Anterior cruciate ligament (ACL) injuries are prevalent in sports and daily life, often leading to functional instability and long-term complications such as osteoarthritis. This literature review synthesizes advancements in postoperative gait analysis following ACL reconstruction (ACLR), focusing on biomechanical alterations, rehabilitation outcomes, and emerging technologies. Current methodologies, including three-dimensional motion capture, force plate kinetics, surface electromyography (sEMG), wearable sensors, machine learning and artificial intelligence, reveal persistent kinematic asymmetries, and altered joint loading patterns in ACLR patients. Rehabilitation interventions, such as neuromuscular training, biofeedback, and AI-assisted systems, show promise in restoring dynamic stability but require standardization and cost optimization. Limitations of existing studies include small sample sizes, short follow-up periods, and methodological inconsistencies. Future research should prioritize multicenter longitudinal studies, multimodal data integration, and AI-driven precision rehabilitation to optimize recovery and mitigate long-term risks. This study aims to elucidate the role of gait analysis in optimizing rehabilitation protocols and mitigating long-term complications by evaluating the strengths and limitations of existing approaches.
Pediatric spondylodiscitis is a rare but clinically significant infection affecting the intervertebral disc and adjacent vertebral bodies. Diagnostic delays are common due to its nonspecific presentation and the limited sensitivity of conventional microbiological methods. Early and accurate pathogen identification is essential to guide antimicrobial therapy, minimize unnecessary invasive procedures, and prevent long-term sequelae. Traditional diagnostic tools—including laboratory tests, imaging, blood cultures, biopsy, and histopathological evaluation—remain fundamental but are often insufficient, as they may yield nonspecific results or culture-negative cases, particularly after prior antibiotic exposure or infection with fastidious organisms. In recent years, molecular approaches, ranging from polymerase chain reaction assays to metagenomic next-generation sequencing, have markedly improved diagnostic accuracy. These techniques allow rapid and comprehensive pathogen detection, including atypical or previously uncultivable organisms, thereby overcoming many limitations of conventional methods. This narrative review synthesizes current evidence on pediatric spondylodiscitis, outlining its epidemiology, clinical features, and the evolving spectrum of diagnostic strategies—from conventional methods to advanced molecular and sequencing-based technologies—while discussing future directions in this challenging field.
Anterior cruciate ligament reconstruction (ACLR) is a widely performed orthopedic procedure, yet postoperative infection, although rare, poses a significant threat to graft integrity and long-term joint function. This review specifically focuses on therapeutic strategies for ACLR-associated infections. Management strategies constitute the core of this review, centering on early surgical debridement, targeted antimicrobial therapy, and, in selected cases, graft retention or removal. Preventive and rehabilitative measures such as graft presoaking with vancomycin, strict intraoperative asepsis, and structured postoperative rehabilitation are also discussed. Long-term functional outcomes are often suboptimal, emphasizing the importance of timely rehabilitation and individualized care. Rather than providing an exhaustive diagnostic review, we highlight therapeutic decision-making and evidence-based treatment pathways, supplemented by stratified comparisons of prospective and retrospective clinical studies. Ongoing research into biofilm-targeting therapies is essential to optimize treatment protocols and minimize infection-related complications.
Objectives: Cartilage defect of the knee joint is a common cause of knee pain and can result in significant functional disability due to its limited capability of spontaneous healing. Existing surgical options—such as microfracture, cartilage or chondrocyte transplantation, and joint replacement—remain limited by inconsistent restoration of durable hyaline cartilage. Autologous collagen-induced chondrogenesis (ACIC), which employs a collagen scaffold, has emerged as a promising single-stage alternative. Nevertheless, high-quality evidence evaluating its long-term efficacy relative to microfracture alone is still lacking. This study investigates the clinical effect of arthroscopic microfracture combined with autologous collagen-induced chondrogenesis for knee cartilage defects over a 5-year follow-up.
Methods: Twenty patients with knee cartilage defects were randomized to receive ACIC + microfracture (n = 10) or microfracture alone (MF, n = 10). Outcomes were assessed using Lysholm, VAS, and IKDC scores at baseline, 1 week, 3, 6, 12 months, and 5 years, alongside MRI-based MOCART scoring. Analyses employed linear mixed-effects models with multiplicity correction and effect size reporting.
Results: Both groups showed significant within-group improvements in Lysholm, VAS, and IKDC over time, but there were no between-group differences and no significant Group × Time interactions, indicating comparable functional recovery. In contrast, the MOCART score showed a significant long-term Group × Time interaction at 5 years (β = 53.1, 95% CI 29.0–77.2, p < 0.001), favoring ACIC + MF. At 5 years, ACIC + MF demonstrated a large structural advantage, although the unadjusted Mann–Whitney p = 0.0196 did not remain significant after multiplicity correction (adjusted p = 0.098).
Conclusion: ACIC + MF resulted in superior long-term structural repair compared with MF, as reflected in MOCART scores, but this did not translate into superior patient-reported outcomes. These findings underscore the divergence between imaging-based repair and clinical function and highlight the need for prospective trials establishing anchor-based MCID and Patient Acceptable Symptom State (PASS) thresholds for MOCART to clarify its clinical significance.
Trial Registration: Chinese National Medical Research Registration and Archival Information System: ChiCTR2400080094
Objective: Coronal balance and shoulder balance affect the results of surgical treatments. Numerous studies on these topics in moderate scoliosis have been reported. However, the risk factors and the association between coronal imbalance and shoulder imbalance in complex spinal deformity remain unknown. The purpose of this study is to investigate whether shoulder imbalance as well as other radiographic factors could predict ultimate coronal imbalance in severe and rigid scoliosis.
Methods: A retrospective study was conducted at our hospital between January 2009 and December 2018. Fifty-one patients with severe and rigid thoracic/thoracolumbar scoliosis (main curve Cobb angle > 80° and flexibility < 25%) were recruited. Patients were divided into the Coronal balance (CB) group (C7PL-CSVL ≤ 20 mm) and the Coronal imbalance (CIB) group (C7PL-CSVL > 20 mm). Then, the patients in the CIB group were stratified based on the aggravation of C7PL-CSVL for further subgroup analysis. Potential risk factors for coronal imbalance and decompensation, including shoulder height data and various radiographic parameters, were analyzed between groups and summarized in a quantitative predictive equation.
Results: Of all patients, 43.1% (22/51) showed coronal imbalance at the last follow-up. Univariate analysis showed that the following parameters were significantly greater in CIB group: shoulder height data including immediately postoperative radiographic shoulder height (RSH, p = 0.001), postoperative clavicle angle (CA, p = 0.000), and postoperative C7PL-CSVL (p = 0.000). Logistic regression identified that immediately postoperative CA [odds ratio (OR) = 6.837, p = 0.008] and C7PL-CSVL (OR = 1.071, p = 0.010) were the independent risk factors for ultimate coronal imbalance. The predictive equation was Risk Index = −5.277 + 1.922 × postoperative CA + 0.068 × postoperative C7PL-CSVL, with positive and negative predictive values of 86.7% and 85.7%, respectively.
Conclusions: The prevalence of coronal imbalance at the last follow-up remained high in severe and rigid scoliosis. Postoperative shoulder imbalance and residual trunk shift could be used as predictors for ultimate coronal imbalance. The aggravation of coronal imbalance might represent a possible compensatory response to shoulder imbalance, as suggested by the observed adverse trends. However, this interpretation should be considered hypothetical, since a direct causal relationship could not be verified yet. Surgeons should pay attention to restore an appropriate relationship between curves in surgical planning for better results.
Objectives: Clavicle fracture fixation is frequently complicated by implant mismatch and mechanical failure due to the complex and highly variable S-shaped anatomy of the clavicle. Conventional morphometric classification systems rely on subjective assessments of curvature and fail to capture the continuous spectrum of clavicular shape variation, limiting their utility for personalized implant design and preoperative planning. Furthermore, large-scale statistical shape modeling studies focusing on Asian populations remain scarce. Therefore, this study aimed to characterize clavicular morphology in an Asian cohort using statistical shape modeling (SSM), investigate sex- and side-related differences, and evaluate the validity of traditional morphological classification systems.
Methods: A retrospective study analyzed 288 clavicles reconstructed from CT scans of 144 adults (94 females, 50 males). Three-dimensional models were segmented in 3D Slicer, aligned, and processed using the Scalismo platform. Principal component analysis (PCA) was performed to establish the SSM and extract modes of variation (MoV). Morphometric parameters were calculated automatically. Independent t-tests assessed sex and side differences, and clustering analysis was conducted to compare data-driven groupings with traditional three-type classifications.
Results: The first six MoV explained 82.38% of total variance. PC01 (50.84%) reflected clavicular length and midshaft width; PC02–PC06 represented curvature and rotational variations. Significant sex differences were observed in PC01, PC02, and PC06 (p < 0.05), whereas no side differences were detected. Agglomerative clustering identified two morphological groups with poor concordance with traditional three-type classifications (Adjusted Rand Index≈0), indicating a continuous rather than discrete distribution of clavicular shapes.
Conclusion: Clavicular morphology exhibits sex-dependent but not side-dependent variability. Traditional categorical classifications inadequately capture anatomical diversity. Large-scale SSM provides objective morphometric evidence to guide personalized preoperative planning and improve implant design in clavicle fracture fixation.
Background: Plate-screw fixation systems have been widely applied in anterior cervical decompression surgery, yet the design of the plates themselves and a series of severe complications arising therefrom have attracted increasing attention from clinicians and scholars. In this study, a novel anterior cervical plate system was designed and subjected to biomechanical testing.
Methods: Twelve fresh goat cadaveric specimens were used. A high-precision digital grating displacement sensor system was used to compare the stability, fatigue resistance, and pull-out strength of the novel PRUNUS plate-screw system to those of the Atlantis plate-screw system in destabilized cervical spines.
Results: The biomechanical test results revealed that the novel PRUNUS plate-screw system provided equivalent three-dimensional stability to that of the Atlantis system, ensuring immediate postoperative stability of the cervical spine after anterior cervical internal fixation and meeting the requirements for rigid internal fixation. In addition, the PRUNUS system exhibited a similar fatigue life and fatigue strength to those of the Atlantis system, which was sufficient to maintain cervical stability after anterior interbody fusion, confirming the long-term safety and efficacy of the PRUNUS system in vivo. The PRUNUS system also showed superior overall fixation and locking performance.
Conclusion: The novel PRUNUS plate-screw system possesses excellent biomechanical properties and provides effective stabilization for the cervical spine.
Objective: There is a paucity of large-scale epidemiological evidence on cartilage injuries among the Chinese population. This cross-sectional study was designed to delineate the prevalence, distribution, and determinants of knee cartilage injuries in patients undergoing primary knee arthroscopy.
Methods: We retrospectively reviewed patients who underwent primary knee arthroscopy from 2017 to 2023. Intraoperative findings were used to document the location, severity, and size of cartilage defects. Mixed-effects logistic regression models were employed to identify independent factors, accounting for bilateral procedures. Analysis of covariance was conducted to assess differences in preoperative Patient-Reported Outcome Measures (PROMs).
Results: Among 25,293 arthroscopies, the overall prevalence of cartilage injury was 66.2%, and severe lesions (Outerbridge Grade III–IV) were present in 26.6%. Patellar cartilage exhibited the highest overall prevalence (39.4%), whereas the trochlea showed the highest prevalence of severe lesions (12.0%). Patella-related disorders revealed the highest prevalence of concomitant cartilage injuries of 86.08% (severe injuries of 51.42%). Positive associations were found between overall cartilage injuries with professional athletic status (adjusted OR = 2.18, 95% CI: 1.47, 3.22, p < 0.001), higher BMI (adjusted OR = 1.05, 95% CI: 1.04, 1.06, p < 0.001), longer injury duration (adjusted OR = 1.00, 95% CI: 1.00, 1.00, p < 0.001), patella-related disorders (adjusted OR = 3.73 vs. meniscal tear, 95% CI: 3.18, 4.37, p < 0.001), and prior musculoskeletal injury (adjusted OR = 1.31, 95% CI: 1.17, 1.47, p < 0.001). Negative associations were observed for pre-injury regular sports participation (adjusted OR = 0.74, 95% CI: 0.65, 0.85, p < 0.001), ACL rupture (adjusted OR = 0.47 vs. meniscal tear, 95% CI: 0.43, 0.52, p < 0.001). A significant sex-age interaction was noted. In males, older age was associated with higher prevalence of cartilage injuries, while females exhibited an even more significant increase after 50 years. For patients with isolated cartilage injuries, patient-reported outcomes and limitations on daily activity were significantly worse than those with other intra-articular disorders (all with p < 0.001).
Conclusions: Knee cartilage injury was highly prevalent in patients undergoing primary arthroscopy. Patellar and trochlear cartilage were the most frequently and most severely affected, respectively. Patella-related disorders carried the greatest risk of concomitant cartilage damage. Several potentially modifiable factors, including regular sports participation, were associated with injury occurrence, underscoring opportunities for prevention and early intervention.
Objective: Total elbow arthroplasty (TEA) is a commonly performed surgical technique for the management of elbow disorders. The Coonrad–Morrey (CM) prosthesis is the most commonly used prosthesis in TEA. The study from Chinese cohorts remains limited, particularly regarding differences between patients with and without RA. Therefore, the purpose of this study was to evaluate the medium- to long-term clinical outcomes using the CM prosthesis in a Chinese cohort, and to compare clinical outcomes between patients with and without RA.
Methods: A retrospective cohort study was conducted involving 74 patients (75 elbows) who underwent TEA using CM prostheses between March 2015 and February 2019. All patients were followed up for a minimum of 5 years (mean follow-up: 83.4 months) and were assessed for elbow range of motion (ROM), Mayo Elbow Performance Score (MEPS), Quick-Disabilities of the Arm, Shoulder and Hand (Quick-DASH) score, pain, complications, and revision surgeries. Kaplan–Meier survivorship analysis was conducted. The differences between patients with and without rheumatoid arthritis (RA) were compared in the subgroup analysis.
Results: At the final follow-up, the average flexion-extension ROM was 105.3° ± 33.6°. The mean MEPS was 85.5 ± 14.3, with a good-to-excellent rate of 81.3%. The mean Quick-DASH score was 30.8 ± 18.1. A total of 26 complications (26/75, 34.7%) were observed in 22 elbows (22/75, 29.3%). Nine elbows (9/75, 12.0%) underwent reoperation. The revision-free rates were 98.7% at 1 year, 94.7% at 2 years, and 90.7% at 5 years. There were no significant differences in elbow function or revision-free rate between patients with and without RA.
Conclusion: TEA using CM prosthesis in Chinese patients can achieve favorable functional outcomes regardless of RA status, with a high 5-year prosthesis survival rate. However, a larger sample size and a longer follow-up period are still required.
Introduction: Complex lumbar disc herniation (CLDH), including huge, migrated, and calcified variants, poses surgical challenges due to factors such as deep-seated lesions, irregular morphology, and adhesion to neural structures. This study aimed to compare the clinical outcomes of two minimally invasive endoscopic approaches—percutaneous endoscopic interlaminar discectomy (PEID) and percutaneous endoscopic transforaminal discectomy (PETD)—in the management of CLDH.
Methods: In this retrospective cohort study, 270 patients with CLDH treated between January 2020 and January 2024 were analyzed. Patients were categorized into three CLDH subtypes and were further divided into PEID and PETD groups based on preoperative imaging findings. Surgical parameters, perioperative data, and complications were recorded. Functional outcomes were evaluated using the visual analogue scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria. Imaging measurements included the cross-sectional area of facet joints (CSA-FJ) and dural sac (DSCA). Statistical analyses were performed using the chi-square test, Wilcoxon rank-sum test, Shapiro–Wilk test, independent-samples t-test, and two-way repeated-measures ANOVA.
Results: All procedures were successfully completed. PEID showed shorter operative time and significantly fewer fluoroscopy exposures compared to PETD (p < 0.05). PETD was associated with a higher facet joint resection rate (p < 0.05), though DSCA improvements were similar between groups. Both groups demonstrated significant reductions in VAS and ODI scores at all follow-up points (p < 0.05), with no statistically significant differences between approaches. Over 80% of patients achieved excellent or good outcomes according to modified MacNab grading. Complications were uncommon and included dural tears (n = 3), epidural hematoma (n = 1), nerve root injury (n = 1), and recurrent herniation (n = 2).
Conclusion: Both PEID and PETD are effective and safe surgical options for treating CLDH. PEID offers reduced operative time and radiation exposure, while PETD requires more extensive facet resection. This study further outlines tailored surgical strategies for different CLDH subtypes, supporting individualized endoscopic treatment selection.
Background: Massive rotator cuff tears (RCTs) often lead to superior migration and poor function. While superior capsular reconstruction (SCR) using the long head of the biceps tendon (LHBT) autograft is a promising technique, the optimal management of its distal portion (tenotomy vs. retention) remains unclear.
Objective: To compare the clinical outcomes of SCR by a long head of the biceps tendon (LHBT) autograft with biceps tenotomy or not in massive RCTs.
Methods: In this retrospective cohort study, we enrolled and followed 59 patients following SCR using the LHBT between 2016 and 2021. Patients were divided into two groups based on intraoperative management of the distal LHBT: the LHBT-retained group and the LHBT-tenotomy group. Statistical comparisons included repeated-measures ANOVA, two-way mixed-design ANOVA, chi-square/Fisher's exact tests, and Mann–Whitney U tests as appropriate. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, constant score and range of motion (ROM), and the acromiohumeral distance (AHD) were assessed as outcome measures.
Results: No major surgical complications were observed in any patient after surgery. The VAS score (7.0 vs. 0.6), AHD (3.2 ± 1.1 vs. 7.8 ± 0.8 mm), ASES (38 vs. 92), constant score (41 vs. 80), and ROM were statistically improved compared to their preoperative values. All patients were further subdivided into two groups according to the management of the distal end of the LHBT after transposition and fixation (retained group: the distal part of the LHBT was retained; tenotomy group: the distal part of the LHBT was resected). The two groups had comparable baseline demographic and clinical characteristics. We found that tenotomy group showed more significant function improvement within 12 months postoperatively (p < 0.05) compared with retained group. Nevertheless, compared with tenotomy group, the AHD of retsained group increased by 1.9 mm (5.0 ± 1.2 mm vs. 3.1 ± 0.8mm). Postoperative imaging assessment at 2 years revealed low and comparable retear rates (grades IV–V) between groups (retained group: 9.7% vs. tenotomy group: 7.1%).
Conclusion: SCR using the LHBT autograft significantly improves outcomes in massive RCTs. While both techniques are effective, patients with distal biceps tenotomy (tenotomy group) exhibited superior early functional recovery (within 12 months), whereas those with an intact distal LHBT (retained group) demonstrated significantly greater improvement in AHD. Both groups achieved comparably low retear rates.
Level of Evidence: Level 4.
Background: In the multiple ligament injury of the knee joint, apart from the anterior cruciate ligament and the posterior cruciate ligament, the Posterolateral Corner and the Posteromedial Corner are two structures that are easily overlooked. If not properly identified and repaired in one stage, the knee joint may be unstable, even failure of cruciate ligament reconstruction. The purpose of this article was to evaluate the effect of knee joint recovery after PLC (Posterolateral Corner) with or without PMC (Posteromedial Corner) injury.
Methods: From 2016 to 2020, we screened a total of 2564 patients, of which 292 patients met the inclusion and exclusion criteria. In the end, a total of 44 people completed the study. Follow-up was performed at 1, 3, 6, 9, and 12 months after surgery. We used pain visual analog scale (VAS) for pain, IKDC score, Lysholm score, Tegner score. Opti-knee (a portable motion analysis system) was used to evaluate the stability of the knee joint at 1 year. In our prospective cohort study, we used the unpaired Student's t-test for statistical analysis.
Results: The knee joint function of PLC group and PLC combined PMC group was better than that before operation at 3 or 6 months after operation. Except for IKDC at 9-month follow-up and Tegner score at 9-month and 12-month follow-up, there was no significant difference between the other groups.
Conclusions: PLC and PLC combined with PMC injury showed similar prognostic effects, although the PLC group was numerically superior to the other group. We recommend primary repair and reconstruction in patients with confirmed PLC and PMC injuries to achieve the best postoperative recovery.
Objectives: To avoid the confusion of mechanism, tissue, morphology, and injury severity that resulted from previous modified AO, the Thoracolumbar Injury Classification and Severity Score (TLICS), the Thoracolumbar AO Spine Injury Score (TL AOSIS), and Load Sharing Classification (LSC), the integrated scoring system is devised for thoracolumbar junction (TLJ) injury that can better assist clinical decision-making strategy.
Methods: We reviewed the literature of TLJ classification and TLICS 4-point treatment. Scoring and remedy strategies were proposed retrospectively. Patients included were validated with the change of Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) after surgical treatment retrospectively. The interobserver and intraobserver reliability was also evaluated.
Results: Nerve, discoligamentous complex (DLC), and vertebral bone that are three main spinal structures are weighted as 5, 4, and 3 points, respectively. If nerve injury ≥ 3 and/or bone + DLC injury ≥ 4, surgical treatment is recommended. If nerve injury = 2, delayed surgery may be needed after close observation of consistent pain. If nerve injury ≤ 1 or the bone + DLC score < 4, conservative treatment is recommended. When LSC ≥ 7, it may require vertebrectomy and anterior/middle column instrumentation. In ADLC = 2 of LSC ≤ 6, the removal of the injured disc and interbody fusion is needed, or only posterior fixation without intervertebral fusion. The consistency of the integrated system indicated substantial reliability.
Conclusion: This system showed substantial reliability and a desirable prognosis in TLJ patients. It could help differentiate injury morphology from severity and prevent the assignment of undue values to certain components, thereby providing a practicable decision-making strategy for TLJ injured patients.
Objective: Anterior cervical discectomy and fusion (ACDF) is a well-established surgical intervention for cervical disc herniation; however, the biological mechanisms underlying its superior pain relief compared to conservative treatment remain incompletely understood. This study aims to evaluate the efficacy of ACDF in treating neurogenic pain and its impact on inflammatory factors and substance P (SP).
Methods: We retrospectively analyzed 110 patients (2016–2023) with neurogenic pain, divided into an ACDF group (n = 51) and a conservative treatment group (n = 59). We assessed serum levels of inflammatory factors [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), monocyte chemotactic protein 1 (MCP-1)], pain mediators [substance P (SP), β-endorphin (β-EP), nitric oxide (NO), prostaglandin E2 (PGE2)], electromyography F-wave parameters, and clinical scores [Visual Analog Scale (VAS) score, Present Pain Intensity (PPI) score, Japanese Orthopedic Association (JOA), Oswestry Dysfunction Index (ODI)] before and 3 months after treatment, with statistical analysis performed using t-tests, χ2 tests, and rank-sum tests as appropriate.
Results: Baseline characteristics and complication rates were comparable (p > 0.05). The ACDF group achieved a higher excellent-good rate (72.55% vs. 54.24%, p < 0.05). After treatment, both groups showed improvements in all biomarkers and clinical scores, but the ACDF group demonstrated significantly greater reductions in IL-6, TNF-α, MCP-1, SP, NO, and PGE2, and a greater increase in β-EP (all p < 0.05). F-wave latency shortened and frequency increased more markedly in the ACDF group (p < 0.05). Clinical scores (VAS, PPI, ODI, JOA) also improved more significantly in the ACDF group (all p < 0.05).
Conclusion: ACDF is superior to conservative treatment in alleviating neurogenic pain and improving neurological function, and it is also safe. This study provides biochemical and electrophysiological evidence for the superior efficacy of ACDF by elucidating its modulatory effects on the neuro-inflammatory cascade, offering new insights into its mechanism of action. The significant modulation of inflammatory factors and pain mediators suggests their potential role as objective indicators for pain assessment.
Objective: Anterior cruciate ligament reconstruction (ACLR) with autologous hamstring tendon is the standard treatment for ACL rupture. However, tibial tunnel enlargement and delayed graft maturation may affect long-term outcomes. Evidence on their mid- to long-term associations with clinical recovery remains limited. The main objectives of this study include: (i) analyze longitudinal changes in tibial tunnel morphology after single-bundle ACLR; (ii) quantitatively evaluate graft maturation at different tunnel regions using the signal intensity ratio (SIR) from MRI; and (iii) examine the correlations between tibial tunnel enlargement, graft healing, and clinical outcomes.
Methods: A retrospective study was conducted on 35 patients who underwent single-bundle ACLR using autologous hamstring grafts and completed a 5-year follow-up. Knee function was evaluated preoperatively and at 2 and 5 years postoperatively using the KT-2000 arthrometer, pivot-shift test (PST) grade, Lysholm Knee Scoring Scale, International Knee Documentation Committee (IKDC) questionnaire, Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Scale, and the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale. Tibial tunnel diameter was measured via MRI at 1 week, 2 years, and 5 years postoperatively. Graft maturation was evaluated using the signal intensity ratio (SIR). Changes in tunnel diameter and SIR over time were analyzed. Pearson correlation coefficients (r) were used to assess the relationship between bone tunnel enlargement (BTE), graft healing, and knee function. Spearman's rank correlation coefficient was used to assess the association between BTE and PST grade.
Results: Tibial tunnel diameter increased from 1 week to 2 years and partially regressed at 5 years, remaining larger than baseline. SIR increased significantly from 1 week to 2 years and decreased slightly by 5 years. At 2 years, tunnel diameter in the tibial tunnel exit (ttE) region was positively correlated with intra-articular graft SIR (r = 0.455, p < 0.01), but not with clinical outcomes. By 5 years, no significant correlation was observed between tibial tunnel diameter and graft SIR. However, tibial tunnel diameter in the ttE region was positively correlated with KT-2000 side-to-side difference (SSD) (r = 0.411, p < 0.05).
Conclusion: Tibial tunnel enlargement progressed until 2 years post-ACLR, then partially regressed by 5 years. BTE was associated with graft healing at 2 years and with anterior knee stability at 5 years but had no significant adverse impact on long-term clinical outcomes.
Objectives: Spinal epidural abscess (SEA) is a life-threatening spinal infection with a pressing need for timely and effective surgical intervention. Conventional surgical approaches for SEA are often accompanied by extensive spinal tissue trauma and impaired spinal stability. This study retrospectively evaluates the efficacy of selective intersegmental laminectomy with irrigation (SILI), aiming to confirm that skip-level laminectomies combined with intraspinal direct irrigation can achieve effective abscess evacuation for SEA.
Methods: After ethics committee approval and patient consent, the authors studied patients with ≥ 3 affected segments and neurological deficits who had SILI from March 2020 to July 2024. Patients who had conventional continuous multisegmental laminectomy with drainage (CMLD) at the same time were controls. Inflammatory markers (WBC, CRP, ESR) were analyzed. MRI results were used to see changes in abscess volume and dura mater sac area. SILI's effect on neurological function was evaluated with 3, 6, and 12 months following up using JOA score, VAS, and modified MacNab criteria. Parametric tests (paired/independent t-test, repeated-measures ANOVA) were for normal data, nonparametric (Friedman test, Mann–Whitney U test, Chi-square test) for nonnormal and categorical data, with p < 0.05 for significance.
Results: All procedures were completed successfully without major complications. Significant improvements were observed across all outcome domains: inflammatory markers demonstrated substantial reductions, with WBC count decreasing from 13.44 ± 2.38 to 8.56 ± 2.26 × 109/L (p < 0.001), C-reactive protein declining from 80.11 ± 21.43 mg/L to 21.18 ± 9.7 mg/L (p < 0.001), and erythrocyte sedimentation rate falling from 93.55 ± 21.75 mm/h to 29.74 ± 9.21 mm/h (p < 0.001). Radiographically, MRI measurements revealed a significant reduction in abscess axial area and abscess volume, alongside effective dural sac area expansion (p < 0.001). Functionally, both JOA scores and pain VAS scores showed statistically significant improvement (p < 0.001). Modified MacNab criteria documented a clinically meaningful increase in “Excellent rate” outcomes from 55.56% at 3 months to 91.67% at 12 months postoperatively (p < 0.001). Interestingly, the SILI technique produced better results in terms of JOA scores at 6 and 12 months postoperatively, as well as in terms of the Modified MacNab criteria at 12 months, compared to the CMLD group.
Conclusions: Through strategic laminectomy site selection, SILI achieves effective evacuation of epidural abscesses via hydrodynamic bidirectional irrigation, enabling sufficient intraspinal debridement. This approach significantly reduces inflammatory markers and improves neurological function postoperatively.
Introduction: Elbow instability often arises from collateral ligament (LUCL) complex failure, causing varus and posterolateral rotatory subluxations. Conventional docking repair requires technical expertise balancing slack and tension. Existing suture anchors lack adjustable tensioning and rely on bone tunnel length for mechanical performance. A novel tensegrity-based suture anchor system was developed to enhance implant-bone fixation and optimize suture tensioning for early stability.
Methodology: Static three-point bending tests were conducted using Sawbones (n = 20) and paired cadaveric elbows (n = 14) with either conventional suture docking (CON) or elbow tensegrity screw (TEN). Force-displacement relationships were plotted. Stiffness, maximum force, and displacement at peak force were measured and compared using nonparametric Mann–Whitney U tests in GraphPad Prism 10.5.0.
Results: In foam elbows, TEN demonstrated significantly higher stiffness (3.46 ± 1.44 N/mm) than CON (1.44 ± 1.17 N/mm, p < 0.01). Maximum forces were 132.60 ± 28.82 N for TEN versus 75.02 ± 20.28 N for CON (p < 0.01), while displacement at peak force was slightly lower in TEN (35.54 ± 5.80 mm) versus CON (39.03 ± 9.05 mm, p = 0.22). In cadaveric elbows, TEN also had greater stiffness (12.79 ± 9.73 N/mm) versus CON (3.53 ± 2.43 N/mm, p < 0.05). Maximum forces were significantly greater for TEN (199.93 ± 35.89 N) compared to CON (140.11 ± 37.23 N, p < 0.05), while displacements at peak force were lower in TEN (22.31 ± 10.06 mm) than CON (38.68 ± 8.64 mm, p < 0.05). All CON samples failed from irreversible yielding and suture stretching, whereas most TEN samples failed due to suture rupture, suggesting superior bone-implant and suture-implant interface resistance.
Conclusion: TEN devices significantly improved mechanical strength and pretensioning over conventional docking, enhancing early stability and reducing yield failure risk.
Objectives: Hip Osteoarthritis (OA) affects a significant component of the adult population, placing itself among the most important causes of disability and need for total hip replacement. Femoroacetabular impingement (FAI) is an anatomic alteration of the proximal femur and/or acetabulum leading to chondro-labral damage and playing a prominent role in OA pathogenesis. Thus, treating FAI is fundamental to relieve hip pain and further joint tissue deterioration. Labral reconstruction is considered the treatment of choice, in particular using tendon allografts or autografts which, however, have some limitations. Here, we investigated the possibility to create a synthetic graft for labral reconstruction to best restore the load bearing and ready to be used in the surgical room.
Methods: The graft was designed analyzing the anatomical structures from intact tissue samples. After a preliminary screening of different polymers, silicone was selected for its flexibility and elasticity to better adhere to the implantation site. We used an FDA-approved biocompatible silicone (VK100), and a mold casting was selected as a fabrication method. Cytocompatibility of VK100 was tested in vitro with an immortalized chondrocytes human cell line (C-28/I2). A cadaver lab was used to test the implantation procedure and to investigate the effects of the device transplantation on hip range of motion, translation, and resultant joint stability. To test the long-term strength of the reconstruction under cyclic loading, synthetic hemipelves were prepared for biomechanical testing and subjected to 10,000 cycles where deflections of up to 5 mm were imposed.
Results: In vitro tests showed that up to 14 days of culture C-28/I2 cells were alive and adherent to VK100 surface with the formation of cell protrusions. As for cell cytotoxicity, a slight increase in LDH levels was observed at 14 days, probably due to the high confluence of adherent cells. We also demonstrated with the ex vivo procedure on cadaver that the device was suitable for arthroscopic implantation without damage or structural compromise during fixation to the acetabular bone. The range of motion and joint stability were preserved after implantation. Furthermore, the graft reconstruction successfully passed strenuous biomechanical cyclic loading. The force peak decreased by less than 10% during the test, indicating no detectable reduction of stiffness nor displacement/failure of the graft. No sign of damage was observed after test completion.
Conclusions: Overall, these results suggest that we have developed a functional synthetic graft that might be quickly transferred to clinical practice.
Objective: Traumatic long bone fractures require precise reduction and stable fixation to achieve optimal outcomes during open reduction and internal fixation (ORIF). Conventional bone-holding instruments are often associated with prolonged operative time, increased blood loss, reliance on surgical assistance, and higher complication rates. This study aimed to evaluate the clinical effectiveness of a newly designed orthopedic repositioning device in reducing operative time, intraoperative blood loss, postoperative pain, and complications compared with conventional ORIF techniques.
Methods: This randomized controlled clinical trial was conducted between 2023 and 2024. Adult patients aged 18–65 years with diaphyseal fractures of the femur, humerus, or tibia who underwent ORIF were enrolled. Patients were randomized into two groups: an intervention group using the novel repositioning device and a control group undergoing conventional ORIF. All surgeries were performed by a single orthopedic surgeon. The device consists of dual bone holders with a lengthening/shortening mechanism that allows controlled traction, angular correction, and plate insertion without device removal. Primary outcome measures included duration of surgery, intraoperative blood loss, postoperative pain assessed by the visual analog scale (VAS), transfusion requirement, and postoperative complications. Statistical analysis was performed using Student's t-test or Mann–Whitney U test for continuous variables and chi-square test for categorical variables, with significance set at p < 0.05.
Results: A total of 58 patients were included in the final analysis (29 per group), with a mean age of 29.9 years and a predominance of male patients (77.6%). Use of the repositioning device was associated with significantly reduced intraoperative blood loss (p < 0.05), shorter surgical duration (p < 0.05), and lower postoperative pain scores (p < 0.05) compared with the control group. The need for blood transfusion was significantly lower in the intervention group (p < 0.001). Postoperative complications occurred in 28.6% of patients in the control group but were not observed in the device group (p = 0.002). No significant difference in hospital length of stay was detected between groups (p = 0.284). Patients were followed for up to 3 months postoperatively.
Conclusion: The novel orthopedic repositioning device improves surgical efficiency and safety in ORIF of long bone fractures by reducing operative time, blood loss, postoperative pain, and complication rates, supporting its clinical value as an effective adjunct for fracture reduction and stabilization.
Objective: Interlaminar endoscopic lumbar discectomy, particularly with the Delta large-channel system, offers significant advantages in treating L5–S1 disc herniation. However, intraoperative pain management under local anesthesia remains challenging. Conventional epidural anesthesia (EA) often leads to unpredictable effects and risks such as motor block. This study proposes a novel endoscopic-assisted peri-root anesthesia (PA) technique to improve analgesic precision and safety.
Methods: This retrospective analysis was conducted on 132 patients who underwent interlaminar endoscopic surgery for L5–S1 disc herniation between January 2022 and December 2023. Patients were divided into PA (n = 65) and EA (n = 67) groups. Perioperative outcomes, including intraoperative pain, motor block incidence, operative time, hospital stay, and complications, were compared using the Mann–Whitney U test, chi-squared test, or Fisher's exact test as appropriate. Anesthesia satisfaction and mid-term functional outcomes (VAS and ODI) were also evaluated.
Results: The results showed that the PA group had significantly lower intraoperative pain levels (median VAS: 2 [1, 2] vs. 2 [1, 4], p = 0.005) and no cases of unexpected motor block compared to six cases (9.0%) in the EA group (p = 0.028). Patients in the PA group had 2.12 times higher odds of reporting a better satisfaction score on the Likert scale compared to those in the EA group (OR = 2.12, 95% CI: 1.14–3.95, p = 0.018, logistic regression).
Conclusion: These findings suggest better immediate neurological preservation with the PA technique, but its long-term efficacy and safety profile, particularly regarding rare complications, still require confirmation through larger, prospective randomized controlled trials with extended follow-up.
Objective: Kümmell’s disease (KD) represents a delayed form of osteoporotic vertebral collapse and shares clinical features with osteoporotic vertebral compression fractures (OVCF). Percutaneous kyphoplasty (PKP) is commonly performed for both conditions, yet comparative evidence and predictors of 1-year outcomes in KD remain limited. This study aimed to evaluate the efficacy and safety of PKP for the treatment of stage I and II KD and to identify factors associated with the outcomes at 1-year follow-up.
Methods: We included 387 inpatients with KD or OVCF who underwent PKP from January 2016 to December 2022. All patients were assigned to the KD group (n = 107) and the OVCF group (n = 280). The difference of demographic data (age, gender, surgical segment, osteoporosis severity and disease duration), clinical efficacy (visual analog scale and Oswestry disability index of pre-operation, 3-day post-operation, 3-month post-operation, and 1-year post-operation), complications (bone cement leakage during surgery and postoperative refractures), and radiographic parameters (anterior vertebral height and kyphotic angle of pre-operation, post-operation, and 1-year follow-up) was analyzed. Intergroup comparisons of continuous variables were performed using the Student's t-test. Repeated measures ANOVA with Bonferroni post hoc correction was used to evaluate intra-group differences of visual analog scale (VAS), Oswestry disability index (ODI), anterior vertebral height (AVH) and kyphotic angle (KA) across different time points. Multivariate logistic regression analysis was employed to identify the independent factors influencing VAS and ODI scores during the follow-up period.
Results: The disease duration of the KD group was much longer than that of the OVCF group. Significant improvements in VAS and ODI were observed at three-day, three-month, and one-year after PKP. Multivariate regression analysis identified the blocky cement distribution pattern, higher preoperative VAS, and higher preoperative ODI as independent risk factors for suboptimal recovery during follow-up. Besides, the KD group had lower AVH and larger KA than the OVCF group preoperatively. Both groups showed significant improvements in AVH and KA after PKP. However, the KD group had a higher rate of type II bone cement leakage (BCL) and more severe cemented vertebral collapse at the final follow-up. The mean bone cement volume was significantly greater in the KD group. Refracture rates were similar between the two groups during follow-up.
Conclusions: PKP can effectively alleviate back pain, improve functional impairment, and correct local deformity in KD patients, with the risks of BCL and vertebral collapse or refractures during follow-up. It is suitable for KD treatment without nerve injury symptoms. Appropriate measures should be taken to reduce the risk of complications.
Objective: Hip fracture is a severe injury in the elderly population and can trigger a strong physiologic stress reaction with potential impact on clinical outcomes. However, few data are available on the temporal evolution of hematologic parameters after this injury. This study aimed to evaluate the temporal trends of key hematological and inflammatory-immune markers in elderly patients with hip fractures.
Methods: A retrospective cohort study was conducted among elderly patients with hip fractures managed at a tertiary referral center from January 2022 to October 2024. Included patients were required to have both complete serial hematological measurements obtained during the first 5 days post-fracture and relevant clinical data. We used generalized estimating equation models for repeated measurements to describe the temporal trends of key hematological markers, with analyses stratified by fracture type and age group.
Results: A total of sixty patients were included, with a mean age of 80 ± 7.4 years (range: 65–96 years) and 68.3% females (n = 41). Within the first 1–5 days post-fracture, hemoglobin decreased by a mean of 9.66 g/L, hematocrit by 3.10 percentage points, neutrophil percentage by 8.12 percentage points, neutrophil count by a mean of 2.41 × 109/L, and neutrophil-to-lymphocyte ratio (NLR) by 3.07 (all p-values < 0.001). Conversely, lymphocyte and monocyte counts exhibited a biphasic change, peaking on day 4 prior to subsequent decline. Subgroup analyses revealed that monocyte levels demonstrated significant interactions between time and fracture type (p = 0.036), whereas both lymphocytes (p = 0.034) and monocytes (p = 0.012) exhibited significant interactions between age and time.
Conclusions: Hemoglobin, hematocrit, neutrophil percentage, neutrophil count, and NLR progressively decrease during days 1–5 after hip fracture in older patients, whereas lymphocyte and monocyte counts exhibit biphasic patterns and vary significantly according to fracture type and age. These findings may help clinicians in interpreting early post-fracture laboratory dynamics and provide a basis for future outcome-oriented validation.
Objective: Excessive lateral pressure syndrome (ELPS), a major cause of anterior knee pain, stems from axial lateral patellar tilt. Current diagnostic methods exhibit limited accuracy, poor reproducibility, and difficulty in cases with morphological abnormalities. This study introduces the Lateral Alignment Angle (LAA) as a novel measurement technique.
Methods: In this retrospective study (June 2021–March 2025), 150 patients were enrolled and matched 1:1 with controls (total n = 300). Two senior surgeons independently measured LAA, Lateral Patellofemoral Angle (LPFA), Patellar Tilt Angle (PTA), and Patellofemoral Index (PFI) at separate time points. Receiver operating characteristic (ROC) curves were constructed to evaluate diagnostic performance, with area under the curve (AUC) computed and optimal cut-off determined by maximum Youden index. Intraclass correlation coefficients (ICC) assessed interobserver reproducibility.
Results: LAA demonstrated superior diagnostic accuracy with an AUC of 0.913, sensitivity of 89.3%, specificity of 88.0%, and overall accuracy of 88.7%, all significantly outperforming LPFA and PTA. LAA achieved higher positive (88.2%) and negative predictive values (89.2%), with a positive likelihood ratio of 7.44 and negative likelihood ratio of 0.12. The ICC for LAA was 0.782, indicating good interobserver reliability. The optimal diagnostic cut-off value was determined to be 5.35°.
Conclusions: The LAA is a stable, accurate measurement that minimizes morphological influence on patellofemoral joint assessment. An LAA greater than 5.35° reliably indicates lateral patellar tilt, providing enhanced diagnostic utility and improved clinical management of ELPS.
Objective: MRI-derived vertebral bone quality (VBQ) score predicts osteoporotic vertebral compression fracture (OVCF) in a fat-dependent way. This retrospective study aimed to evaluate the predictive potential of inter-vertebral signal concordance index (ISCI), derived by MRI in a fat-independent way, as a novel factor for assessing the risk of OVCF.
Methods: Patients who suffered OVCF (OVCF group) and lumbar degenerative diseases (non-OVCF group) between January 2022 and July 2024 were included. The ISCI was calculated from the MRI signal intensity of the L1–L4 vertebrae, measured from the lumbar T1-weighted, T2-weighted, and short tau inversion recovery (STIR)-weighted sequences. The demographic data, including sex, age, body mass index (BMI), and medical history, were recorded. The ISCIs of the OVCF and non-OVCF groups were additionally compared. Inter-group comparisons were performed using the rank-sum, chi-square, or median test, as appropriate. Risk factors were identified by logistic regression, and correlations were assessed using Spearman's correlation coefficient.
Results: A total of 448 patients were included in this study. The T1-ISCIs, T2-ISCIs, and STIR-ISCIs of the OVCF group were higher than those of the non-OVCF cohort (13.18 vs. 9.90, 14.69 vs. 10.68, and 19.31 vs. 15.67, respectively, all p < 0.001). Comparative analysis of the ISCIs across the subgroups categorized by sex and age revealed that the T1-ISCIs, T2-ISCIs, and STIR-ISCIs were higher in the OVCF group. Additionally, there were no significant differences in the ISCIs across fresh, old, and fresh + old fracture type subgroups. The results of multivariate logistic regression analysis revealed that the STIR-ISCI (odds ratio (OR) = 1.025, p = 0.013) could serve an independent predictive factor for assessing the risk of OVCF.
Conclusions: The study evaluated a novel index for predicting the risk of OVCF. The T1-ISCI and STIR-ISCI could serve as potential predictive factors for evaluating the risk of OVCF in clinical practice.
Objective: Total hip arthroplasty (THA) improves function in patients with dysplastic hip osteoarthritis (DHOA). However, its effect on reducing fall risk remains unclear. This study aimed to evaluate fall risk following THA in patients with DHOA.
Methods: This retrospective cohort study included 85 patients who had DHOA and underwent THA between September 2019 and September 2022 and were evaluated as having a preoperative fall risk (Fall Risk Index 5 items [FRI-5] ≥ 6). They were categorized into two groups according to the FRI-5 score 1 year postoperatively. Evaluation parameters included FRI-5 score, age, sex, body mass index (BMI), Harris hip score (HHS), perceived leg length discrepancy (P-LLD), and radiographic parameters. Logistic regression was used to assess risk factors for postoperative falls.
Results: The FRI-5 score significantly decreased from 7.79 (6.0–13.0) preoperatively to 4.56 (0–13.0) postoperatively (p < 0.001). The number of falls during the year decreased from 36 (42.4%) to 18 (21.2%) after surgery (p = 0.005). The high-risk and low-risk groups comprised 33 and 52 individuals, respectively. The high-risk group was significantly older than the low-risk group (p = 0.006). Postoperative P-LLD was significantly large in the high-risk group compared to that in the low-risk group (p = 0.005). Preoperative and postoperative sagittal vertical axes (SVA) were significantly larger and preoperative lumbar lordosis (LL) was significantly lower in the high-risk group than in the low-risk group (p = 0.039, p = 0.034, and p = 0.021, respectively). Logistic regression analysis identified age (OR: 1.2, 95% CI: 1.05–1.36, p = 0.006), preoperative low LL (OR: 0.944, 95% CI: 0.892–0.999, p = 0.046), and postoperative P-LLD (OR: 5.81, 95% CI: 1.23–27.5, p = 0.026) as significant factors associated with fall risk.
Conclusion: THA for patients who have DHOA at high risk of falls reduces the likelihood for falls. Therefore, surgeons should plan surgeries considering the risk factors post-THA.
Objective: Precise and reproducible control of wedge resection remains challenging in osteotomy correction for ankylosing spondylitis–related rigid kyphosis, and reports of robotic stereotactic execution beyond pedicle screw placement are limited. This technical note describes the operative workflow of robot-assisted stereotactic osteotomy (RASO), focusing on quantitative wedge planning and stereotactic execution feasibility.
Methods: The RASO technique and operative workflow are described. Patients with type II ankylosing spondylitis-related thoracolumbar deformity who underwent single-level three-column RASO between May and November 2023 were analyzed. Preoperative planning was performed using Surgimap wedge simulation with ratio-of-closure–based prediction, and stereotactic osteotomy trajectories were executed using the Mazor X Stealth Edition system. Perioperative parameters and immediate postoperative radiographic findings were descriptively assessed to evaluate the feasibility and reliability of the proposed operative workflow.
Results: This technique was successfully implemented in 15 patients. The mean operative duration was 304.2 ± 51.4 min, and the mean intraoperative blood loss was 486.7 ± 229.5 mL. Planning–execution concordance demonstrated acceptable agreement, with a maximal ratio-of-closure–related deviation of ≤ 5.18° and a mean difference of 0.2° between planned and achieved osteotomy Cobb angles. The mean thoracolumbar kyphosis (TLK) improved from 50.2° to 13.2°, the chin-brow vertical angle (CBVA) improved from 36.7° to 15.1°, the PT improved from 35.6° to 26.6°, and the sagittal vertical axis (SVA) improved from 207.6 to 93.7 mm. Three intraoperative durotomies occurred during the decompression phase; one patient developed delayed cerebrospinal fluid leakage. No neurological deficits, hardware failure, or mortality were observed. All patients achieved osseous fusion and demonstrated improvements in health-related quality of life measures.
Conclusions: This technical note demonstrates the technical feasibility and workflow reliability of robot-assisted stereotactic osteotomy for rigid ankylosing spondylitis–related thoracolumbar kyphotic deformity. Quantitative wedge planning can be reproducibly translated into robotic stereotactic intraoperative execution. Further studies are required to define the broader clinical role and potential applications of this technique.Trial Registration: Chinese Clinical Trial Registry: 2400090375.
Purpose: Although percutaneous endoscopic lumbar decompression (PELD) has achieved substantial technical advancements over recent decades, it still presents considerable technical challenges in elderly patients with high iliac crest morphology who have concomitant lumbar foraminal stenosis and nerve root canal stenosis. To evaluate the preliminary clinical efficacy of percutaneous endoscopic lumbar decompression (PELD) assisted by an L-shaped impactor system in elderly patients with high iliac crest anatomy complicated by lumbar foraminal stenosis.
Methods: A retrospective cohort analysis was conducted on 40 elderly patients with high iliac crest anatomy and radiologically confirmed foraminal stenosis who underwent L-shaped impactor-assisted PELD between January 2022 and August 2023. Patients were divided into early (first 20 cases) and late (latter 20 cases) groups by surgical order. Outcome measures included preoperative/postoperative visual analog scale (VAS) scores for low back/leg pain, Oswestry Disability Index (ODI), MacNab criteria (1 day, 3-month, and 12-month follow-ups), and foraminal anteroposterior diameter, operation time, blood loss, and complications.
Results: VAS scores significantly improved from 6.83 ± 1.03 preoperatively to 3.00 ± 0.72 at 12 months. ODI scores decreased progressively from 55.9 ± 4.9 to 11.7 ± 1.9 at final follow-up. Excellent/good outcomes by MacNab criteria were achieved in 92.5% of patients at 12 months. Complications included transient dysesthesia (one case) and aggravated postoperative low back pain (one case). Compared with the early group, the late group had shorter operation time (58.90 ± 6.91 vs. 66.05 ± 7.26 min), less blood loss (30.85 ± 5.84 vs. 36.10 ± 6.75 mL), and lower postoperative VAS (3.80 ± 1.17 vs. 4.65 ± 1.23 < 0.05).
Conclusion: The L-shaped impactor-assisted PELD technique demonstrates favorable clinical efficacy in treating foraminal stenosis in elderly patients with high iliac crest anatomy. A favorable learning curve exists: more experience shortens operative time, reduces blood loss, and improves postoperative pain control without compromising safety. This minimally invasive approach may serve as a feasible surgical option for anatomically complex cases, warranting further prospective validation.
Z. He, Y. Chen, Z. Liu, et al., “Biomechanical Advantages of Novel Duet Screws Plus Bilateral Satellite Rods Fixation in the Correction Surgery for Adult Spinal Deformity,” Orthopaedic Surgery 17 (2025): 2454–2466. https://doi.org/10.1111/os.70121.
In the originally published version of this article, the authors’ affiliation was incorrect.
The published address read:
“Department of Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China”
The correct affiliation should be:
“Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.”
We apologize for this error.