Background: Intervertebral disc degeneration (IVDD), a prevalent spinal disorder, is closely associated with abnormal mechanical stress. The nucleus pulposus (NP), annulus fibrosus (AF), and cartilaginous endplate (CEP) collectively respond to mechanical loading. The mechanosensitive Piezo 1 ion channel senses mechanical stress changes and converts the mechanical signals into chemical signals, and serves a pivotal role in IVDD pathogenesis.

Objective: This review summarizes the regional effects of Piezo 1 on mechanical stress-induced IVDD and evaluates therapeutic strategies targeting Piezo 1 to maintain disc homeostasis.

Methods: A systematic search of preclinical and clinical studies was conducted to delineate Piezo 1's phenotypic impacts, mechanistic pathways, and therapeutic potential in NP, AF, and CEP.

Results: In the NP, activated Piezo 1 contributes to cellular senescence, apoptosis, ferroptosis, extracellular matrix (ECM) degradation and synthesis, oxidative stress, inflammation, and catabolic processes. Key regulatory targets involved include NLRP3, MAPK, p38, MMPs, ADAMTS, p65, Periostin, p53, p16, GRP78, CHOP, Cyt-c, and Drp1. In the CEP, Piezo 1 mediates inflammation-induced CEP degeneration through the CaMKII/Drp1 pathway and further participates in cellular senescence and apoptosis by activating Bax and caspase-3 while inhibiting Bcl-2. In the AF, Piezo 1 mediates apoptosis through the Ca²⁺/Calpain2/Caspase-3 signaling pathway. Therapeutically, targeting Piezo 1 has demonstrated significant preclinical potential, including attenuating pathological alterations via pharmacological inhibition, selectively suppressing degenerative cascades through genetic/RNAi approaches, and modulating channel activity by nutritionally regulating membrane lipids.

Conclusion: Piezo 1 serves as a critical mechanotransducer in IVDD, exhibiting region-specific effects on disc pathophysiology. Targeting Piezo 1 signaling not only offers mechanistic insights but also holds translational potential as a therapeutic strategy to improve IVDD, meriting further exploration in preclinical and clinical contexts.

In recent years, there has been a proliferation of literature describing new technologies increasingly integrated into the surgical management of pelvic fractures. However, the available data are heterogeneous, scattered, and sometimes limited to small series or single-center studies. This review aims to present new technologies in the field of pelvic and acetabular fractures and explore their potential benefits for surgeons and patients. The goal is to describe current concepts, advantages, and limitations and to open a discussion about future use and development. The search was conducted through Medline, Central and Embase databases from inception to January 2025 following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol. A total of 841 records were reviewed and 115 studies were included according to the inclusion and exclusion criteria. Technologies such as robotics, navigation, patient-specific management, and 3D printing are being developed for the management of pelvic injuries. These technologies demonstrate greater surgical accuracy without increasing complications. In pelvic and acetabular fractures surgery, new technologies are very attractive and are a promising help for management of these complex injuries and need to be improved before being included in routine care.

Objective: This study introduces a modified minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) technique to address the limitations of conventional MIS-TLIF, including soft tissue injury, excessive reliance on intraoperative fluoroscopy, and a steep learning curve. We evaluated the clinical efficacy of this modified approach in the treatment of single-level degenerative lumbar spine disease, with the aim of elucidating its advantages over the traditional technique and summarizing key technical considerations.

Methods: This retrospective study analyzed 286 patients who underwent surgery between January 2018 and July 2021 for single-level degenerative lumbar disease. Patients were divided into modified MIS-TLIF (n = 131) and traditional MIS-TLIF (n = 155) groups. Clinical outcomes were evaluated using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association (JOA) scores. Surgical parameters included operation time, intraoperative blood loss, fluoroscopy time, hospital stay, and complication rates. Radiographic assessments used CT and dynamic lateral X-rays to evaluate interbody fusion, while MRI was used to measure the fatty infiltration ratio of the multifidus (MF-FI Ratio). Continuous variables were compared between groups using independent-samples t tests, whereas categorical variables were analyzed using the chi-square test or Fisher's exact test when expected cell counts were < 5. Paired t tests were employed to compare preoperative and postoperative measurements within each group. A two-tailed p < 0.05 was considered statistically significant.

Results: Baseline characteristics showed no significant differences between groups (p > 0.05). Postoperative VAS, ODI, and JOA scores improved significantly in both groups (p < 0.05). All cases achieved successful fusion at the final follow-up. Compared to the traditional group, the modified MIS-TLIF group had shorter operation time (101.83 ± 26.23 vs. 117.81 ± 27.87 min), less blood loss (111.83 ± 26.22 vs. 147.68 ± 28.19 mL), shorter fluoroscopy time (12.35 ± 1.72 vs. 50.33 ± 6.36 s), fewer complications (5/131 vs. 16/155), and a lower MF-FI ratio (36.67% ± 4.52% vs. 39.61% ± 4.58%).

Conclusion: The modified MIS-TLIF technique better preserves paravertebral muscles, reduces radiation exposure, shortens operative time, and lowers complication rates, offering a more optimized treatment option for managing single-segment lumbar degeneration.

Objective: Identifying the risk factor for occurrence of trochanteric/femoral neck fractures has always been difficult and crucial for prognosis of the diseases. The goal of this study is to evaluate the difference of P1NP/β-CTX between trochanteric and femoral neck fractures and establish these two BTMs as independent risk factors for these two subtypes of hip fractures in the elderly.

Methods: Following case–control study design, 83 elderly patients with fragile hip fractures from two tertiary hospitals recruited between February 2023 to August 2024 were assigned into intertrochanteric fracture group (42 cases) and femoral neck fracture group (41 cases). Baseline characteristics including age, sex, height, weight, BMI, and history of diabetes/Parkinson's disease were collected after admission. Besides, P1NP/β-CTX/PTH/25(OH)D blood tests and dual energy x-ray absorptiometry (DXA) were performed on all participants before surgical operation. The statistical significances of categorical variables and continuous variables were established through χ²-tests and independent samples t-tests, respectively. Multivariable logistic regression analysis was applied to detect potential associations between the selected variables and hip fracture subtype.

Results: The difference in P1NP between the trochanteric fracture group and femoral neck fracture groups is statistically significant. Specifically, patients with trochanteric fractures showed a markedly higher value of P1NP than those with femoral neck fractures (p = 0.044). However, no significant difference was observed for β-CTX between the two groups (p = 0.941). Furthermore, BMDs at trochanter and total hip regions in the trochanteric fracture group were significantly lower than those in the femoral neck fracture group (p = 0.028; p = 0.022). After multifactorial logistic regression, P1NP, weight, and female were stronger risk factors for trochanteric fracture (OR 0.969, 95% CI 0.948–0.990, p = 0.004; OR 0.531, 95% CI 0.284–0.992, p = 0.047; OR 0.082, 95% CI 0.008–0.837, p = 0.035), while height was found to be independently associated with femoral neck fracture (OR 1.715, 95% CI 1.023–2.874, p = 0.041).

Conclusions: Compared with femoral neck fractures, P1NP was established as an independent risk factor for trochanteric fractures, suggesting the great potential of this BTM as a predictive indicator and postoperative complication monitor for trochanteric fractures.

Purpose: Ligament tension balance is essential for successful and long-term implant survival of total knee arthroplasty (TKA). Conventional manual tensioning methods are subjective and vary with the surgeon experience. This study evaluated the inter- and intra-rater reliability of pre-resection ligament tension assessments using an imageless robotic-assisted TKA system.

Methods: In this prospective study, 24 patients (30 knees) with end-stage knee osteoarthritis underwent CORI-assisted TKA from September 2024 to February 2025. Three specialist and three trainee surgeons each performed three repeated varus and valgus stress assessments across flexion and extension. Each medial and lateral gap measurement was recorded. Intraclass correlation coefficients (ICCs) were calculated with a two-way mixed-effects and two-way random-effects model.

Results: Both specialists and trainees demonstrated excellent intra- and inter- rater reliability (ICC > 0.90) for medial and lateral gaps in extension and medial gap in flexion. Flexion lateral reliability was good-to-excellent for trainees (ICC = 0.873, 95% CI: 0.784–0.933) and moderate-to-excellent for specialists (ICC = 0.838, 95% CI: 0.729–0.913).

Conclusions: Pre-resection ligament tension assessment with an imageless robotic system yields high inter- and intra-rater reliability, reducing variability linked to surgeon experience. Digital tensioners may standardize soft tissue balancing in TKA, potentially improving surgical outcomes and reproducibility.

Evidence Level: Level III, prospective quasi-experimental study.

Objective: Adjacent segment retrolisthesis is a common yet frequently overlooked complication after lumbar fusion, which may lead to reoperation. However, its risk factors, particularly those related to preoperative degenerative status and intraoperative variables, remain poorly understood. Therefore, this study aimed to elucidate the risk factors that contribute to the development of retrolisthesis in the adjacent segment following transforaminal lumbar interbody fusion (TLIF).

Methods: We retrospectively reviewed 473 patients who underwent lower lumbar fusion for degenerative diseases from June 2017 to September 2022, with a minimum follow-up of 2 years. Seventy patients who developed radiographic retrolisthesis postoperatively were included in the RR group, and 18 patients with symptoms were classified into the symptomatic retrolisthesis (SR) group. Using a 1:2 ratio, 140 patients without retrolisthesis were matched as the non-retrolisthesis (NR) group. Preoperative MRI was used to assess fat infiltration and cross-sectional area of the erector spinae, multifidus, and psoas muscles, as well as total endplate score and disc degeneration. CT was used to evaluate facet degeneration and pedicle screw-related facet joint violation. Independent sample t-tests and chi-square tests were used for group comparisons, and multivariate logistic regression analysis was performed to identify independent risk factors.

Results: Baseline age, sex, and bone mineral density were comparable between groups. Multivariate analysis showed that higher preoperative total endplate score (OR 2.086, 95% CI 1.496–2.907, p < 0.001), greater paraspinal muscle fat infiltration (OR 1.117, 95% CI 1.046–1.192, p = 0.001), facet degeneration (OR 2.838, 95% CI 1.762–4.570, p < 0.001), and postoperative facet violation (OR 1.911, 95% CI 1.330–2.746, p = 0.001) were independent risk factors for RR. Predictors of SR included total endplate score (OR 3.506, p = 0.002), fat infiltration of paraspinal muscles (OR 1.230, p = 0.008), facet degeneration (OR 8.940, p = 0.002), and postoperative facet violation (OR 2.873, p = 0.024).

Conclusion: Preoperative degeneration of adjacent endplates, facet joints, and paraspinal muscles, together with postoperative facet joint violation, appears to be significantly associated with the development of retrolisthesis. Patients with retrolisthesis often present with persistent or severe low back pain after lumbar fusion, resulting in impaired quality of life.

Objective: Adult degenerative scoliosis (ADS) presents a therapeutic dilemma between achieving adequate neural decompression and avoiding the morbidity associated with long-segment fusion. This study aimed to compare clinical outcomes of patients diagnosed with ADS undergoing single-segment posterior lumbar interbody fusion (PLIF) with selective nerve root block (SNRB) versus long-segment PLIF.

Methods: A retrospective cohort study was conducted of patients with ADS undergoing elective spinal fusion at a single medical center from July2019 to December 2021. Cohorts were divided into single-segment PLIF with SNRB (SS-PLIF+SNRB) or long-segment (≥ 3) PLIF (LS-PLIF) groups. The preoperative and postoperative spinal pelvic parameters were measured using X-rays. Clinical symptoms were measured using the Oswestry Disability Index (ODI) and a visual analog scale (VAS). The patients' quality of life was evaluated using Short Form-12. Length of stay, postoperative complications, and revision surgery were recorded. Continuous variables were analyzed using Student's t-test or Mann–Whitney U test as appropriate, while categorical variables were compared using chi-squared or Fisher's exact tests.

Results: A total of 87 patients (32 single, 55 long) were included. There were no significant differences in age, gender, BMI, preoperative spinal pelvic parameters, or preoperative clinical symptoms between the groups (p > 0.05). Patients in the SS-PLIF+SNRB group had a shorter hospital stay (p < 0.01) and a lower revision surgery rate (p < 0.01). No significant differences were noted in postoperative complications (p > 0.05). Patients in the SS-PLIF+SNRB group had better improvements in ODI and SF-12 scores 6 months after surgeries, and no significant differences were found in all clinical outcomes at the final follow-up.

Conclusion: Single-segment PLIF with SNRB can achieve the same efficacy as a long-segment PLIF for treating ADS. Single-segment PLIF with SNRB in appropriately selected patients may provide satisfactory improvements in ODI, SF-12, and VAS leg score and mitigate hospital length of stay and revision surgery rates.

Objective: Massive irreparable rotator cuff tears cause severe shoulder dysfunction. Superior capsular reconstruction (SCR) is effective, but optimal graft material is controversial; combined autologous fascia lata and LARS ligament needs validation.

Methods: We retrospectively analyzed 30 patients who underwent superior capsular reconstruction using autologous fascia lata combined with LARS ligament for massive irreparable rotator cuff tears between November 2023 and May 2025. We evaluated American Shoulder and Elbow Surgeons (ASES) scores, University of California, Los Angeles (UCLA) scores, Constant-Murley (CMS) scores, visual analogue scale (VAS) scores, shoulder range of motion, and acromiohumeral distance (AHD). Paired t-tests or Wilcoxon signed-rank tests were used to compare preoperative and postoperative outcomes, and p < 0.05 was considered statistically significant. And analyzed the complications after the operation.

Results: All 30 patients were followed up for a mean duration of months (12.35 ± 2.13). Seven cases involved isolated irreparable supraspinatus tendon tears, 19 cases had combined supraspinatus and infraspinatus tendon tears, and 4 cases included subscapularis tendon tears. In 3 cases, the long head of the biceps tendon was fixed to replace the anterior aspect of the supraspinatus tendon; in the remaining cases, the long head of the biceps tendon was transected. No glenoid fossa deformity was observed. At final follow-up, all functional scores improved significantly (all p < 0.05): ASES score increased from 31.04 ± 4.26 to 82.12 ± 3.23, UCLA score from 11.83 ± 4.15 to 30.44 ± 1.83, and CMS score from 32.44 ± 6.72 to 83.42 ± 4.75. The VAS score decreased from 5.84 ± 0.87 to 1.22 ± 0.42 (p < 0.05). Active range of motion in shoulder forward flexion, abduction, external rotation, and internal rotation improved significantly (all p < 0.05). Postoperative AHD significantly increased from 4.25 ± 0.41 mm to 10.15 ± 0.16 mm (p < 0.05). No complications such as wound infection, nerve injury, anchor loosening, lateral thigh pain, hematoma, or numbness occurred.

Conclusion: For patients with massive irreparable rotator cuff tears, superior capsular reconstruction using autologous fascia lata combined with LARS ligament effectively alleviates shoulder pain, enhances glenohumeral stability, and improves shoulder function.

Background: The geriatric nutritional risk index (GNRI) is a simple index for evaluating malnutrition, but whether it contributes to the development of prosthesis aseptic loosening (PAL) after total joint arthroplasty (TJA) is controversial. The aim of this study was to determine whether the GNRI is independently associated with PAL.

Methods: We retrospectively analyzed the medical data of 13,265 patients who underwent primary TJA at our institution between 2012 and 2023. After matching the patients to one another at a 1:2 ratio on the basis of clinical demographic variables, we compared the GNRI and other nutritional data in 205 patients who experienced PAL and 410 patients who did not experience PAL. We also compared common risk factors associated with PAL between the two groups. Multiple logistic regression was performed to analyze the relationship between the preoperative GNRI and PAL, and the predictive ability of the GNRI was assessed using the receiver operating characteristic (ROC) curves.

Results: The occurrence of malnutrition (defined by the GNRI) was significantly greater among PAL patients in the total hip arthroplasty (THA) group (38.3 vs. 9.0%, p < 0.001) and in the total knee arthroplasty (TKA) group (20.9% vs. 5.8%, p = 0.009). Multivariate regression analysis revealed that a low GNRI independently predicted a greater risk of PAL in the THA group (OR 1.091, 95% CI 1.041 to 1.145, p < 0.001) and in the TKA group (OR 1.240, 95% CI 1.060 to 1.451, p = 0.007). The ROC curves revealed an AUC of 0.729 for the GNRI in the THA group and 0.844 for the GNRI in the TKA group, which was greater than the AUC values for other common indicators.

Conclusion: A low GNRI is an independent risk factor for PAL after primary TJA, and the GNRI is more effective at predicting such risk than other commonly used indicators among elderly patients.

Background: An anatomical supra-pectineal quadrilateral surface buttress plate (Union Plate) has been designed and shown promising mechanical strength in vivo. Robot-aided technique has shown promising results in navigation of infra-acetabular and posterior column screws placement. This study sought to further examine whether the emerging anatomical plate provided advantages over the reconstruction plate in robot-aided complex acetabular fracture surgery.

Methods: A retrospective cohort analysis comparing two internal fixation methods was conducted between September 2023 and January 2025. Specifically, 23 patients with complex acetabular fractures received robot-aided Union Plate fixation (Union Plate group), while another 20 patients underwent robot-aided reconstruction plate fixation (Reconstruction plate group). Intra-operative plate contouring time, robot-aided manipulation time, the number of channel adjustments per periarticular long screws, total operation time, blood loss, periarticular long screw placement quality, fracture reduction quality, hip joint function, and postoperative complications were compared between the two groups.

Results: With identical robotic assistance, the Union Plate group experienced significantly shorter times for robot-aided manipulation (−12 min), intraoperative plate contouring (−9 min), and total operation (−23 min), along with reduced blood loss (−128 mL) and fewer channel adjustments of the periarticular long screws, compared to the reconstruction plate group. Both groups achieved satisfactory periarticular long screws placement, with a 95.7% perfect rate in the Union Plate group and 90.4% in the reconstruction plate group, showing no significant difference. Neither group experienced iatrogenic neurovascular injuries or screw penetration. There were also no significant differences in postoperative complications, fracture reduction quality, or hip joint function between the groups.

Conclusion: In surgery for complex acetabular fractures, the Union Plate showed superior operability and safety compared to traditional reconstruction plates. It required less time for robot manipulation, intraoperative plate contouring, and total operation, while also resulting in reduced blood loss and fewer adjustments of the periarticular long screws.

Objective: While paraspinal muscle degeneration is closely linked to lumbar disc herniation (LDH), the relationship between radicular compression and paraspinal muscle degeneration remains controversial, and evidence regarding the effect of percutaneous endoscopic lumbar discectomy (PELD) on paraspinal muscle degeneration is limited. This study aimed to investigate the correlation between radicular compression and paraspinal muscle degeneration in LDH patients and to evaluate postoperative changes in paraspinal muscles following PELD.

Methods: A total of 185 patients with single-level L4-5 LDH complicated by unilateral nerve root compression who underwent PELD between January 2020 and January 2023 were retrospectively enrolled. Preoperative and postoperative L3–S1 T2-weighted MRI scans were acquired. Paraspinal muscle cross-sectional area (CSA) and fat infiltration (FI) were measured using ImageJ, and total CSA (TCSA) and functional CSA (FCSA) were calculated. Paired-samples t-tests for bilateral paraspinal muscle differences and pre- to postoperative parameter changes; Spearman correlation analysis for continuous variable correlations; independent-samples t-tests, chi-square tests or one-way ANOVA for intergroup comparisons. A two-tailed p < 0.05 was considered statistically significant.

Results: Of this cohort, 108 patients completed the 3-month postoperative follow-up, and 29 underwent longitudinal follow-up for over 12 months. At the L3–5 level, the CSA on the compression side was lower than that on the non-compression side. At the L5–S1 level, the CSA and FI on the compressed side were greater than those on the opposite side. After PELD surgery, the CSA of the paraspinal muscles significantly increased, and the FI significantly decreased on the compression side. The duration of lower extremity pain (LEP) was positively correlated with the FI of the multifidus (MF) and erector spinae (ES) at all three levels; moreover, on the compression side, the correlation coefficient increased with decreasing segment length.

Conclusion: Degeneration of the multifidus and erector spinae muscles, especially the FI, is significantly associated with nerve root compression. Moreover, the duration of LEP is meaningful for assessing paraspinal muscle degeneration. Paraspinal muscle degeneration significantly improved after PELD, and longer preoperative LEP duration was associated with greater improvement in FI.

Objective: Distal radioulnar joint (DRUJ) instability is commonly assessed clinically via physical examination, such as a ballottement test, which evaluates palmar-dorsal translation of the radius relative to the ulna. However, the normal physiological range of translation and the factors influencing it remain poorly defined, limiting the test's diagnostic precision. This study aimed to quantify the normal range of DRUJ translation and identify its associated factors in a healthy population.

Methods: Healthy adult participants were recruited between January 1, 2025, and April 30, 2025. Data on occupation, gender, age, height, weight, handedness, wrist circumference, forearm length, and grip strength were recorded. A custom-designed device was used to measure the palmar, dorsal, and combined DRUJ translations in forearm pronation, supination, and neutral positions. Univariate and multivariate analyses were performed to identify factors influencing translation.

Results: The mean (±SD) combined DRUJ translation was 11.9 ± 4.2 mm in pronation, 12.4 ± 3.9 mm in supination, and 13.3 ± 4.6 mm in the neutral position. Significant side-to-side differences were observed for all translations in pronation and for both palmar and dorsal translations in the neutral position. No significant side-to-side difference was found in supination. Compared to pronation and supination, combined and palmar translations were significantly greater in the neutral position. Conversely, dorsal translation was greatest in supination. Multivariate analysis revealed that combined DRUJ translation in supination was significantly influenced by grip strength, forearm length, weight, and age.

Conclusion: Our findings establish reference values for DRUJ translation and demonstrate that it is influenced by forearm position and multiple factors. To improve the clinical utility of the ballottement test, we recommend performing it in forearm supination while comparing both limbs. Specifically, combined DRUJ translation with forearm supinated is significantly affected by grip strength, forearm length, weight, and age.

Level of Evidence: 3.

Objective: The proximal femoral laterally bionic intramedullary nail (PFLBN) is a novel cephalomedullary fixation system incorporating an additional lateral wall screw. This study aimed to compare the stress distribution and displacement characteristics of PFLBN with those of proximal femoral nail antirotation (PFNA) and proximal femoral bionic nail (PFBN) in AO/OTA 31-A3.1 intertrochanteric fractures using finite element analysis.

Method: Finite element models of an AO/OTA 31-A3.1 intertrochanteric femoral fracture were constructed based on computed tomography data from a healthy adult femur. Three fixation constructs (PFNA, PFBN, and PFLBN) were simulated under axial loading representing single-leg stance equivalent to three times body weight (2100 N). Von Mises stress distribution and displacement patterns of the femur and implants were evaluated.

Result: In all models, peak implant stress was concentrated at the junction between the main nail and the cephalocervical component. Compared with PFNA, the PFLBN model demonstrated a 17.2% reduction in peak implant stress and a 23.2% reduction in peak femoral stress. Maximum femoral and implant displacements in the PFLBN model were reduced by 19.5% and 19.2%, respectively. Notably, the PFLBN exhibited the highest construct stiffness and effectively mitigated stress concentration on the medial femoral cortex through the load-redistribution mechanism of the lateral wall screw. While the PFBN showed improved metrics over the PFNA, the PFLBN provided superior mechanical stability specifically for the simulated lateral wall deficiency.

Conclusion: Under axial single-leg stance loading, PFLBN exhibited lower peak stresses and smaller displacements than PFNA and PFBN in this finite element model of AO/OTA 31-A3.1 fractures. These computational findings describe differences in stress redistribution and construct behavior and warrant further experimental and clinical validation.

Objective: Although the Musculoskeletal Tumor Society (MSTS) score, Toronto Extremity Salvage Score (TESS), and Knee Society Score (KSS) are widely used for postoperative functional evaluation in patients undergoing rotating hinge knee (RHK) megaprosthesis reconstruction, their accuracy in reflecting objective gait performance remains uncertain. The study aimed to analyze the correlations between these scoring systems and gait parameters.

Methods: This retrospective study included 21 patients who underwent RHK between April 2023 and April 2025. At one-year follow-up, functional outcomes were assessed using MSTS, TESS, and KSS. Gait parameters were collected using the Intelligent Device for Energy Expenditure and Activity (IDEEA v3.1, MiniSun LLC). All functional assessments were completed on the same day as the gait analysis. Linear regression analyzed correlations between each scoring system and gait parameters. Friedman and Wilcoxon signed-rank tests compared median coefficients of determination across scoring systems. Stepwise multiple linear regression was used to examine the relationships between the scoring system subitems and gait parameters.

Results: Significant correlations were observed between all three scoring systems and multiple gait parameters after RHK (p < 0.05). The TESS had a significantly greater median R² than did the MSTS score and KSS (p < 0.05), especially for walking velocity (R² = 0.76), step length (R² = 0.75), initial contact phase (R² = 0.65), and stride length (R² = 0.58). Multiple linear regression analysis revealed that the MSTS “walking” and KSS “function” subitems independently or jointly predicted key gait parameters, including walking velocity, step length, and cadence (R² > 0.48).

Conclusions: All three scoring systems showed correlations with multiple key gait parameters in patients who underwent RHK. However, TESS demonstrated stronger and more consistent correlations and therefore appeared to be a more representative score of gait recovery.

Objective: Postoperative pain and swelling often impede early rehabilitation after Achilles tendon repair. This study aimed to evaluate the clinical efficacy of an acupuncture-integrated Chinese-Western medicine accelerated rehabilitation protocol following acute Achilles tendon rupture repair.

Methods: We prospectively analyzed 193 patients with acute Achilles tendon rupture treated between May 2022 and November 2023. Participants were stratified into three postoperative rehabilitation groups: accelerated rehabilitation (AR, n = 69), traditional rehabilitation (TR, n = 61), and sham acupuncture (SA, n = 63). All patients underwent identical surgical procedures, with postoperative complications documented. Pain was assessed using the Visual Analog Scale (VAS) at postoperative days 1 and 4, and weeks 1, 2, and 4. Limb swelling was quantified by measuring calf and midfoot circumference differences between affected and unaffected limbs. Functional outcomes were evaluated at 12 weeks using objective measures (one-leg heel-rise height [OHRH] and time [OHRT]) and validated scales (Achilles tendon Total Rupture Score [ATRS], AOFAS ankle-hindfoot score, and Holden Walking Ability Classification [HWAC]). Functional outcomes were evaluated at 12 weeks. Statistical analyses were performed using one-way ANOVA, Kruskal–Wallis H test, χ² test, or Fisher's exact test as appropriate, with Bonferroni correction for multiple comparisons.

Results: Compared with the TR group and the SA group, the AR group had lower VAS scores on the 4th day (p < 0.001) and 1 week (p < 0.001) postoperatively, and more obvious reduction of limb swelling on the 4th day (p < 0.001) and 1 week (p < 0.001) postoperatively. At 12 weeks postoperatively, the AR group showed higher OHRH (p < 0.001) and longer OHRT (p < 0.001). There was no statistically significant difference in ATRS scores, AOFAS ankle-hindfoot scores, and HWAC among the three groups at 12 weeks postoperatively.

Conclusion: The early adoption of the acupuncture-integrated accelerated rehabilitation strategy after acute Achilles tendon rupture repair can effectively reduce pain and accelerate the resolution of swelling within 1 week after surgery, which facilitates early functional mobilization for patients.

Trial Registration: NCT05957614 (https://www.clinicaltrials.gov/, registered 15 July 2023)

Objective: Subtrochanteric shortening osteotomy (SSO) with autogenous cortical plate grafting is a critical but technically demanding procedure in total hip arthroplasty for Crowe type IV developmental dysplasia of the hip. Conventional instruments often result in inaccurate osteotomies and unstable graft fixation. This study aimed to evaluate a novel surgical instrumentation system designed to address these challenges.

Methods: A retrospective cohort study was conducted on 49 patients (60 hips) with Crowe type IV DDH who underwent primary THA with SSO. The control group included 25 patients (30 hips) treated with conventional instruments. The novel instrumentation group included 24 patients (30 hips) treated with the newly developed system. All surgeries were performed by a single senior surgeon. Demographic and clinical data were analyzed, and all patients completed the 24-month postoperative follow-up. Statistical analysis was performed using t-tests and chi-squared tests as appropriate.

Results: The mean operative time was significantly shorter in the novel instrumentation group than in the control group (t = 2.123, p = 0.040). The novel instrumentation system was estimated to reduce the time required for the autogenous cortical plate technique by 43%. Patients in the novel instrumentation group also reported significantly less intraoperative blood loss (t = 3.078, p = 0.003). The satisfaction rate regarding autogenous graft and wire positions was significantly higher in the novel instrumentation group (χ² = 5.455, p = 0.020). No significant differences were observed in clinical scores between the two groups during the 24-month follow-up. No severe perioperative or postoperative complications occurred in either group.

Conclusion: The novel surgical instrumentation system demonstrated advantages over conventional devices in terms of operating time, blood loss, and satisfaction with autogenous graft and wire positioning. It represents an ideal set of surgical tools for Crowe type IV DDH patients undergoing THA with SSO.

Level of Evidence: Level III, retrospective study.

Objectives: Talar cysts, a common manifestation of osteochondral lesions of the talus (OLT), often result from trauma and cause significant pain and dysfunction. Cysts > 10 mm require grafting, and autologous iliac bone is an ideal graft source. However, accessing posteromedial lesions remains challenging: oblique osteotomies are associated with high osteoarthritis rates (up to 50%) and delayed union, while bi plane chevron osteotomies have reported malunion rates as high as 30%. To address these limitations, this study investigated the effectiveness of medial malleolus triple plane osteotomy combined with autologous iliac bone grafting for large talar cysts.

Methods: This retrospective case series included patients with talar cysts larger than 10 mm in diameter who were treated in our Hospital between February 2021 and March 2023. Patients underwent medial malleolus triple-plane osteotomy with autologous iliac bone grafting. Postoperative outcomes were assessed, including neurological complications, skin healing, radiological assessment of fracture healing, graft fusion, joint space evaluation, American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS-AHS), Kaikkonen functional scores, and Visual Analogue Scale (VAS) scores. Statistical analyses were performed using paired t-tests to compare preoperative and final follow-up scores.

Results: A total of nine patients (mean age 34.20 ± 9.23 years; seven males) were included, which had a follow-up period of 23.00 ± 7.80 months. Primary wound healing was achieved in all cases, with no neurovascular injuries reported. Postoperative X-rays demonstrated that the osteotomy lines became indistinct at 3 months, disappeared progressively by 6 months, and were fully healed by 12 months, at which point the internal fixation was removed. The grafted talar region exhibited sclerosis at 3 months, progressive assimilation with surrounding bone density at 6 months, and subtle visibility of the graft site at 12 months. At final follow-up, compared to preoperative values, patients had significantly improved VAS scores (p < 0.05), AOFAS-AHS scores (92.37 ± 2.09 vs. 59.39 ± 6.31, p < 0.05), and Kaikkonen functional scores (89.11 ± 3.11 vs. 60.23 ± 2.79, p < 0.05).

Conclusions: Medial malleolus triple-plane osteotomy and autologous iliac bone grafting might be effective in treating talar cysts in this series of patients. Patients experienced less pain and improved functional scores at the final follow-up with no neurovascular injuries.

Background: Thoracolumbar burst fractures with neurological deficits require decompression and stabilization. The spinous process-splitting approach (SPSA) achieves neural decompression while preserving the posterior osteoligamentous complex and minimizing paraspinal muscle injury.

Objective: Although various posterior surgical techniques are available for thoracolumbar burst fractures with neurological deficits, achieving adequate neural decompression while maximally preserving the posterior osteoligamentous complex remains technically challenging; a standardized approach that balances sufficient decompression with posterior structural preservation is still lacking. Therefore, we aimed to describe a modified SPSA combining the Wiltse interval with spinous process splitting for decompression, and to preliminarily evaluate its feasibility, safety, and early clinical and radiographic outcomes.

Methods: We retrospectively reviewed seven consecutive male patients who underwent posterior fixation, decompression, and fusion via modified SPSA between January 2020 and December 2024. Outcomes included American Spinal Injury Association (ASIA) grade, Visual Analog Scale (VAS) for pain, Gardner angle, anterior vertebral height ratio, and spinal canal encroachment ratio, assessed preoperatively, at 1 week postoperatively, and at 14 ± 2 months. Repeated-measures ANOVA was performed (α = 0.05).

Results: All procedures were completed successfully with mean operative time of 172.1 ± 95.7 min. All patients improved by at least one ASIA grade postoperatively, with no neurological deterioration. VAS scores decreased from 6.86 ± 0.90 preoperatively to 3.29 ± 0.49 at 1 week, and to 1.14 ± 0.38 at final follow-up (F = 350.00, p < 0.01). Gardner angle improved from 19.63° ± 8.92° to 4.39° ± 4.08° and remained stable at 4.69° ± 4.27° (F = 54.65, p < 0.01). Anterior vertebral height ratio increased from 51.82% ± 1.20% to 91.96% ± 7.93% and was maintained at 91.30% ± 8.13% (F = 89.41, p < 0.01). Spinal canal encroachment decreased from 62.32% ± 14.90% to 16.42% ± 10.78% postoperatively and remained stable at 16.89% ± 11.54% (F = 48.49, p < 0.01). All fractures achieved radiographic union without loss of correction.

Conclusions: Modified SPSA combining the Wiltse interval and midline spinous process splitting appears feasible for achieving decompression, reduction, and fixation while preserving posterior structures in selected patients with thoracolumbar burst fractures and neurological deficits. Larger prospective comparative studies are required to confirm long-term efficacy and define optimal patient selection criteria.

J. Li, Z. An, J. Wu, et al., “Construction of the Adjusted Scoliosis 3D Finite Element Model and Biomechanical Analysis under Gravity,” Orthopaedic Surgery 15 (2023): 606–616, https://doi.org/10.1111/os.13572.

In Figure 7, the subgraph labeled T2 incorrectly uses the subgraph that originally belonged to L2, resulting in inconsistency between the image and the annotations. The subgraph T2 has been replaced with the accurate version. All the images and annotations under this figure (including T2 and L2) are now accurate.

The correct version is shown below:

We apologize for this error.

J. Liu, L. Yang, H. Zhang, J.- Y. Zhang, and Y.- C. Hu, “Effects of Allogeneic Bone Substitute Configurations on Cell Adhesion Process In Vitro,” Orthopaedic Surgery 15 (2023): 579–590. https://doi.org/10.1111/os.13395.

In Figure 6A, the panel for the bone powder group was incorrect:

The correct version is shown below:

We apologize for this error.