within physiological ranges. The head posture at the presentation was consistently low, the foal could not lift its head above the shoulder joint throughout the whole examination, the neck muscles were spastically tensed and clinical signs of ataxia were present. The foal underwent a closed reduction in the subluxation under general anesthesia and a fiberglass semicircular gutter was created to stabilize the neck in the desired position. The ataxia symptoms began to improve around day 12 post manipulation, and the fiberglass stabilizer was removed after 16 days post manipulation, followed by radiographs. The dislocation of C2/C3 was no longer visible on the radiographs, and the foal was able to assume a normal neck posture after the removal of the fixator. Full article

Introduction: Arthroscopic Bankart repair (ABR) is associated with an increased failure rate over time. The Recenter implant, a metal block, is designed to reinforce capsulolabral repair. The aim of this study was to evaluate whether the addition of the Recenter implant to ABR reduces the rate of recurrence in patients with glenohumeral anterior instability. Materials and Methods: This was a retrospective, multicentric case–control study focusing on patients surgically treated for anterior shoulder instability from February 2012 to November 2019. This study compared patients undergoing ABR augmented with the “Recenter” implant (augmented ABR group) against those receiving traditional ABR. Primary outcomes measured included recurrence rates. Secondary outcome measures included functional scores (Walch–Duplay and the subjective shoulder test [SST], the auto Rowe score, satisfaction, pain, and the presence or absence of subjective subluxation and apprehension), return to sports, the range of motion, as well as other complications. Results: Thirty-two patients with augmented ABR were compared to forty-eight patients in the traditional ABR group, with mean follow-up periods of 5.2 ± 1.3 years and 6.1 ± 1.5 years, respectively. Three patients (9.4%) experienced recurrence in the “Recenter” group, versus eight (16.7%) in the other group (p > 0.05). The Walch–Duplay score was 70.2 ± 8.2 in the “Recenter” group and 64.2 ± 8 in the control group (p > 0.05). The SST score out of 100 was, respectively, 84.6 ± 6 and 81.5 ± 5.5 (p = 0.05). There were no early complications in the implant group. No statistically significant differences were observed between the two groups for the other outcomes. Conclusions: ABR safely restores shoulder stability in selected patients with subcritical glenoid bone deficiency. However, the addition of the Recenter metal implant did not improve outcomes compared to traditional Bankart repair and introduced presumed significant surgical time, technical challenges, and additional costs. Full article

Introduction: Joint hypermobility (JH) is mobility beyond the normal range of motion. JH can be an isolated finding or a characteristic of a syndrome. Characteristics related to the sitting position with atypical body positions, such as sitting in splits (S), with the foot on the head (F), in W (W), in a concave shape (C), episodes of dislocations, and subluxations, suggest impacts on body mechanics since childhood, with damage to the conformation of the joints. Objectives: Identify preclinical signs of JH, in addition to Beighton Score (BS), through signs that are easily recognized early by pediatricians and family members to avoid possible joint deformities in the future. Methods: The medical records of 124 children (59.7% girls) between one and nine years old were analyzed. JH was assessed using the BS, a history of luxations/subluxations, and the concave (C), “W”, “splits” (S), and foot (F) on head sitting positions. Results: The concave sitting position was the most common, followed by W, F, and S in decreasing order. A total of 52.4% of the children had BS > 6, with a higher prevalence among girls (60.8%) compared to boys (40.0%); a difference statistically significant (p = 0.024, Fisher’s exact test). Thirty-two patients (27.4%) had luxations/subluxations with the higher scores. Conclusions: Sitting in S, F, W, and C positions are preclinical phenotypic characteristics of JH, easily identified by pediatricians and family members to prevent possible joint deformities. BS ≥ 6 is more frequently observed in all positions. The majority of the total sample has BS > 6, with a significant female gender influence. Among those with a history of occasional joint dislocations and subluxations, half of them have the highest BS scores. Full article

Background/Objectives: The aim of the study is to present middle-term results of tailored bone and soft-tissue surgeries in subluxated and dislocated hips in children affected by cerebral palsy. Methods: A total of 87 medical records belonging to 73 children affected by CP, treated with combined soft-tissue releases, VDO, and pelvic osteotomy, were reviewed retrospectively. Radiological measurements of AI, RI, and NSA were obtained before surgery, postoperatively, at 12 and 24 months after surgery. Results were assessed globally and by GMFCS, age, and Robin score. Results: Postoperative results are not statistically influenced by age and GMFCS levels at surgery. All three radiographic parameters showed persistent statistically significant improvement after surgery and at follow-up, respectively. Conclusions: Obtaining the best possible concentric reduction of the femoral head in the acetabulum, with simultaneous multilevel soft-tissue rebalancing, creates the best mechanical and biological environment to allow the reshaping of both articular surfaces, obtaining physiological internal joint pressure. The anatomical best congruency is protective from recurrence. Full article