Clinical benefits of early-stage autologous conditioned serum and injectable platelet-rich fibrin on healing superficial digital flexor tendonitis in donkeys

Injectable platelet-rich fibrin (I-PRF) has been explored for its regenerative potential, but its application in tendon healing remains unstudied. Autologous conditioned serum (ACS), commonly used in joint therapies, inhibits interleukin 1-mediated inflammation, though its role in tendon healing is not well established. This study aimed to evaluate the clinical benefits of I-PRF alone and in combination with ACS in tendon healing. Twenty-three donkeys with forelimb superficial digital flexor (SDF) tendonitis were examined at admission (T0) and randomly assigned to PRF/ACS treated group (n  = 10), PRF group (n  = 7), or included as a control group (n  = 6). Among clinical parameters, tendon shape and weight-bearing scores at T150 were significantly improved (P  < 0.001) in the PRF/ACS group compared to the control group. Regardless of the tendon cross-sectional area (T-CSA), all other ultrasonographic parameters showed significant improvement in the PRF/ACS group compared to the control group. T-CSA increased throughout the study in PRF group but significantly decreased at T150 in control and PRF/ACS groups. The combination therapy had a significant improvement in fiber alignment score (FAS) and T-CSA compared to PRF group. Early lesion resolution in PRF/ACS at T90 and later in PRF at T150 suggests superior healing in PRF/ACS group. Persistent increase in T-CSA in the PRF group indicates ongoing healing, while its reduction in the PRF/ACS groups reflects more progressed healing stages and superior outcomes. Conversely, the presence of hyperechoic dots and misaligned tendon fibers in the control group suggests inferior healing outcomes. Intralesional I-PRF combined with ACS significantly enhanced clinical and ultrasonographic healing characteristics in donkeys with SDF tendonitis.

Ideal pin length and interval in tension band wiring using ring pins for transverse olecranon fractures: a biomechanical study

BACKGROUND

Several clinical and biomechanical studies on tension band wiring (TBW) using a ring-pin system have been conducted, but no consensus has been reached on the ideal surgical technique. In this study, we aimed to determine the ideal interval and length of ring pins for the treatment of transverse olecranon fractures using TBW with a ring-pin system.

METHODS

A biomechanical study was performed using 32 fourth-generation composite ulnae and a ring-pin system specially designed for TBW. Four groups of eight sawbones were created based on the interval and length of the ring pins. A cyclic loading test was performed to measure stability during the active range of motion exercises. A load-to-failure test measured the maximal load until fixation loss.

RESULTS

All groups were stable, with a micromotion of < 1.0 mm, except for Group 3 (length: 50 mm, interval: 10 mm) during the cyclic loading test. The mean micromotion and displacement of Group 3 were significantly higher than those of Groups 2 and 4 (length: 90 mm, interval: 10 mm). The maximal load to failure in Group 3 was significantly lower than that of Groups 2 and 4.

CONCLUSION

Inserting two ring pins in parallel at a 10-mm interval with a length of ≥ 70 mm for TBW in transverse olecranon fractures is recommended. Further widening of the pin interval provides no biomechanical benefit and may result in technical difficulties owing to the anatomical features of the ulna; in summary, 50-mm ring pins show significantly lower mechanical strength.

Reoperations After Operatively and Non-Operatively Treated Periprosthetic Knee Fractures: A Nationwide Study on 1,931 Fractures After Primary Total Knee Arthroplasty

BACKGROUND

Periprosthetic knee fracture (PPKF) following total knee arthroplasty (TKA) can be difficult to treat. A PPKF can be treated both operatively and nonoperatively, and the treatment varies between fracture sites. This study aimed to assess the risk of reoperation according to the fracture site and treatment of the PPKF.

METHOD

This study is a nationwide cohort study using register data from 1997 to 2022. Cruciate-retaining or posterior-stabilized primary TKA were identified from the Danish Knee Arthroplasty Register. Subsequent PPKFs, fracture treatments, and later reoperations were identified through the International Classification of Diseases, tenth edition (ICD-10) diagnosis and procedure codes in the Danish National Patient Register. In addition, indications for revision total knee arthroplasty (rTKA) in the Danish Knee Arthroplasty Register were used to identify PPKFs and the reason for reoperation.

RESULTS

We included 1,931 PPKFs (1,494 femoral, 207 patellae, and 230 tibial) with an overall two-year reoperation risk of 20% (95% confidence interval (CI): 18 to 23). Femoral PPKFs had a two-year reoperation risk of 16% (CI: 12 to 22) after nonoperative treatment and 21% (CI: 18 to 24) after operative treatment. Patellar PPKFs had a two-year reoperation risk in five to 17 after nonoperative treatment and 46% (CI: 30 to 69) after operative treatment. Tibial PPKFs had a two-year reoperation risk of 17% (CI: 11 to 27) after nonoperative treatment and 36% (25 to 53) after operative treatment.

CONCLUSIONS

The overall two-year reoperation risk was 20% (CI: 18 to 23). Operative-treated PPKFs had a higher risk of reoperation across all fracture locations. The highest reoperation risk was found after operatively treated patella and tibial PPKFs (46 and 36%, respectively), and the lowest reoperation risk was found after nonoperative-treated patella PPKFs.

The "Bag of Bones" Treatment of Comminuted Intra-articular Distal Humerus Fractures in the Elderly

BACKGROUND

Extensively comminuted intra-articular distal humerus fractures in the elderly present a challenging therapeutic dilemma. The purpose of this study was to investigate the results of nonoperative treatment of these fractures in a select subset of patients.

METHODS

Patients treated with nonoperative management for a comminuted intra-articular distal humerus fracture between 2007 and 2018 were reviewed. Patients were administered 3 elbow-specific functional outcomes instruments.

RESULTS

A total of 8 patients (2 men, 6 women) were treated with brief immobilization followed by early range of motion. All had fractures with extensive comminution of the articular surface such that open reduction and internal fixation was not feasible. Average age was 70 years. At an average of 33 months postinjury, average flexion was 124°, and extension was -27°, with full forearm rotation. No patients required pain medications at the latest follow-up. At 33 months of follow-up, the average Mayo Elbow Performance Score was 92/100 (100 optimal), Oxford Elbow Score was 43/48 (48 optimal), and Quick Disabilities of the Arm, Shoulder, and Hand Score was 10/100 (0 optimal). All patients were satisfied with the nonsurgical treatment that they received.

CONCLUSIONS

Nonoperative treatment for comminuted intra-articular distal humerus fractures results in acceptable functional outcome in elderly patients and should be considered when the fracture is not amenable to internal fixation and in lower-demand patients with higher surgical risk.

Influence of pre-operative co-morbidities on pain and function outcomes at 1 year after primary total knee arthroplasty

INTRODUCTION

Multimorbidity has been found to be associated with more pain and poorer function following total knee arthroplasty (TKA). We describe the relationship between both the total number of pre-operative co-morbidities, and individual co-morbidities, with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 12 months after TKR.

METHODS

We performed a secondary analysis on 290 participants from the Arthroplasty Pain Experience (APEX) trial, with seventeen imputations by Chained Equations. Using multivariable adjusted linear regression models, we analysed the relationship between total number of pre-operative co-morbidities, followed by individual co-morbidities, with WOMAC score at 12 months after randomisation.

RESULTS

Patients with ≥ 5 co-morbidities have worse outcomes compared to patients with 3 co-morbidities, scoring -9.6 points for function (95% CI -15.3 to -3.8), and -9.8 points for pain (95%CI -15.9 to -3.8). Patients reported worse pain with osteoporosis (-7.8 95%CI -14.1 to -1.6), peripheral vascular disease (-17.8 95%CI -34 to -1.8), depression (-9.8 95%CI -18.1 to -1.4), anxiety (-9.7 95%CI -18 to -1.4) or degenerative disc disease (-7.5 95%CI -13.3 to -1.7). Worse function was associated with osteoporosis (-7.1 95%CI -12.9 to -1.4), diabetes mellitus (-9.1 95%CI -15.6 to -2.6), anxiety (-8.1 95%CI -16 to -0.2) and degenerative disc disease (-8.6 95%CI -14.1 to -3.2).

CONCLUSION

Pre-operative multimorbidity is associated with worse outcomes after TKA. Patients with pre-operative osteoporosis, anxiety and degenerative disc disease had worse pain and function at 12-months. Surgeons may use these results during discussion with patients about their potential outcome after TKA.

Association between sarcopenia on residual back pain after percutaneous kyphoplasty for osteoporotic vertebral compression fractures

OBJECTIVE

This study aimed to investigate whether sarcopenia affects residual back pain (RBP) after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCF).

METHODS

We retrospectively analyzed the clinical data of 231 patients with single-segment OVCF treated with PKP between January 2023 and December 2023. Postoperative RBP was assessed at 1 month using the visual analogue scale (VAS). Patients with a VAS score ≥ 4 were classified as the RBP group, while those with a score < 4 served as controls. Sarcopenia was diagnosed using the skeletal muscle mass index (SMI), calculated by dividing the cross-sectional muscle area at the T12 vertebral level (measured via chest CT) by height squared. Univariate analysis compared clinical and imaging data between groups, and binary logistic regression identified risk factors.

RESULT

No significant differences were observed between groups in gender, BMI, surgical segment, hypertension, diabetes, or coronary heart disease (P > 0.05). However, age, BMD, SMI, bone cement usage, and sarcopenia prevalence differed significantly (P < 0.05). Binary logistic regression identified BMD and sarcopenia as independent risk factors for RBP after PKP.

CONCLUSION

OVCF patients with sarcopenia have a higher likelihood of postoperative RBP, with an incidence approximately twice that of non-sarcopenic patients. Preoperative sarcopenia screening should be prioritized, and postoperative anti-muscular atrophy therapy actively implemented.

Effect of a Laparoscopic Donor Nephrectomy in Healthy Living Kidney Donors on the Acute Phase Response Using Either Propofol or Sevoflurane Anesthesia

Surgical trauma elicits a complex inflammatory stress response, contributing to postoperative morbidity and recovery variability. This response is influenced by patient-specific factors and surgical and anesthetic techniques. To isolate the impact of anesthesia on the acute phase response, we investigated plasma proteomic changes in a uniquely homogeneous cohort of healthy, living kidney donors (n = 36; propofol = 19; sevoflurane = 17) undergoing laparoscopic donor nephrectomy. Proteomic profiling of plasma samples collected preoperatively and at 2 and 24 h postoperatively revealed 633 quantifiable proteins, of which 22 showed significant perioperative expression changes. Eight proteins exhibited over two-fold increases, primarily related to the acute phase response (CRP, SAA1, SAA2, LBP), tissue repair (FGL1, A2GL), and anti-inflammatory regulation (AACT). These changes were largely independent of anesthetic type, though SAA2 and MAN1A1 showed anesthetic-specific expression. The upregulation of these proteins implicates the activation of immune pathways involved in host defense, tissue remodeling, and inflammation resolution. Our findings provide a molecular reference for the surgical stress response in healthy individuals and highlight candidate biomarkers for predicting and managing postoperative outcomes. Understanding these pathways may support the development of strategies to mitigate surgical stress and enhance recovery, particularly in vulnerable patient populations.

[Comparative study of posterior axillary edge approach and arthroscopic assisted reduction in treatment of Ideberg type and glenoid fracture of the scapula]

Objective

To compare the effectiveness of posterior axillary edge approach and arthroscopic assisted reduction in the treatment of Ideberg type Ⅰ and Ⅱ glenoid fracture of the scapula.

Methods

The clinical data of 26 patients with fresh Ideberg type Ⅰ and Ⅱ scapular fractures admitted between June 2021 and September 2024 who met the selection criteria were analyzed retrospectively. The patients were divided into two groups according to different treatment methods. Ten cases in the posterior axillary edge group were fixed by open reduction plate through the posterior axillary edge approach, and 16 cases in the arthroscopy group were treated with suture anchor fixation under arthroscopy. There was no significant difference in baseline data between the two groups ( P>0.05), such as gender, age, surgical side, Ideberg type, cause of injury, time from injury to operation, rotator cuff injury, and superior labrum anterior posterior (SLAP) injury, etc. The operation time and fracture healing time were recorded and compared between the two groups, and the shoulder pain was evaluated by visual analogue scale (VAS) score at 1 week, 1 month, and 3 months after operation. At 3 and 6 months after operation, the range of motion of shoulder joint in anteflexion, abduction, external rotation, internal rotation, and backward extension was evaluated, the upper limb dysfunction was evaluated by the Disability Assessment Scale of Arm, Shoulder, and Hand (DASH), and the shoulder joint function was evaluated by the Constant-Murley score. The differences between 6 months and 3 months after operation (changes) were statistically analyzed.

Results

Patients in both groups were followed up 11-13 months, with an average of 12.5 months. The operation time and fracture healing time in the posterior axillary edge group were significantly shorter than those in the arthroscopy group ( P<0.05). There was no complication such as wound infection, vascular and nerve injury, loss of reduction, bone nonunion, or glenohumeral instability in both groups. At 1 week after operation, the VAS score in the posterior axillary edge group was significantly higher than that in the arthroscopy group ( P<0.05); there was no significant difference in the VAS score between the two groups at 1 and 3 months after operation ( P>0.05). At 6 months after operation, the changes of shoulder joint in anteflexion, internal rotation range of motion and DASH scores in the posterior axillary edge group were significantly lower than those in the arthroscopy group ( P<0.05), while the changes of abduction, external rotation, backward extension range of motion and Constant-Murley scores were not significantly different between the two groups ( P>0.05).

Conclusion

For Ideberg type Ⅰ and Ⅱ glenoid fracture of the scapula, the posterior axillary edge approach for internal fixation has a short operation time, fast fracture healing, and is beneficial for early functional recovery; arthroscopic assisted reduction has minimal trauma and can handle joint injuries simultaneously. Both surgical procedures are safe and effective, and individualized selection should be made based on soft tissue conditions and combined injuries.

Limb Occlusion Pressure Versus Standard Pneumatic Tourniquet Pressure in Anterior Cruciate Ligament Surgery: A Randomized Controlled Trial

BACKGROUND

Tourniquets are frequently used to minimize blood loss. Standard pressures (STPs) are typically higher than minimum limb occlusion pressure (LOP), which can contribute to postoperative pain among other complications. We sought to investigate the effect of STP versus LOP on postoperative pain and opioid medication use after anterior cruciate ligament reconstruction (ACLR).

METHODS

Sixty patients (age = 37 ± 15 years) undergoing ACLR were recruited and randomized into STP (275 mm Hg; M = 15/F = 15) or LOP (180 ± 29 mm Hg; M = 15/F = 15) group. A photoplethysmography probe was used to determine appropriate tourniquet pressures for the LOP group. Tourniquet and surgical site pain (Visual Analog Scale scores 0 to 10), as well as opioid medication usage, was recorded for 14 days after surgery. A generalized linear mixed model was used to detect differences in pain and medication use over the 14 days. The type-I error was defined as = 0.05.

RESULTS

Tourniquet site pain was less in the LOP group during postoperative days (PODs) 1 to 5 (P < 0.05) and averaged across the two-week postoperative period (P = 0.015). Surgery site pain was less in the LOP group at PODs 9 and 14 (P < 0.05). Reduced opioid medication use was observed in the LOP group at PODs 3, 4, and 7 and averaged across the postoperative window (P < 0.05).

CONCLUSION

Individualized LOPs yield decreased postoperative pain and narcotic use compared with STP during ACLR.

Diffuse tenosynovial giant cell tumors of the hand and wrist, a case series and literature review

This study aimed to evaluate the management and outcomes of diffuse tenosynovial giant cell tumors (DTGCT) in the hand and wrist. We retrospectively reviewed five cases treated surgically between 2016 and 2020, with a minimum follow-up of two years. Preoperative MRI was used to assess tumor diffusion and involvement of adjacent structures, while diagnosis was confirmed through histological analysis of biopsy samples. Surgical treatment involved en bloc resection of the primary lesions. The study found a 37.5% recurrence rate, with recurrences occurring on average 6.7 months after initial surgery. Bone resection was needed in 60% of cases, either initially or due to recurrences. Active surveillance or repeat surgery managed recurrences. The findings highlight the importance of comprehensive preoperative imaging and aggressive surgical resection to minimize recurrence risk.

Comparison of Platelet-Rich Plasma Properties Used in Athletic Musculoskeletal Conditions: A Clinical Practice Report

This study evaluates the properties of platelet-rich plasma (PRP) preparations used by a professional sports club's medical department for treating musculoskeletal conditions in athletes. PRP samples were prepared using 20 ml and 50 ml Hy-tissue® PRP Kits (Fidia Farmaceutici S.p.A., Abano Terme, Italy) from 13 total blood samples. They were analyzed to assess platelet (PLT), leukocyte, and red blood cell concentrations. Results showed both kits effectively concentrated PLT with an average enrichment factor of 2.9×, though the 50 ml kit produced higher total PLT counts (4.7 Bl) than the 20 ml kit (1.7 Bl). White and red blood cell levels were significantly reduced, indicating high PRP purity. DEPA (dose of injected PLT, efficiency of production, purity of the PRP, activation of the PRP) classification revealed a superior quality score, from A to D in the three prior parameters, for the 50 ml kit (BCA vs. CCA). Despite acceptable PLT concentration, the efficiency of PLT recovery was low across both kits. The findings underscore the importance of evaluating PRP characteristics to optimize therapeutic outcomes and highlight the need for protocol refinement to enhance preparation efficiency. These results advocate for standardized reporting and classification to support evidence-based application of PRP in sports medicine.

Development of hyaluronic acid-based hydrogels for chronic diabetic wound healing: A review

This research delves into the advancements in chronic skin wound treatment, with a particular focus on diabetic foot ulcers, utilizing hyaluronic acid (HA)-based hydrogels. Hyaluronic acid, an integral component of the skin's extracellular matrix, plays a crucial role in process such as inflammation, angiogenesis, and tissue regeneration. Due to their three-dimensional network structure, biocompatibility, hydrophilicity, and gas exchange capabilities, HA-based hydrogels are considered highly suitable for promoting wound healing. Nonetheless, pure HA hydrogels exhibit limitations including insufficient mechanical strength and rapid release of encapsulated substances. To address these limitations, the incorporation of bioactive materials such as chitosan and collagen was investigated. This combination not only optimized mechanical strength and degradation rates but also enhanced antibacterial and anti-inflammatory properties. Furthermore, responsive hydrogel dressings were developed to adapt to the specific characteristics of the diabetic wound microenvironment, enabling on-demand drug release. These advancements present new perspectives for the treatment of diabetic foot ulcers.

Radiofrequency for Chronic Knee Pain: A Literature Review

Objective

This review aimed to explore the current applications of radiofrequency (RF) therapy in managing chronic knee pain and to compare different treatment strategies.

Methods

A comprehensive review of recent literature was conducted, concentrating on variations in target selection, guidance techniques, and treatment parameters that influence therapeutic outcomes.

Results

RF therapy is a minimally invasive and effective treatment for chronic knee pain, providing faster recovery compared with traditional interventions. However, differences in treatment options can lead to significant variability in the efficacy and safety.

Conclusion

A thorough understanding of the distinct characteristics of various RF therapy strategies is required for optimizing chronic knee pain management. Future research should emphasize systematic evaluation of these approaches to refine clinical practice and establish evidence-based pain management protocols.

Management of Postoperative Pain Following Primary Total Knee Arthroplasty: A Level I Evidence-Based Bayesian Network Meta-Analysis

Background: Postoperative pain management after total knee arthroplasty (TKA) is crucial for promoting early recovery. Advances in pain management techniques have significantly improved outcomes after TKA. Recently, multimodal analgesia has emerged as a key concept in pain management following TKA, using regional anaesthesia to reduce narcotic use and minimise narcotic-related side effects. This Bayesian network meta-analysis compared different treatment options for the management of postoperative pain following primary TKA. Methods: This study was conducted following the 2020 PRISMA statement. In January 2025, all randomised controlled trials (RCTs) related to postoperative pain management following TKA were accessed. Pain reported on postoperative days (PODs) 1-3 was evaluated. Results: Data from 7199 patients were retrieved. Of these, 63.2% (4232 of 6691) were women, and the mean age was 66.7 ± 3.1 years. The mean length of follow-up was 10.2 ± 18.3 weeks. At baseline, comparability was confirmed for age (p = 0.1), BMI (p = 0.8), and visual analogue scale (VAS, p = 0.1). On POD 1, single-shot SNB/three-in-one block was associated with a lower VAS, followed by continuous intra-articular analgesia/local infiltration analgesia (LIA)/posterior capsule infiltration (PCI) and continuous femoral nerve block (FNB)/intermittent SNB. On POD 2, continuous intra-articular analgesia/LIA/PCI was associated with a lower VAS, followed by continuous FNB/PCI and single-shot femoral triangle block (FTB)/single-shot infiltration between the popliteal artery and capsule of the knee (IPACK). On POD 3, continuous ACB was associated with a lower VAS, followed by continuous intra-articular analgesia/LIA/PCI and continuous FNB/PCI. Conclusions: Continuous intra-articular analgesia/LIA/PCI was associated with the best pain control following primary TKA. Multimodal analgesia, which incorporates peripheral nerve blockade and periarticular injections, has become a key concept in contemporary pain management following TKA.

Use of controlled nail dynamization technique for femoral shaft hypertrophic nonunion

Background

Femoral nonunion after intramedullary nailing (IMN) of a diaphyseal long bone fracture is a severe complication that requires effective management. The IMN dynamization has been used to treat hypertrophic nonunions previously. However, routine nail dynamization has only a low success rate and the risk of limb shortening.

Methods

Two patients with femoral shaft fracture hypertrophic nonunion at 4 or 5 months after intramedullary nailing were treated with the therapeutic paradigm named "controlled nail dynamization". In this paradigm, the interlocking nails are removed but the dynamic hole nails are retained. At the same time, four Poller screws were used to limit the movement of the intramedullary nail in the coronal and sagittal planes. The intramedullary nail can only generate compressive stress along the axial direction of the femoral shaft, thereby promoting fracture healing. So this technique was named "controlled nail dynamization".

Results

Here, we describe two cases of delayed healing of the femoral diaphysis, which were successfully treated through controlled nail dynamization. Followed up for more than 12 months. Bone union was achieved in both patients, and there were no complications such as nonunion and internal fixation failure.

Conclusion

The controlled nail dynamization is feasible for safe and effective treatment for femoral shaft hypertrophic nonunion.

Golf After Total Hip and Knee Arthroplasty: Getting Back Into the Swing

Golf is a popular sport with an estimated 60 million participants worldwide. The sport remains popular among older adults, including those with a total hip arthroplasty (THA) or total knee arthroplasty (TKA) because of the low-moderate intensity of the activity. Accordingly, golfers who are contemplating undergoing THA or TKA are interested in the rate of return to play, outcomes, and limitations after surgery. The factors affecting return to golf are numerous, including patient-specific factors and biomechanical changes in the hip and knee affecting the golf swing. Specifically, younger age, male sex, and lower body mass index are independent predictors of return to golf. Furthermore, changes in leg length, alignment, and implant type/position can also affect function and play. Despite these factors, golfing patients routinely demonstrate successful return to their sport with less pain and improved mobility after THA and TKA. A comprehensive preoperative evaluation, expectation setting to return to any recreational activity, patient-specific surgical planning, and a functional rehabilitation program can provide optimal outcomes in those wishing to return to golf after total joint arthroplasty.

Does use of glucagon-like peptide-1 agonists increase perioperative complications in patients undergoing shoulder arthroplasty?

BACKGROUND

Amidst the rising prevalence of type 2 diabetes mellitus (T2DM) and obesity among individuals undergoing total shoulder arthroplasty (TSA), the impact of glucagon-like peptide-1 (GLP-1) therapy on surgical outcomes merits thorough investigation. Though it is known that GLP-1 therapy poses an interesting challenge for anesthesia during the perioperative period, little is known regarding the effects of these medications on surgical outcomes. This study aimed to evaluate the influence of GLP-1 on postoperative outcomes and length of stay (LOS) in patients T2DM undergoing TSA.

METHODS

A retrospective cohort analysis was performed using a national database to identify primary TSA patients aged 18 and above with T2DM prescribed GLP-1 therapy at the time of surgery. Exclusion criteria included revision surgery, TSA for fracture, type 1 diabetes, steroid-induced diabetes, and contraindications for GLP-1 therapy. A control group of T2DM TSA patients not on GLP-1 therapy was used, and a 1:4 propensity-score match was performed. Incidence rates and odds ratios via multivariable logistic regression were calculated. The primary outcomes were 90 days major medical complications and LOS. Secondary outcomes included 2-year joint-related complications.

RESULTS

In the 90-day follow-up cohort, 64,567 patients met inclusion criteria, with 8481 (13.1%) on GLP-1 therapy. No significant increase in 90 days major complications, including deep vein thrombosis, cardiac arrest, myocardial infarction, cerebrovascular accident, pneumonia, pulmonary embolism, urinary tract infection, surgical site infection, hypoglycemic event, sepsis, or readmission, was found between GLP-1 and non-GLP-1 cohorts after multivariable logistic regression. In the 2-year follow-up cohort, 47,814 patients were included, with 5969 (12.5%) on GLP-1 therapy. Similarly, 2-year joint-related complications, including all-cause revision, prosthetic joint infection, periprosthetic fracture, and aseptic revision, showed no significant differences between the GLP-1 and non-GLP-1 cohorts. No significant difference was observed in LOS in the 90-day cohort.

CONCLUSION

This study provides a comprehensive analysis of GLP-1 therapy's impact on TSA outcomes, revealing no significant change in postoperative complications or LOS. The lack of increased postoperative risk underscores the potential of GLP-1 therapy in managing T2DM without adverse effects on TSA recovery. These insights contribute to understanding postoperative management in orthopedic surgery, indicating that we did not note any increased risk with GLP-1 use perioperatively in TSA patients, unlike in other populations like the total knee arthroplasty patients. Future research should focus on prospective analyses to further elucidate the role of GLP-1 therapy in surgical outcomes, aiming to enhance patient care and optimize postoperative strategies for patients with T2DM undergoing TSA.

Targeting the Infrapatellar Branch of the Saphenous Nerve for Pain Relief in Patients With Acute or Chronic Knee Pain: A Systematic Review of Randomized Controlled Trials and Cohort Studies

Blocking the infrapatellar branch of the saphenous nerve (IPBSN) can provide analgesic benefits for patients with postoperative acute pain or chronic pain, with minimal adverse effects. To evaluate the analgesic efficacy and potential adverse events associated with IPBSN block in patients suffering from acute or chronic knee pain. We conducted a systematic review across PubMed, Cochrane, Web of Science, and Embase to identify all relevant randomized controlled trials (RCTs) and cohort studies according to predefined selection criteria. The study quality of the RCTs was evaluated using the Cochrane risk of bias assessment tool, while cohort studies were assessed using the ROBINS-I risk of bias tool. The primary outcomes measured were pain intensity and opioid consumption following the nerve block. A total of eight studies were included in this systematic review, encompassing 613 subjects with 276 participants in the control group and 337 participants in the IPBSN block group. The level of evidence was rated high for the RCTs and moderate for the cohort studies. The nerve block was administrated either through the injection of local anesthetic or percutaneous cryoneurolysis targeting the IPBSN. The results indicated that the IPBSN block significantly improved pain relief and reduced opioid consumption in patients with acute postoperative or chronic pain, with no significant difference in the rate of adverse events relating to the procedures or device. The IPBSN block holds promise for improving pain relief and reducing opioid consumption. However, further well-designed randomized controlled trials are needed to confirm these results.

Ultrasound-guided interventions in elite soccer players

In the world of elite soccer, or football as we call it in the UK, a player who cannot play for any length of time costs the team money and team performance. The time to return to play (RTP) is crucial in any player's career, and the use of ultrasound-guided ultrasound injections has become important in the management of injury. In this article, I will explain the importance of good practice when performing these procedures and the use of steroids, sodium hyaluronic acid, platelet-rich plasma (PRP), and other therapies in achieving the goal of decreasing the time of RTP for the footballer. KEY POINTS: •Injection therapies are routine practice in maintaining and treating soccer injuries. •Injection therapies can be safely performed under ultrasound guidance.

Mid-term results of total elbow arthroplasties in the treatment of geriatric distal humerus fractures

BACKGROUND

While double plate fixation is the gold standard treatment for distal humerus fractures in the general population, it is the source of many complications in the elderly. Total elbow arthroplasty (TEA) has been proposed as an alternative treatment, with satisfactory short-term functional outcomes. However, little is known about the longevity of the implant and the mid- and long-term complications of this procedure.

MATERIALS AND METHODS

A total of 58 TEAs were performed in 57 patients with comminuted distal humerus fractures between September 2008 and September 2019. All patients were clinically (ranges of motion, Mayo Elbow Performance Score [MEPS] and Disabilities of the Arm, Shoulder and Hand [QuickDASH] functional scores) and radiographically assessed. The minimum follow-up was 2years, and the mean follow-up was 4.7years.

RESULTS

The overall complication rate was 20.7%, with ulnar nerve damage, complex regional pain syndrome, and severe stiffness being the main complications. The mean MEPS was 85.3, and the mean QuickDASH was 28.1. The mean flexion was 122°, and the mean extension was -23.5°. There were no prosthetic revisions. Of these patients, 17% had radiolucent lines, and 13% had bushing wear at the last follow-up.

DISCUSSION

TEA is an effective technique for treating comminuted distal humerus fractures in the geriatric population. The prosthesis's mid-term survivorship was highly satisfactory, with a complication rate that remained low and was generally lower than that of osteosynthesis, with identical functional outcomes. TEAs are indicated in elderly patients, for whom maintaining the fullest possible autonomy is paramount. Our findings suggest that TEAs have sufficient longevity to guarantee a functional, pain-free elbow with no need for reoperation.

LEVEL OF EVIDENCE

IV; case series.

Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Shows Reduced Graft Failure Rates and Superior Residual Rotational Stability Regardless of Anterolateral Ligament Reconstruction Graft: A Systematic Review

Objectives: The aim of this study is to evaluate the literature for comparing clinical outcomes of anterior cruciate ligament reconstruction (ACLR) with concomitant anterolateral ligament reconstruction (ALLR) versus isolated ACLR, with a primary focus on analyzing differences in outcomes based on the type of graft used for ALLR. Methods: We identified comparative studies involving primary ACLR performed in conjunction with ALLR. Graft failure rates, residual pivot shift, residual anterior-posterior (AP) laxity at follow-up, and patient-reported outcome measures were determined. Variables associated with isolated ACLR and ACLR combined with ALLR were compared based on the type of graft used for ALLR. Results: This systematic review included nine studies involving 2740 patients. Combined ACLR with ALLR using hamstring tendon (HT) autografts or tibialis allografts showed lower graft failure rates than isolated ACLR (HT autograft: rate, 0-5.9%, odds ratio [OR], 2.16-12.91; tibialis allograft: rate, 0%, OR, 2.00-5.27). Similarly, the combined procedure showed reduced residual pivot shift rates (HT autograft: rate, 0-9.1%, OR, 2.00-12.16; tibialis allograft: rate, 0%, OR, 7.65-15.33) compared to isolated ACLR. Residual AP laxity and patient-reported outcomes were similar or more favorable for the combined procedure; however, the results were heterogeneous. Complications related to the type of graft used for ALLR or the presence of ALLR itself were not reported. Conclusions: Regardless of the graft type used for ALLR, the combination of ACLR with ALLR showed better clinical outcomes, including reduced graft failure rates and superior residual rotational stability compared to isolated ACLR. However, the high heterogeneity observed across studies suggests that these findings should be interpreted with caution, and further research is needed to draw more definitive conclusions.

Total knee arthroplasty in patients with degenerative spine disease: does spinal fusion affect outcomes? A matched comparative analysis using a national database

BACKGROUND

The need for total knee arthroplasty (TKA) and spinal fusion (SF) for degenerative spine disease (DSD) is increasing. However, it is still unknown if prior SF for DSD impacts outcomes following TKA. This study aims to fill this gap by comparing the risk of complications and revisions in patients undergoing TKA with DSD between patients with and without SF.

METHODS

This study is a retrospective review of the PearlDiver Mariner Database between 2010 and 2020. On the basis of whether or not patients had had prior SF, the patients undergoing TKA were divided into two groups: patients with DSD and SF and patients with DSD and without SF. The two groups were matched on the basis of age, gender, the Charlson Comorbidity Index (CCI), and obesity. Surgical complications (mechanical loosening, prosthetic dislocation, periprosthetic fractures, and stiffness) and revisions at 1, 2, and 3 years were compared between the groups.

RESULTS

The patients in the TKA with DSD and no SF cohort were older (64.9 ± 8.4 versus 63.3 ± 8.1 years, p < .001), had higher CCI (2.0 ± 2.2 versus 1.6 ± 2.0, p < .001), and had a lower rate of obesity (58.7% versus 61.7%, p < .001). After being matched, 8887 patients remained in each group. There was a higher rate of stiffness and manipulation under anesthesia (MUA) in the no-fusion cohort at 1 year (0.7% versus 0.1%, p < .001; and 0.5% versus 0.2%, p < .001, respectively), 2 years (1.2% versus 0.5%, p < .001; and 1.1% versus 0.6%, p < .001, respectively), and 3 years (1.7% versus 0.7%, p < .001; and 1.6% versus 0.9%, p < .001, respectively).

CONCLUSIONS

This study shows no increase in risk of surgical complications and revisions after TKA in patients with DSD and SF compared with patients without SF. Notably, SF was shown to be protective of stiffness and MUA after TKA in patients with DSD.

Advancements in Regenerative Therapies for Orthopedics: A Comprehensive Review of Platelet-Rich Plasma, Mesenchymal Stem Cells, Peptide Therapies, and Biomimetic Applications

Background/Objectives: Regenerative therapies have gained interest in orthopedic applications for their potential to enhance tissue regeneration, functional recovery, and pain modification. This review evaluates the clinical efficacy of platelet-rich plasma (PRP), mesenchymal stem cells (MSCs), peptide-based treatments, and biomimetic materials in orthopedic care, with a focus on pain reduction and functional outcomes. Methods: A structured literature search in PubMed (January 2009-January 2025) identified 160 studies. After applying inclusion criteria prioritizing randomized controlled trials (RCTs) and clinical trials, 59 studies were included: 20 on PRP, 20 on MSCs, 10 on peptide therapies, and 7 on biomimetics. Data extraction focused on pain reduction and functional recovery, with risk of bias assessed using the Cochrane Risk of Bias (RoB) tool and ROBINS-I tool. A random-effects meta-regression analysis was conducted to evaluate the impact of therapy type, sample size, and risk of bias on reported pain reduction outcomes. Results: Meta-regression analysis identified MSC therapy as the most effective intervention for pain reduction (β = 8.45, p < 0.05), with PRP and peptide-based therapies showing moderate improvements, and biomimetic therapies demonstrating the lowest effect. PRP provided short-term pain relief, particularly in acute injuries and tendon repair, though inconsistencies in preparation methods limited success in chronic conditions. MSC therapies demonstrated cartilage regeneration and early osteoarthritis improvement, but high costs and ethical concerns remain barriers to widespread adoption. Peptide-based therapies and biomimetic materials, including engineered scaffolds and autologous protein solutions, showed promise for infection control and wound healing, though further research is needed to optimize dosing, delivery methods, and long-term safety. Conclusions: Regenerative therapies offer significant potential in orthopedic care, with MSC therapies demonstrating the most reliable regenerative effects, PRP providing short-term symptomatic relief, and peptide-based and biomimetic treatments emerging as promising adjuncts. However, standardized protocols and large-scale clinical trials are needed to establish long-term efficacy and improve clinical translation for broader adoption.

Effects of Autologous Tenocyte Injection for Overuse and Degenerative Tendinopathies: A Systematic Review

Background: The term tendinopathy commonly describes a series of alterations in the tendon, leading in functional impairment and pain, treated with several approaches, including exercises, physical agents, and injection therapies. Among the latter, autologous tenocyte injection (ATI) involves harvesting tenocytes from a healthy tendon of the patients and then isolating the tenocytes and culturing for 4-5 weeks. To date, there is still a lack of consensus about the efficacy of ATI in improving pain and function; therefore, the present review aimed to assess the role of ATI in the treatment of chronic tendinopathies. Methods: Two authors conducted a comprehensive search across PubMed Medline, Web of Science, Scopus, Cochrane Library, and Google Scholar (PROSPERO: CRD42024565211). From 174 articles, we finally included 5 articles. Results: The main effect obtained was the pain relief and, consequently, the improvement of patients' quality of life. The clinical improvement is also evident at MRI in which it is possible to see a progressive reduction with a general disappearance of the T2 signal hyperintensity between 4 months and 1 year. All the articles agree on the safety of ATI in chronic tendinopathies. Conclusions: ATI might represent a safe and valuable option in the management of chronic tendinopathies as a second line treatment in the case of resistant tendinopathies, with a minimal risk of side effects.

Impact of Enhanced Recovery After Surgery Protocols on Outcomes Up to Two Years After Adult Structural Spine Disorder Surgery

STUDY DESIGN

Retrospective cohort study of prospectively enrolled database.

OBJECTIVE

We analyze the recovery pattern of patients with adult structural spine disorder (ASD) who underwent corrective surgery with enhanced recovery after surgery (ERAS+) protocol, including physical and psychological prehabilitation components, compared with a non-ERAS protocol (ERAS-) up to 2 years (2Y) after surgery.

BACKGROUND

Spine surgery for ASD is often highly invasive, which can contribute to prolonged recovery. The trajectory of recovery may be accelerated by the application of enhanced recovery principles.

MATERIALS AND METHODS

Inclusion criteria were operative patients with ASD older than 18 years with complete baseline, 90 days perioperative, and 2Y postoperative data. We assessed differences in baseline demographics, surgical details, baseline health-related quality of life (HRQL), and surgical outcomes between ERAS+ and ERAS- patients. Outcomes included adverse events, reoperations, and radiographic parameters such as sacral slope, pelvic tilt, pelvic incidence-lumbar lordosis mismatch, sagittal vertical axis, lumbar lordosis, T2 to T12 kyphosis, and maximum Cobb angle. In addition, HRQL measures included the physical component summary, Oswestry Disability Index, Neck Disability Index, EuroQol 5 dimensions, Scoliosis Research Society Questionnaire 22r total and domain scores, Numeric Pain Rating Scale-back, and Numeric Pain Rating Scale-leg. We used multivariable logistic regression and analysis of covariance to adjust for confounding.

RESULTS

A total of 471 patients with ASD met the inclusion criteria, with 59 designated ERAS+. Those individuals with ERAS+ were older (64.1 ± 13.0 vs. 58.0 ± 16.0; P = 0.005), had a higher Charlson Comorbidity Index, (2.4 ± 1.8 vs. 1.4 ± 1.6; P < 0.001), and exhibited a higher modified ASD frailty index (8.2 ± 5.4 vs. 6.3 ± 4.9; P = 0.019). The adjusted analysis demonstrated the ERAS+ cohort demonstrated a lower likelihood of overall reoperations (Odds ratio (OR): 0.3; 95% CI: 0.13-0.89), and a lower likelihood of overall adverse events (OR: 0.4; 95% CI: 0.19-0.93). ERAS+ was more likely to achieve the minimal clinically important difference in the Scoliosis Research Society Questionnaire 22r total scores at 6 months (6M; OR: 3.1; 95% CI: 1.2-8.4), self-image domain at 6M (OR: 9.0; 95% CI: 1.6-50.0), in the pain domain at 6M (OR: 3.5; 95% CI: 1.01-11.9) and 1 year postoperatively (OR: 2.6; 95% CI: 1.03-6.7), and in the SF-36's physical component summary (PCS) scores at 1 year (OR: 2.1; 95% CI: 1.05-4.2). No other statistically significant differences in HRQL were observed at the remaining time points (P > 0.05).

CONCLUSION

Our work is the first to evaluate HRQL metrics and complications over 2Y following ASD correction with ERAS. Despite presenting with more severe baseline frailty and higher comorbidity profiles, patients with ASD who underwent corrective surgery with an ERAS protocol experienced fewer short-term adverse events and improved HRQL. We believe ERAS following ASD surgery leads to faster functional recovery, reduced postoperative deconditioning, and improved quality of life.

Systemic Rejuvenating Interventions: Perspectives on Neuroinflammation and Blood-Brain Barrier Integrity

The aging process results in structural, functional, and immunological changes in the brain, which contribute to cognitive decline and increase vulnerability to neurodegenerative diseases such as Alzheimer's disease (AD), Parkinson's disease (PD), and stroke-related complications. Aging leads to cognitive changes and also affect executive functions. Additionally, it causes neurogenic and neurochemical alterations, such as a decline in dopamine and acetylcholine levels, which also impact cognitive performance. The chronic inflammation caused by aging contributes to the impairment of the blood-brain barrier (BBB), contributing to the infiltration of immune cells and exacerbating neuronal damage. Therefore, rejuvenating therapies such as heterochronic parabiosis, cerebrospinal fluid (CSF) administration, plasma, platelet-rich plasma (PRP), and stem cell therapy have shown potential to reverse these changes, offering new perspectives in the treatment of age-related neurological diseases. This review focuses on highlighting the effects of rejuvenating interventions on neuroinflammation and the BBB.

Effect of intraperitoneal ropivacaine during and after cytoreductive surgery on time-interval to adjuvant chemotherapy in advanced ovarian cancer: a randomised, double-blind phase III trial

BACKGROUND

In a previous phase II trial, intraperitoneal local anaesthetics shortened the time interval between surgery and adjuvant chemotherapy, an endpoint associated with improved survival in advanced ovarian cancer. Our objective was to test this in a phase III trial.

METHODS

A double-blind, phase III parallel superiority trial was conducted at two university hospitals in Sweden, within a public and centralised healthcare system. Women >18 yr with advanced ovarian cancer scheduled for cytoreductive surgery, an ASA physical status of 1-3 with no speech/language issues, were eligible. Participants were randomly assigned using a central computerised system to receive either ropivacaine 0.2% or saline 0.9% (placebo) intraperitoneally during and after surgery. The primary endpoint was time to return to intended oncologic therapy (RIOT), analysed using t-test and linear regression adjusted for centre.

RESULTS

Of the 225 women randomised between August 2020 and December 2023 (ropivacaine n=113; placebo n=112), 175 were included in the modified intention-to-treat analysis (ropivacaine n=86; placebo n=89). Median age: ropivacaine group 64 yr (56-73 yr), placebo group: 66 yr (57-74 yr). The mean RIOT in the ropivacaine group was 26.5 days vs 25.8 days in the placebo group, with a mean difference of 0.7 days (-2.2 to 3.4 days; P=0.65). Per-protocol analysis of 166 women yielded similar results, mean difference of 0.5 days (-2.4 to 3.4 days; P=0.74) days. There were no differences in short-term recovery or postoperative morbidity.

CONCLUSION

Intraperitoneal local anaesthetic did not shorten the time to RIOT among women undergoing surgery for advanced ovarian cancer in this trial.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov (NCT04065009), European Union Clinical Trials Register (2019-003299-38/SE).

The effect of platelet-rich plasma on ferroptosis of nucleus pulposus cells induced by Erastin

Background

Intervertebral disc degeneration (IVDD) has been linked to ferroptosis, a type of programmed cell death. The role of platelet-rich plasma (PRP) in mitigating ferroptosis in nucleus pulposus (NP) cells within IVDD remains unclear.

Purpose

This study aims to verify the effectiveness of PRP in reducing ferroptosis in NP cells induced by Erastin.

Methods

Primary NP cells were isolated from SD rats, and a ferroptosis model was established using Erastin. PRP was prepared and applied to assess its impact on ferroptosis-related markers, including reactive oxygen species (ROS), iron content, and glutathione peroxidase 4 (GPX4). The effects of PRP on the ultrastructure of NP cells were also observed using transmission electron microscopy (TEM).

Results

PRP treatment significantly restored GPX4 levels (431.47 ± 4.70 ng/L vs. 69.70 ± 4.06 ng/L, P < 0.05), reduced ROS levels (45.06 ± 3.78 vs. 155.36 ± 3.56, P < 0.05), and decreased iron content (32.24 ± 096 μg/L vs. 59.25 ± 3.72 μg/L, P < 0.05) in ferroptotic NP cells compared to the sham group. Additionally, PRP significantly increased the expression levels of collagen Ⅱ (0.72 ± 0.02 vs. 0.33 ± 0.02, P < 0.05) and aggrecan (0.81 ± 0.01 vs. 0.31 ± 0.02, P < 0.05) compared to the sham group. TEM analysis also showed improvements in mitochondrial ultrastructure. These findings suggest that PRP can alleviate ferroptosis and promote cellular recovery.

Conclusions

The study demonstrates the potential of PRP as a therapeutic intervention in IVDD by mitigating ferroptosis in NP cells, offering a new theoretical basis for PRP treatment in degenerative disc diseases.

Complications Associated with Surgical Management of Olecranon Fractures: A Systematic Review

PURPOSE

The purpose of this study was to systematically review the literature to assess surgical complications following surgical management of olecranon fractures.

METHODS

A literature search of MEDLINE, Embase, and the Cochrane Library was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Clinical studies reporting complications following olecranon fracture management were included. The complication profile of plate fixation (PF), screw fixation, and tension band wiring (TBW) was recorded. Implant removal rates were considered independent of complication rates.

RESULTS

Eighty-six studies were included in the analysis, with 5,161 patients who underwent an olecranon fracture treatment with an average age of 50.2 years (range, 7.4-88.8) and an average follow-up of 30.8 months (range, 3-218). The majority of studies used PF (58.1%). Screw fixation had higher implant complications than PF (5.9% vs 3.0%, p < 0.001), and PF had the highest percentage of musculoskeletal complications (3.6%, p <0.001) and wound complications (4.8%, p = 0.048). Nerve complications were similar among the 3 surgical options (p = 0.233). PF had the lowest complication rate (12.6%, p < 0.001), while screw fixation had the lowest reoperation (8.6%, p < 0.001) and implant removal rates (6.2%, p < 0.001). The overall complication rate for TBW was 18.4%, with loss of reduction being the most common complications occurring in 2.8% of patients.

CONCLUSION

PF demonstrated lower overall complications compared with screw fixation, with increased rates of symptomatic implants requiring removal which contributed to higher reoperation rates. TBW demonstrated an inferior complication profile compared with both modern fixation options. Further research should expand on the limited comparative studies between screw and PF.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Conservative versus surgical treatment for displaced olecranon fractures in the elderly: a retrospective study and a review of the literature

BACKGROUND

Surgery is the gold standard treatment of displaced olecranon fracture, but it presents a high rate of complications, especially in the elderly, including wound breakdown and fixation failure. Conservative treatment of these fractures has recently been proposed with good functional outcomes. The aim of this retrospective study was to compare the functional results and level of satisfaction of displaced olecranon fractures which were managed surgically or conservatively in geriatric patients. The rate of implant removal and reoperation in the surgical group were also calculated.

MATERIALS AND METHODS

Sixteen and eleven patients aged ≥ 75 years (mean 83 and 86.2, respectively) with isolated Mayo IIA or IIB olecranon fracture were surgically and conservatively treated, respectively. All but 1 were females. Due to coronavirus pandemic, they were contacted by phone to validated clinical scores (QuickDASH, PREE and VAS), which were used to assess the outcome.

RESULTS

At an average follow-up of 26.5 months in the conservative group and 53.1 in the surgical group (range 4-82), the mean Quick DASH was 11.67 and 11.2, respectively, while the mean PREE was 11.36 and 12.67, respectively. There was no significant difference in functional outcomes between the two groups, and all patients were satisfied. Seven complications occurred in the surgical cohort (33.3%), requiring reoperation in 4 cases (19%).

CONCLUSIONS

Displaced olecranon fractures can successfully be treated conservatively in low-demand geriatric patients with good functional results and high satisfaction rate.

Treatment of Pediatric Displaced Intraarticular Olecranon Fractures with Resorbable Poly-L-Lactic-Co-Glycolic Acid (PLGA) Pins and Polydioxanone (PDS) Loops

BACKGROUND

Pediatric olecranon fractures, though rare, can be serious. Treatment varies by type and severity; displaced, intraarticular fractures usually need surgery, where biodegradable implants are emerging as an encouraging option to metal hardware.

METHODS

Our prospective, single-center, single-arm case series evaluates three pediatric olecranon fracture patients treated by resorbable poly-L-lactic-co-glycolic acid (PLGA) pins and polydioxanone (PDS) loops between Jan 2022 and January 2023 at the Department of Pediatrics, University of Pécs, Clinical Complex.

RESULTS

All patients achieved complete radiological healing with excellent functional recovery and no implant-related complications at one-year follow-up.

CONCLUSIONS

Resorbable PLGA pins and PDS loops provide a promising alternative to conventional metallic fixation in pediatric olecranon fractures, abolishing the need for a second implant-removal surgery while maintaining stability and biocompatibility. Our findings support the child-friendly nature and growing role of biodegradable materials in pediatric fracture management.

Infrapatellar branch of saphenous nerve: from anatomy, sonoanatomy to its clinical implications

The infrapatellar branch of the saphenous nerve (IPBSN) is implicated in nerve injury from different knee surgeries because of its intimate course relative to the knee joint capsule. Pain physicians encounter patients in their practice for the management of neuralgia of this nerve or in the context of advanced management of knee osteoarthritis. This article aims to provide a comprehensive review of the anatomy, sonoanatomy, and the intervention of the IPBSN in pain management of infrapatellar neuralgia and chronic knee pain.

Does Resurfacing the Patella Increase the Risk of Extensor Mechanism Injury within the First 2 Years after Total Knee Arthroplasty?

Extensor mechanism injury (EMI) following total knee arthroplasty (TKA) is a potentially catastrophic complication and may lead to significant morbidity or need for revision reconstructive procedures. Patellar resurfacing (PR), while commonly performed during TKA, reduces overall patella bone stock and may increase the risk of EMI after TKA. The purpose of this study was to assess if PR in elderly patients raises the risk for subsequent EMI.The American Joint Replacement Registry (AJRR) was queried to identify Medicare patients ≥65 years old undergoing primary elective TKA for osteoarthritis between January 2012 and March 2020. Patient age, sex, and Charlson Comorbidity Index (CCI) were collected. Records were subsequently merged with Medicare claims records and evaluated for the occurrence of patella fracture, quadriceps tendon rupture, or patellar tendon rupture based on International Classification of Diseases 9 and 10 (ICD 9/10) diagnosis codes within 2 years of TKA. Patients were stratified based on whether PR occurred or not (NR). Logistic regression was used to determine the association between PR and EMI.A total of 453,828 TKA were eligible for inclusion and 428,644 (94.45%) underwent PR. The incidence of PR decreased from 96.06% in 2012 to 92.35% in 2022 (p < 0.001). Patients undergoing PR were more often female (60.93 vs. 58.50%, p < 0.001) and had a lower mean CCI (3.09 [1.10] vs. 3.16 [1.20], p < 0.001). Odds for EMI did not differ based on whether PR was performed (odds ratio [OR]: 0.85, 95% confidence interval [CI]: 0.65-1.11, p = 0.2246). Increasing age (OR: 1.06, 95% CI: 1.05-1.07, p < 0.0001]) and CCI (OR: 1.06, 95% CI: 0.95-1.19, p = 0.0009) were associated with EMI.PR is commonly performed during TKA in the United States and was not found to increase odds for EMI within 2 years of TKA in patients ≥65 years old. Increased age and medical comorbidity were associated with higher odds for subsequent EMI.

Patellar resurfacing in contemporary total knee arthroplasty: Frequency of complications in a matched cohort

Introduction

Optimum patient selection and outcomes following patellar resurfacing are ongoing debates amongst the arthroplasty community. This study compared the outcomes of patients who had a total knee arthroplasty (TKA) with patellar resurfacing to those left with their native patella.

Methods

A retrospective review of 1941 TKAs performed between 2016 and 2020 was conducted. 41 TKAs without patellar resurfacing and with 2-years of minimum follow-up were identified. Of these, 38 TKAs were matched on age (exact), sex (exact), and body mass index (±10) to 38 TKAs that had patellar resurfacing. The indications for patella resurfacing were subjective based upon the surgeon preference and assessment of cartilage quality. Paired t-tests and chi-square tests were used for analysis.

Results

There was 1 major patellofemoral complication in both the resurfaced group (patellar fracture) and the non-resurfaced group (patellar tendon tear), requiring nonoperative management and revision surgery, respectively. However, in the non-resurfaced group there were 4 cases of subjective patellofemoral pain compared to none in the resurfaced group (p = 0.37). Additionally, 3 non-resurfaced patients required manipulation under anesthesia (MUA) compared to none in the resurfaced group (p = 0.44).

Discussion

There was no difference in the frequency of major patella-specific complications between the groups. However, there was a non-statistically significant trend towards increased patellofemoral pain and MUA in the non-resurfaced group. Based on this study both methods of treatment remain viable options, but the trend towards increased pain and stiffness should continue to be closely evaluated.

Automatic measurement of X-ray radiographic parameters based on cascaded HRNet model from the supraspinatus outlet radiographs

Background

Rotator cuff injury is a common cause of shoulder pain. Precise and efficient measurement of morphological parameters is necessary in the clinical diagnosis and evaluation of shoulder disorders. However, manual measurement is a time-consuming and labor-intensive task, with low inter-observer reliability. The automatic measurement of radiographic parameters in supraspinatus outlet radiographs has not been reported yet. Thus, the objective of this study was to use a cascaded High-Resolution Net (HRNet) model based on deep learning (DL) algorithms to automatically measure morphological parameters from supraspinatus outlet radiographs and assess its performance. It was intended for use in early screening of patients with rotator cuff disease and to guide them to further consultation.

Methods

This cross-sectional study collected 1,668 supraspinatus outlet radiographs from the picture archiving and communication system of Gansu Provincial Hospital of Traditional Chinese Medicine and the Affiliated Hospital of Gansu University of Chinese Medicine. Among them, 521 images were provided for test datasets and 1,147 images were provided for a model training dataset and validation dataset. Landmarks were annotated for acromio-humeral interval (AHI), acromial tilt (AT), and 3 lines in Park's acromial classification (line huo-acrf, line acro-acro1, and line huo-acro1). R4 radiologist reviewed the means of 3 radiologists as a reference standard. Model performance was assessed by calculating the percentage of correct key points (PCK), intra-class correlation coefficients (ICCs), Pearson's correlation coefficients, mean absolute error, and root mean square error. The reliability of R1, R2, R3, AI with R4 and inter-observer reliability of R1, R2, and R3 for acromial morphology classification were assessed by Cohen's kappa coefficient.

Results

Within the 3-mm threshold, the PCK of the model ranged from 74% to 100%. Compared to the reference standard, the model had reliable measurement of AHI, AT, line huo-acrf, line acro-acro1, line huo-acro1 (ICC =0.73-0.94) and moderate reliability of acromial morphology classification (k=0.50-0.56).

Conclusions

The cascaded HRNet developed in this study can automatically measure morphological parameters of the shoulder. It may aid early clinical screening for shoulder disorders and assist physicians in treatment decisions.

Are Drains Associated With Infection After Operative Fixation of High-Risk Tibial Plateau and Pilon Fractures?

OBJECTIVES

To determine the association between closed suction drainage and postoperative infection in patients with tibial plateau or pilon fractures. Secondarily, this study assessed whether intrawound vancomycin powder modified the association of closed surgical drains with infection.

METHODS

DESIGN

Secondary analysis of the Effect of Intrawound Vancomycin Powder in Operatively Treated High-risk Tibia Fractures: A Randomized Clinical Trial (VANCO).

SETTING

Thirty-six academic trauma centers.

PATIENT SELECTION CRITERIA

All patients with high-risk tibia fractures Orthopaedic Trauma Association/Arbeitsgemeinschaft fur Osteosynthesefragen (OTA/AO classification 41B/C or 43B/C) from the VANCO trial were considered. Closed suction drains were placed based on the treating surgeon's discretion. Patients were randomly assigned to receive 1-gram intrawound vancomycin powder in the surgical wound at definitive fixation or the standard infection prevention protocol at each center.

OUTCOME MEASURES AND COMPARISONS

Deep surgical site infection (SSI) within 6 months. Comparisons were made between patients treated with and without drains. Subgroup analysis also examined the effect of drains in patients with and without intrawound vancomycin powder.

RESULTS

Of the 978 study patients, 197 (20%) were treated with drains. Deep infection rates did not significantly differ between patients with or without surgical drains (8% vs. 8%, P = 0.88). However, intrawound vancomycin powder significantly modified the association of surgical drains on deep SSI (interaction P = 0.048). Specifically, patients with drains but no vancomycin powder had the highest deep infection rate (13%; 95% confidence interval, 6%-19%). When vancomycin powder was used in addition to a drain, deep SSI rates were reduced by 10% (95% confidence interval, 2%-17%, P = 0.01).

CONCLUSIONS

This study suggests that closed suction drains after operative fixation of high-risk tibia fractures may not be associated with deep infection in general. However, a secondary analysis raises the possibility that drains are associated with reduced deep infection rates if topical vancomycin powder is used but associated with increased infection rates if vancomycin powder is not used.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Editorial Commentary: Biologics Injections for Partial-Thickness Rotator Cuff Tears Show Promise

Partial-thickness rotator cuff tears (PTRCTs) are difficult to treat. Conservative treatment typically includes physical therapy, nonsteroidal anti-inflammatory drugs, and injectables (e.g., corticosteroid injections, hyaluronic acid, platelet-rich plasma [PRP], stem cells). Recent studies have demonstrated that PRP alone or in combination with other injectables (e.g., PRP + hyaluronic acid) provides a positive short-term therapeutic benefit in patients with PTRCTs. Yet, effects tend to diminish after 1 year. Up to 42% of patients with PTRCTs treated conservatively exhibit tear progression necessitating surgical intervention, and some research shows that PRP may inhibit tendon regeneration. The efficacy and safety of PRP preparations and concentrations can vary, and the optimal biologic injectable and formulation is unknown. Yet, preoperative corticosteroid injections can increase risk of infection after shoulder arthroscopy; thus, continued investigation of biologic injection for rotator cuff tears is indicated.

Hook plate fixation and tension band wiring in the treatment of Mayo type II olecranon fractures

BACKGROUND

Olecranon fractures account for 8 ∼ 10% of all elbow fractures and usually require surgical intervention. Tension band wiring (TBW) is considered as the standard treatment while it is associated with high re-operation rates.

OBJECTIVE

This study aims to compare the functional outcomes, complications and re-operations of hook plate fixation (HPF) versus TBW in treating Mayo Type II olecranon fractures.

METHODS

A retrospective cohort study was conduct at Beijing Jishuitan Hospital. Medical records from May 2020 to April 2021 were reviewed. Functional outcomes, complications, and re-operations were assessed during the follow-up.

RESULTS

A total number of 62 patients were included, with a number of 27 undergoing HPF and 35 receiving TBW. The HPF group and the TBW group achieved similar range of motion (ROM), the Mayo Elbow Performance Score (MEPS), and the Disabilities of the Arm, Shoulder, and Hand (DASH) scores (P > 0.05). The HPF group had a significantly lower re-operation rate (44.4% vs. 80.0%, P < 0.01) comparing to the TBW group.

CONCLUSION

Hook plate fixation can be considered as a viable alternative to tension band wiring, offering similar functional outcomes and complication rates but significantly lower re-operation rates.

Current status of nanofat in the management of knee osteoarthritis: A systematic review

BACKGROUND

Osteoarthritis (OA) is a prevalent joint disorder requiring innovative treatment approaches.

AIM

To evaluate the use of nanofat, a specialized form of adipose tissue-derived cells, in the treatment of OA, by examining its efficacy, safety profile, mechanisms of action, comparative effectiveness, and long-term outcomes.

METHODS

A comprehensive review of preclinical studies, clinical trials, and in vitro investigations was conducted. The included studies provided insights into the potential role of nanofat in OA treatment, addressing its efficacy, safety profile, mechanisms of action, comparative effectiveness, and long-term outcomes.

RESULTS

Clinical studies consistently reported the efficacy of nanofat in providing pain relief and functional improvement in patients with OA. Local adverse events were limited to the injection site, such as localized pain and inflammation, and resolved within a few days to weeks. Systemic adverse events were rare, and no significant long-term complications were observed. Mechanistically, nanofat was found to enhance chondrocyte proliferation, reduce inflammation, and promote angiogenesis, thereby contributing to its therapeutic effects.

CONCLUSION

Nanofat therapy holds promise as a therapeutic option for managing OA, providing pain relief, functional improvement, and potential tissue regeneration. The safety profile of nanofat treatment appears favorable, but long-term data are still limited. Standardized protocols, larger randomized controlled trials, longer follow-up periods, and cost-effectiveness evaluations are warranted to establish optimal protocols, comparative effectiveness, and long-term outcomes. Despite current limitations, nanofat therapy demonstrates translational potential and should be considered in clinical practice for OA treatment, with careful patient selection and monitoring.

Early Clinical Outcomes of Polyaxial Locking Cap Plate Fixation for Fixation of Displaced Olecranon Fractures

Objectives

The purpose of this study is to evaluate the outcomes of a polyaxial locking plate utilizing locking-cap fixation for treatment of patients with displaced olecranon fractures.

Methods

A retrospective review was performed for all consecutive patients at two institutions with displaced olecranon fractures treated with a polyaxial locking plate. Patients were required to have at least 1-year follow up. Clinical outcomes including the Disabilities of the Arm, Shoulder, and Hand (DASH) score, Single Assessment Numeric Evaluation (SANE), along with a Likert-scaled satisfaction survey ranging between 1-5 (1= very unsatisfied and 5= very satisfied) were collected.

Results

The plate osteosynthesis was performed on 24 patients with displaced olecranon fractures. Functional outcome scores were collected on 19 (79.2%) patients. The mean age at the time of surgery was 57.9 years (range, 23 to 78) and mean clinical follow-up was 21.0 ± 6.6 months (range, 12-34 months). All patients achieved osseous union in an acceptable position. Four (16.7%) patients complained of plate related pain and 6 (25%) patients complained of postoperative stiffness. Complications were found in 3 (12.5 %) patients, which included two neuropathies and one hardware failure in which a patient presented following a fall with a broken screw. No patients required revision surgery nor removal of hardware. A total of 16 (84%) patients were somewhat to very satisfied. The mean SANE score was 87.8 ± 14.6 (range: 45-100) and the mean DASH score was 13.8 + 17.5 (range: 0-55.8). Seventeen (89%) patients rated their elbows as 75% or better on SANE assessment and 16 (84%) patients achieved DASH scores of less than 30.

Conclusion

Polyaxial plate fixation utilizing locking-cap technology resulted in excellent short-term functional outcomes in patients with displaced olecranon fractures. Further follow-up is needed to determine the long-term outcomes of locking-cap constructs for olecranon fractures.

Surgical Technique for Performing Endoscopic Carpal Tunnel Release without Converting to an Open Technique, and Analysis of the Reasons for Conversion

OBJECTIVE

Endoscopic carpal tunnel release (ECTR) has advantages over open carpal tunnel release (OCTR); however, complications with ECTR are more likely to occur if the surgeon continues the procedure despite encountering difficulties. Techniques to minimize the need for conversion to OCTR have been infrequently discussed in the literature. This study aims to present a technique for performing ECTR without conversion to the open approach and to analyze the reasons for such conversions.

METHODS

A total of 1160 hands in 771 patients who underwent single-portal ECTR between January 2001 and December 2020 were analyzed. We evaluated the rate and reasons for conversion and compared clinical severity and electrodiagnostic grades between the ECTR and OCTR conversion groups to identify patient characteristics associated with conversion.

RESULTS

A total of 18 hands in 17 patients required conversion to OCTR (1.56%). In the first 5 years, 9 out of 251 ECTRs (3.59%) were converted, but since then, the conversion rate significantly decreased with increasing surgical experience. The most common reasons for conversion were poor visualization of the transverse carpal ligament due to the transbursal approach with a hypertrophic synovial membrane. As the preoperative clinical grade worsened, the conversion rate significantly increased. The OCTR conversion rate also tended to rise with more severe electrodiagnostic grades. Outcomes for all 18 wrists were successful at the 6-month follow-up.

CONCLUSIONS

A thorough subligamentous extrabursal approach is essential for achieving a clear endoscopic view of the transverse carpal ligament and performing ECTR without the need for conversion to open surgery.

Cracking the code: Understanding ESWT's role in bone fracture healing

Bone non-union has always been a research hotspot in the field of orthopedics. Non-unions are often accompanied by symptoms such as pain, deformity, and dysfunction, which can significantly affect patients' quality of life and cause related socioeconomic problems. Clinically, there are various treatments available for non-unions, and the main treatment methods are divided into surgical and non-surgical treatments. At present, surgery is the most widely used treatment for bone non-unions and has a high healing rate. However, even after surgery, some patients still face the problem of bone non-union. Furthermore, a small number of patients have surgical contraindications and could not tolerate surgery. Therefore, alternative treatments are needed to improve outcomes for patients with bone fractures. Extracorporeal shock wave therapy (ESWT) is a non-invasive treatment method with similar efficacy and better safety compared with surgery. Nevertheless, the exact mechanism for ESWT to treat patients with bone non-union are still not well understood. This article reviews the mechanisms of ESWT in promoting bone fracture healing by regulating osteoblasts and osteoclasts, providing a theoretical foundation for the clinical application of ESWT. The Translational Potential of this Article: This review provides a comprehensive overview of the mechanisms underlying ESWT on promoting bone fracture healing by regulating osteoblasts and osteoclasts. The information provided in this article can offer a novel non-invasive method for clinicians to treat bone non-union.

Safety and Feasibility of Internal Fixation Using Bioabsorbable Versus Titanium Materials for Short-Level Lamina Reimplantation: A Comparative Clinical Study

OBJECTIVE

Lamina-implantation is gradually becoming the main surgical method for the treatment of intraspinal tumors. Traditional titanium (Ti) internal fixation not only produces artifacts, which affects the observation of tumors and dural sac closure, but also faces the problem of secondary surgical removal. In this study, absorbable material were used in lamina replantation for the first time and was evaluated for its efficacy and safety.

METHODS

We retrospectively enrolled patients who underwent short-segment lamina replantation for intraspinal tumors in our center from February 2020 to November 2022. After condition matching of the number of fixation segment and fixation position, the baseline information, complications, neurological function, quality of life, spinal mobility and bone healing rate of the absorbable group and the Ti group were compared. Fisher exact, Chi-square, or rank sum test were used for categorical variables, and t-test was used for continuous variables to distinguish differences between groups.

RESULTS

Cerebrospinal fluid leak was the most common complication, with no difference between the two groups (12.9% vs. 19.4%, p = 0.366). The bone healing rates of the two groups at 3 months after surgery were 77.4% and 87.1%, respectively, and there was no significant difference (p = 0.508). At 1 year after surgery, the resorbable group showedlower levels of anxiety/depression (1.20 ± 0.41 vs. 1.61 ± 0.61, p = 0.050), however, it did not affect the overall quality of life of the patients at 1 year.

CONCLUSION

Both titanium and absorbable internal fixation have shown good clinical results in the treatment of intraspinal tumors by laminareplantation. Regardless of cost, absorbable screws and plates are also suitable options for patients undergoing lamina replantation, because it has no stress shielding effect and does not require secondary removal. In addition, there are no artifacts in the image, which is more conducive to observing the recurrence of the tumor and the closure of the dural sac.

Use of platelet-rich plasma in rheumatic diseases

Platelet-rich plasma (PRP) has gained increasing recognition as a promising therapeutic agent in managing rheumatic diseases. Conventional treatments, including nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and disease-modifying antirheumatic drugs (DMARDs), primarily act on reducing inflammation but fail to address the underlying mechanisms of connective tissue degradation. PRP, an autologous preparation enriched with growth factors and bioactive molecules, is pivotal in modulating inflammation and fostering tissue regeneration. This review overviews the therapeutic potential of PRP across a spectrum of rheumatic diseases, such as osteoarthritis (OA), rheumatoid arthritis (RA), systemic sclerosis (SSc), and osteonecrosis. The regenerative capacity of PRP, driven by vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), and transforming growth factor-beta (TGF-β), promotes tissue repair, reduces cartilage damage and improves joint function. Emerging evidence supports the efficacy of PRP in early-stage OA, demonstrating superior outcomes over traditional therapies like hyaluronic acid and glucocorticoids in terms of pain relief and functional improvement. Despite its benefits, PRP therapy is characterized by variability in treatment responses, with challenges in standardizing preparation protocols and treatment regimens. This review highlights the need for robust clinical trials to establish uniform treatment protocols, optimize patient selection, and evaluate the long-term clinical outcomes of PRP therapy in rheumatic diseases.

The IL-1β/STAT1 Axis inhibits STAT3 function via Sequestration of the transcriptional activator GLIS2, leading to postoperative vascular dysfunction

Surgery-induced endothelial dysfunction is crucial in thrombus formation, driven by the release of inflammatory mediators due to surgical trauma. The STAT family, known for amplifying inflammatory responses via cytokine activation, plays an unclear role in the signaling mechanisms from surgery to molecular activation, and their regulatory effects on inflammation vary. This study aimed to identify key signaling pathways responsible for vascular dysfunction post-surgery and to discover potential targets for predicting or preventing thrombosis. To explore this, endothelial cells were co-cultured with post-surgical trauma serum and analyzed using various assays. Bioinformatics analysis linked surgical trauma with pathways involving thrombosis, interleukins, cytokines, and STAT signaling. Elevated inflammatory mediators were observed in mouse serum post-surgical trauma, with IL-6 activating STAT3 to enhance endothelial proliferation, while IL-1β activated STAT1, inhibiting STAT3's effects. Gli-similar 2 (GLIS2), a novel coactivator of STAT3, was found to regulate STAT transcription. STAT1, however, inhibited GLIS2's interaction with STAT3, suppressing STAT3's role in endothelial proliferation. The study concludes that IL-1β-triggered STAT1 activation impedes GLIS2-STAT3 interaction, reducing STAT3's transcriptional activity and leading to endothelial dysfunction, presenting new targets for preventing post-surgical trauma endothelial dysfunction and thrombosis.

Different polymethylmethacrylate (PMMA) reinforcement strategies for long bone osteoplasty procedures: a controlled laboratory comparison using the 4-point bending test

BACKGROUND

Cementoplasty has been successfully used for treating fractures in various parts of the human body, although the use in weight-bearing long bones is a subject of controversial debate. Strategies to improve the mechanical properties of polymethylmethacrylate-based bone cement (BC) comprise changing the chemical composition or the application of metal reinforcement strategies. In clinical practice reinforced bone cement is used despite biomechanical basic research regarding this topic being scare.

OBJECTIVE

The aim of the present study was to evaluate the biomechanical properties of two different reinforcement strategies against non-reinforced polymethylmethacrylate-based BC subjected to bending stress.

METHODS

In this controlled comparative laboratory analysis, we evaluated two types of reinforcement strategies in comparison to a control group (C). BC was reinforced with a Kirschner wire (group CW) or with a prestressed twinned steel cable (group CC); control group C was native polymethylmethacrylate-based BC. All the samples were prepared using a custom-made mould and underwent 4-point bending stress until fracture using a testing machine. Flexural strength, maximum strain, and Young's modulus were assessed for the three groups and compared using the Kruskal‒Wallis test.

RESULTS

The mean flexural strength in MPa was 48 ± 12 in C, 64 ± 6 in CW, and 63 ± 14 in CC. A significantly greater flexural strength of + 33% was found in both reinforced groups than in the C group (C vs. CW p = 0.011, C vs. CC p = 0.023). Regarding the flexural strength, no statistically significant difference could be found between the two reinforcement strategies CW and CC (p = 0.957). The maximum strain was 3.0% in C and CW and 3.8% in CC and no difference between the three groups was observed (p = 0.087). The Young's modulus in GPa was 2.7 for C, 2.8 for CW, and 2.4 for CC. The comparison of Young's module using the Kruskal-Wallis test showed no statistically significant difference between CC, CW and C (p = 0.051).

CONCLUSIONS

We detected an improvement in flexural strength in the reinforced groups. Both reinforcement through K-wire and prestressed cables promoted increased flexural strength. Furthermore, less material failure was observed with possible realignment and subsequent residual stability despite bone cement fracture. From a biomechanical view, the concept of macro metal reinforcement of osteoplasty is viable.

Near-Infrared Spectroscopy Allows for Monitoring of Bone Fracture Healing via Changes in Oxygenation

Bone fractures are associated with hypoxia, but no longitudinal studies of perfusion measurements in human patients have been reported despite the clinical and research potential. In this longitudinal observational cohort study, the near-infrared spectroscopy (NIRS) device PortaMon was used to assess oxy-(O2Hb), deoxy-(HHb) and total (tHb) haemoglobin, as well as the differences between O2Hb and HHb (HbDiff) and the tissue saturation index (TSI) at three different depths in the fracture gap. Linear mixed effect models were fitted to analyse time effects. One-way ANOVAs were conducted to compare groups. The time points corresponding to minima were calculated via linear regression. In this study, 11 patients with tibial shaft fractures underwent longitudinal measurements. Additionally, 9 patients with diagnosed tibial shaft nonunion and 23 age-matched controls were measured once. In the longitudinal group, all fractures healed, and decreases in O2Hb and HbDiff (all p < 0.05) were observed, with minima occurring 19-21 days after fracture. O2Hb values in nonunion patients did not differ from the minima in longitudinally measured union patients, whereas differences in HHb and tHb were significant (all p < 0.05). Previously, the onset of hypoxia has been assumed to be much faster. The characteristic trajectories of the NIRS parameters O2Hb and HbDiff can be used to fulfil the need for a non-invasive method to monitor fracture healing. These results suggest that NIRS could supplement radiographs and clinical impressions in daily clinical practice and may enable earlier diagnosis of nonunion.

Does a Specific Sequential Combination of Antiseptic Solutions for Chemical Debridement in Periprosthetic Joint Infection Improve Outcomes vs. Solution Alone? An In Vivo Study

Background: Chemical debridement is a fundamental step during the surgical treatment of both acute and chronic periprosthetic joint infection (PJI). However, there is no consensus on the optimal solution, nor is there sufficient evidence on the optimal irrigation time and combination of solutions. In an in vitro study, our group recently demonstrated that sequential combination debridement (SCD) with 3% acetic acid (AA) followed by 10% povidone iodine (PI) and 5 mM hydrogen peroxide (H2O2) was the best strategy for reducing bacterial load. The present study aimed to validate these findings in an in vivo model. Results: The median (IQR) log CFU/mL was lower in the group of mice treated with SCD (2.85 [0.00-3.72]) than in the Bactisure™ group (4.02 [3.41-4.72], p = 0.02). While this reduction was also greater than in the PI group (3.99 [1.11-4.33]), the difference did not reach statistical significance (p = 0.19). Cell viability assays showed no differences between treatments. S. aureus bacteremia was detected in 10% of mice treated with SCD, compared to 30% in the PI group and 10% in the Bactisure™ group. The difference was not statistically significant (p = 0.36). Conclusion: Our findings confirm that SCD significantly reduced bacterial load in an in vivo S. aureus PJI model, showing superior anti-biofilm activity compared to Bactisure™ and comparable performance to PI alone. These results highlight SCD's potential to serve as a standardized chemical debridement protocol, combining enhanced efficacy with clinical applicability. Methods: We tested SCD with 3% AA for 3 min, 10% PI for 3 min, and H2O2 for 3 min in a 7-day Staphylococcus aureus (ATCC29213)-based murine femur PJI model and compared the results with single treatments of 10% PI for 3 min or Bactisure™ solution for 3 min. A sterile steel implant with local administration of saline solution for 3 min was used as a non-infected control. After completing irrigation procedures, under anesthesia, mice were euthanized, and implants were analyzed for CFU/mL counts and cell viability rates. Blood cultures were obtained pre-euthanasia to detect bacteremia.