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Objective: To culturally adapt and validate the Italian version of the Shoulder Instability—Return to Sport after Injury (SI-RSI-I) scale. Methods: The SI-RSI-I was developed by adapting the Anterior Cruciate Ligament—Return to Sport Index—Italian version and replacing the term "knee" with "shoulder." Subsequently, it underwent validation following COSMIN recommendations. The study involved athletic participants who experienced SI. They completed the SI-RSI-I together with other measurement instruments: Western Ontario Shoulder Instability Index, Kerlan-Jobe Orthopedic Clinic Score, EuroQol-5D-5L, and Numeric Pain Rating Scale. The following psychometric properties were investigated: structural validity, internal consistency, test–retest reliability, measurement error, and construct validity. Results: The study included 101 participants (age mean [SD] 28.5 [7.4] y; 83 males, 18 females). The SI-RSI-I showed a single-factor structure, excellent internal consistency (α =.935), and excellent test–retest reliability (ICC =.926; 95% CI,.853–.964). The standard error of measurement was 6.1 points, and the minimal detectable change was 17.0 points. Furthermore, SI-RSI-I demonstrated moderate to strong correlations with all reference scales, confirming 8 out of 9 (88.0%) hypotheses, thus establishing satisfactory construct validity. Conclusion: The SI-RSI-I has demonstrated robust internal consistency, reliability, validity, and feasibility as a valuable scale for assessing psychological readiness to return to sport in Italian athletes with SI. [ABSTRACT FROM AUTHOR]

Purpose: This paper presents a modification of the needle-assisted retropupillary fixation technique for iris-claw intraocular lenses (IOLs). We introduce a novel, minimally invasive reenclavation technique for managing subluxated retropupillary iris-claw IOLs. Methods: The technique was successfully performed on four patients diagnosed with subluxated retropupillary iris-claw IOLs. This approach involved a novel, minimally invasive reenclavation technique that utilized three needles: one long, straight translimbal needle crossing the anterior chamber and two needles introduced through the pars plana to reposition and securely reenclavate the IOL. Results: All patients experienced immediate and significant visual recovery, with their baseline visual acuities reestablished postoperatively. Importantly, no post-operative complications were observed during the six-month follow-up period, highlighting the safety and efficacy of the technique. Conclusion: Our novel, minimally invasive technique for reenclavation of iris-claw IOLs, employing just three needles, eliminates the need for trocar insertion, infusion cannulas, or sutures. This approach offers significant advantages, including a shorter operative time and minimal surgical manipulation, leading to faster patient recovery and fewer complications. [ABSTRACT FROM AUTHOR]

Background: Surgery is often offered to patients with mallet fractures that have a large, displaced fragment and/or joint subluxation. However, the surgical approach remains a subject of debate, and surgery is frequently associated with unsatisfactory outcomes. We felt that the angle formed by the fracture line and the long axis of the distal phalanx on a lateral view radiograph (fracture line angle [FLA]) could be useful in determining the appropriate treatment strategy. The aim of this study was to assess the FLA and its distribution in mallet fractures. Methods: Three researchers measured the mallet FLA and the percentage of articular surface (PAS) involved in the lateral radiographs of 103 patients with a mallet fracture. Results: There was a strong correlation between the mallet FLA and the percentage of joint surface involvement between the three researchers. The mean FLA was 42.59° (±11.54) and it ranged from −1 to +1 standard deviation in 73 individuals (70.87%). The FLA varied over a wide range, while clustering near the average value. The average PAS involvement was 46.5% (±8.7%). There was no correlation between FLA and PAS involvement (p > 0.05). Conclusions: It is possible to quantify the mallet FLA accurately and consistently. It varies widely, regardless of the PAS involvement. When choosing the type of treatment and making prognostic predictions, the mallet FLA may be a helpful guide. Level of Evidence: Level IV (Diagnostic) [ABSTRACT FROM AUTHOR]

Subtalar osteoarthritis in the context of flatfoot (recently renamed Progressive Collapsing Foot Deformity (PCFD)) may be treated through subtalar joint (SJ) arthrodesis with anticipated consequences on three-dimensional bony configuration. This study investigates the correction of PCFD-related deformities achieved after Anterolateral Arthroscopic Subtalar Arthrodesis (ALAPSTA). In this retrospective study, we evaluated pre- and post-operative (at 6 months) weight bearing computed tomography (WBCT) images of patients diagnosed with PCFD with a degenerated SJ (2 A according to PCFD classification) and/or peritalar subluxation (2D) with or without associated flexible midfoot and/or forefoot deformities (1B, 1 C and 1E) which underwent ALAPSTA as a standalone procedure between 2017 and 2020. Multiple measurements were used to assess and compare pre and post-operative PCFD classes. Thirtythree PCFD (33 patients, median age 62) were included in the study. Preoperative medial facet subluxation was 28.3 % (IQR, 15.1 to 49.3 %). Overall PCFD 3D deformity improved with a reduction of the foot and ankle offset from 9.3 points (IQR, 7.8 to 12) to 4 (IQR, 0.9 to 7) (p < 0.001). Class A-hindfoot valgus (median tibiocalcaneal angle and median calcaneal moment arm improved by 9.4 degrees (p < 0.001) and 11 mm (p < 0.001), respectively), class B-midfoot abduction (median talonavicular coverage angle improved by 20.5 degrees, p < 0.001) and class C-forefoot varus (median sagittal talo-first metatarsal angle improved by 10.2 degrees (p < 0.001)) were significantly corrected after surgery. Class D was difficult to assess due to the fusion procedure. No patient had a pre-operative valgus deformity at the ankle (no class E), and no significant change of the talar tilt was observed (p = 0.12). In this series, ALAPSTA performed as a standalone procedure to treat patients diagnosed with PCFD with a degenerated subtalar joint and/or peritalar subluxation was effective not only at correcting hindfoot alignment but also flexible midfoot abduction and flexible forefoot varus. Level IV, case series [ABSTRACT FROM AUTHOR]

Case: We present 3 cases demonstrating radiographic posterior subluxation in lateral functional radiographs taken in the flexed-seated position. Two of the patients were asymptomatic, and 2 showed the posterior translation of the femoral head, which is almost a dislocation, with spontaneous reduction. The subluxation can occur not only in patients after lumbar fusion surgery but also in patients with relatively normal lumbar spine due to excessive hip flexion. Conclusion: Functional lateral radiographic assessment in the flexed-seated position may be useful in detecting asymptomatic subluxation and identifying patients at high risk of dislocation after THA. [ABSTRACT FROM AUTHOR]

Background: The use of a distal tibial allograft (DTA) for reconstruction of a glenoid defect in anterior shoulder instability has grown significantly over the past decade. However, few large-scale clinical studies have investigated the clinical and radiographic outcomes of the DTA procedure. Purpose: To conduct a systematic review and meta-analysis of clinical studies with data on outcomes and complications in patients who underwent the DTA procedure for recurrent anterior shoulder instability with glenoid bone loss. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A comprehensive search of major bibliographic databases was conducted for articles pertaining to the use of a DTA for the management of anterior shoulder instability with associated glenoid bone loss. Postoperative complications and outcomes were extracted and compiled in a meta-analysis. Results: Of the 8 included studies with 329 total participants, the mean patient age was 28.1 ± 10.8 years, 192 (83.8%) patients were male, and the mean follow-up was 38.4 ± 20.5 months. The overall complication rate was 7.1%, with hardware complications (3.8%) being the most common. Partial graft resorption was observed in 36.5% of the participants. Recurrent subluxation was reported in 1.2% of the participants, and recurrent dislocation prompting a reoperation was noted in 0.3% of the participants. There were significant improvements in clinical outcomes, including American Shoulder and Elbow Surgeons score (40.9-point increase; P <.01), Single Assessment Numeric Evaluation (47.2-point increase; P <.01), Western Ontario Shoulder Instability Index (49.4-point decrease; P <.01), Disabilities of the Arm, Shoulder and Hand (20.0-point decrease; P =.03), and visual analog scale (2.1-point decrease; P =.05). Additionally, postoperative shoulder range of motion significantly increased from baseline values. Conclusion: The DTA procedure was associated with a low complication rate, good clinical outcomes, and improved range of motion among patients with anterior shoulder instability and associated glenoid defects. [ABSTRACT FROM AUTHOR]

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

Aims: The Bankart and Latarjet procedures are two of the most common surgical techniques to treat anterior shoulder instability with satisfactory clinical and functional outcomes. However, the outcomes in the adolescent population remain unclear, and there is no information regarding the arthroscopic Latarjet in this population. The purpose of this study was to evaluate the outcomes of the arthroscopic Bankart and arthroscopic Latarjet procedures in the management of anterior shoulder instability in adolescents. Methods: We present a retrospective, matched-pair study of teenagers with anterior glenohumeral instability treated with an arthroscopic Bankart repair (ABR) or an arthroscopic Latarjet (AL) procedure with a minimum two-year follow-up. Preoperative demographic and clinical features, factors associated with dislocation, and complications were collected. Recurrence, defined as dislocation or subluxation, was established as the primary outcome. Clinical and functional outcomes were analyzed using objective (Rowe), and subjective (Western Ontario Shoulder Instability Index (WOSI) and Single Assessment Numeric Evaluation (SANE)) scores. Additionally, the rate of return to sport was assessed. Results: A total of 51 adolescents were included, of whom 46 (92%) were male, with 17 (33%) in the Latarjet group and 34 (66%) in the Bankart group. The mean age at time of surgery was 18 years (15 to 19). There were no intraoperative complications. At a median follow-up of nine years (IQR 2 to 18), recurrence was observed in 12 patients in the Bankart group (35.3%) and one patient in the Latarjet group (5.9%) (p = 0.023). Satisfactory postoperative outcomes were obtained, with mean Rowe, WOSI, and SANE scores noted at 95 (10 to 100), 325 (25 to 1,975), and 87.5 (10 to 100), respectively. Most patients (29 in the Bankart group (85.3%) and 16 in the Latarjet group (94.1%)) were able to return to sport (p = 0.452). Conclusion: The ABR and AL procedures both obtain satisfactory clinical and functional outcomes in the treatment of anterior glenohumeral instability in adolescents with a low complication rate. However, the ABR is associated with a significantly higher recurrence rate. Cite this article: Bone Jt Open 2024;5(11):1041–1048.

A small proportion of children with a sudden onset torticollis ("wry neck") presents with an atlantoaxial rotatory subluxation, usually after mild trauma or recent head or neck infection. Torticollis is a clinical diagnosis and imaging is usually not indicated, though often performed in clinical practice. Atlantoaxial rotatory subluxation on imaging is often a physiological phenomenon in torticollis, and concomitant neurological symptoms are therefore rare. Treatment is primarily conservative, with analgesics, a rigid neck collar, and if needed benzodiazepines to counteract muscle spasms and anxiety. In case of treatment failure or chronic subluxation, cervical repositioning and fixation under general anesthesia may be considered. Surgical treatment is only indicated in a small percentage of patients with chronic refractory subluxation, concomitant cervical fractures, or congenital anomalies. Early diagnosis and treatment are important, since this is associated with a more successful conservative outcome than a prolonged approach. [ABSTRACT FROM AUTHOR]

A care algorithm for partial globe subluxation cases with optic nerve and at least one extraocular muscle (EOM) transection is presented after a literature review was performed using key term variations of globe, ocular, subluxation, optic nerve evulsion or transection, and trauma. Partial globe subluxation cases with transection of the optic nerve and at least 1 EOM were included. Exclusion criteria included globe rupture, complete enucleation defined by a globe without at least 1 EOM attachment, or unclear details confirming optic nerve transection. Including the patient presented herein, a total of 24 patients with 26 eyes were analyzed. About 73.08% of cases underwent initial repositioning (n = 19), with 11.54% of those requiring secondary enucleation or evisceration (n = 3). Of the secondarily managed cases, 2 of the 3 cases listed pain (n = 2) and inadequate cosmesis (n = 1) as rationale. We found that 26.92% of cases underwent initial enucleation (n = 7), citing lack of visual potential and limiting later complications. Most cases favored repositioning, which was typically sustainable. Initial repositioning can improve cosmetic outcome and psychological impact. Given the low risk of later management, cases of traumatic partial subluxation with EOM and optic nerve transections should attempt initial repositioning. [ABSTRACT FROM AUTHOR]

Developmental hip dysplasia is a common problem encountered in orthopaedic practice; early diagnosis and closed containment of the femoral head in younger children aims to allow remodelling to occur. For older children, with less remodelling potential, surgical intervention with femoral and/or pelvic/acetabular osteotomies may be required. There are many osteotomies described, all with a common goal of normalizing anatomy and preventing long term degenerative changes. Individual osteotomies can be classified as redirectional or salvage subtypes, then indications by the age of the child/degree of skeletal maturity. The osteotomy options and outcomes from available literature are explained and a flowchart to summarize the authors recommended choices is provided. [ABSTRACT FROM AUTHOR]

Management of patients with recurrent anterior glenohumeral instability in the setting of subcritical glenoid bone loss (GBL), defined in this study as 20% GBL or less, remains controversial. This study aimed to compare arthroscopic Bankart with remplissage (ABR + R) to open Latarjet for subcritical GBL in primary or revision procedures. We hypothesized that ABR + R would yield higher rates of recurrent instability and reoperation compared to Latarjet in both primary and revision settings. A retrospective study was conducted on patients undergoing either arthroscopic ABR + R or an open Latarjet procedure. Patients with connective tissue disorders, critical GBL (>20%), <2 year follow-up, or insufficient data were excluded. Recurrent instability and revision were the primary outcomes of interest. Additional outcomes of interest included subjective shoulder value, strength, and range of motion (ROM) One hundred eight patients (70 ABR + R, 38 Latarjet) were included with an average follow-up of 4.3 ± 2.1 years. In the primary and revision settings, similar rates of recurrent instability (Primary: P =.60; Revision: P =.28) and reoperation (Primary: P =.06; Revision: P = 1.00) were observed between Latarjet and ABR + R. Primary ABR + R exhibited better subjective shoulder value, active ROM, and internal rotation strength compared to primary open Latarjet. However, no differences were observed in the revision setting. Similar rates of recurrent instability and reoperation in addition to comparable outcomes with no differences in ROM were found for ABR + R and Latarjet in patients with subcritical GBL in both the primary and revision settings. ABR + R can be a safe and effective procedure in appropriately selected patients with less than 20% GBL for both primary and revision stabilization. [ABSTRACT FROM AUTHOR]

There is a common concern that range of motion (ROM) is negatively affected by the Latarjet procedure. We hypothesize that the Latarjet procedure results in full recovery of ROM postoperatively and significantly improved patient-reported outcome measures. Patient data were prospectively collected from a randomized controlled trial to analyze outcomes after open Latarjet procedure. Inclusion criteria involved a minimum follow-up of 6 months and unilateral shoulder instability. Study outcome was assessed by postoperative ROM at 6 months postoperatively and compared to the preoperative ROM of the ipsilateral shoulder as well as the ROM of the unaffected contralateral shoulder. All ROM measurements were performed using a motion capture system to ensure consistent and reliable measurements. The study included a total of 84 patients. ROM was measured in external rotation with the shoulder adducted (ER1), external rotation with the shoulder abducted 90° (ER2), internal rotation with the arm abducted 90° (IR2), and active forward elevation (AE). The mean difference in ROM between the operated arm vs. the contralateral healthy arm at 6 months postoperatively was 3.4° in ER1 (P =.19), 4.2° in ER2 (P =.086), 2.2° in IR2 (P =.36), and 2.4° in AE (P =.045). Subanalysis of patients with and without sling use revealed no significant difference in ROM between the operated shoulder and the contralateral shoulder at 6 months in either group, with the exception of ER2 in the sling group. In this latter group, ROM was 71° in the operated arm and 79° in the contralateral arm (P =.0094). Mean preoperative pain score was 25.7 (95% CI 21.4-30.1) vs. 13.0 postoperatively at 6 months (95% CI 9.50-16.5) (P <.00001). Mean preoperative Single Assessment Numeric Evaluation instability was 42.9 (95% CI 38.4-47.3) vs. 86.2 postoperatively at 6 months (95% CI 83.6-88.7) (P <.00001). Mean preoperative Rowe score was 38.5 (95% CI 34.3-42.7) vs. 84.3 at postoperative month 6 (95% CI 81.1-87.4) (P <.00001). Latarjet procedure performed for anterior instability using a capsular repair results in complete ROM recovery in ER1, ER2, and IR2 at 6 months postoperatively, with only a slight discrepancy in active elevation. Sling use after the Latarjet procedure results in no benefit over postoperative recovery without the use of a sling. Sling use negatively affects the ROM in ER2, taking as reference the contralateral arm of the same patient, when compared to patients who did not use a sling postoperatively. [ABSTRACT FROM AUTHOR]

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Background: Anterior shoulder instability is a common pathology seen especially in young men and highly active patient populations. Subluxation is a commonly encountered clinical issue, yet little is known about the effects of first-time subluxation compared with dislocation on shoulder stability and clinical outcomes after surgical stabilization. Purpose: To compare revision and redislocation rates as well as patient-reported outcomes (PROs) between subluxators and dislocators after a first-time anterior shoulder instability event. Study Design: Cohort study; Level of evidence, 3. Methods: Included were patients who underwent operative intervention for a first-time anterior instability event between 2013 and 2020 at a single institution. Exclusion criteria were posterior/multidirectional instability, revision surgery, and recurrent instability. The main outcomes of interest were the rates of redislocation and revision. Demographics and surgical details were retrospectively collected. Instability was categorized as subluxation (no documentation of formal shoulder reduction) or dislocation (documented formal shoulder reduction). Labral tear location and size were determined from preoperative magnetic resonance imaging scans. PROs and return-to-sport, redislocation, and revision rates were collected from prospective survey data. Results: A total of 256 patients (141 subluxators and 115 dislocators) were available for analysis. There were no significant differences in baseline demographics or preoperative physical examination findings. Rates of bony Bankart lesions were comparable, but Hill-Sachs lesions were more commonly present in dislocators compared with subluxators (88.7% vs 53.9%; P <.01). There were no group differences in labral tear size, incidence of concomitant posterior or superior labrum anterior-posterior tears, or number of anchors used. Rates of remplissage were comparable between groups. Prospectively collected survey data of 60 patients (35 subluxators, 25 dislocators) were collected at 6.4 and 7.1 years of follow-up, respectively. Rates of recurrent dislocation (11.8% vs 20.0%) and revision (8.8% vs 16.0%) were comparable between subluxators and dislocators, respectively. All PROs and return-to-sport rates were comparable between groups. Conclusion: Subluxators and dislocators may present with comparable rates of redislocation and revision surgery even at midterm follow-up. Both cohorts may further present with comparable injury characteristics and PROs. Given the findings, future prospective studies comparing outcomes of first-time instability events are needed. [ABSTRACT FROM AUTHOR]

Temporomandibular disorder (TMD) is considered a complex disorder that follows the biopsychosocial model. The current study aimed to explore the effect of clinic location and referring physicians on the distribution of Axis I diagnoses according to the Diagnostic Criteria for TMD (DC/TMD). Eighty-eight patients from a dental school Orofacial Pain Clinic (DentalOFP) and 104 patients from a hospital Orofacial Pain Clinic (HospitalOFP) were examined by the same dentist who was certified as a DC/TMD examiner and compared. Significant differences between the two clinics were noted, including age (p = 0.002), gender (p = 0.019), symptom duration (p < 0.001), and referring physician's profile (p < 0.001). While 55.7% of referring physicians were dentists in the DentalOFP clinic, only 13.5% of referring physicians were dentists in the HospitalOFP clinic. DentalOFP clinic presented with characteristics of a tertiary clinic, as to female: male ratio and longer symptom duration. Significant differences were found as to intra-articular disorders (IAD) (p = 0.019), degenerative joint disorder (DJD) (p = 0.041), and subluxation (p = 0.015). There were no significant differences as to local myalgia (p = 0.128), myofascial pain with referral (p = 0.389), and arthralgia (p = 0.096). Multiple parameters, such as age, gender, symptom duration, primary vs. tertiary clinic, clinic location, and referring physicians may affect the overall DC/TMD Axis I profile. This study supports abandoning the term TMD. It is suggested to assess each Axis I diagnosis separately, and for each Axis I diagnosis, to follow the International Classification of Orofacial Pain (ICOP), as to primary vs. secondary etiologies, and acute vs. chronic conditions, to provide appropriate treatment. [ABSTRACT FROM AUTHOR]

Background: In the treatment of terrible triad injury of the elbow (TTIE), the indication and the appropriate approach and sequence for coronoid process (CP) fixation remain debatable. No gold standard protocol has been established for CP fixation. In this study, we evaluated the midterm outcomes of coronoid-first repair through an anterior approach in patients with unstable TTIE. Materials and methods: This prospective observational study included patients with TTIE who exhibited posterior or posterolateral subluxation/dislocation during examination under anesthesia (EUA) at our institute between January 2019 and December 2021. All patients underwent coronoid-first repair through an anterior approach, regardless of fragment size. After CP fixation, radial head fixation/replacement and lateral ulnar collateral ligament repair were performed through the lateral Kocher approach. Radiographic and functional (Mayo Elbow Performance Score [MEPS] and Disabilities of Arm, Shoulder, and Hand score [DASH]) assessments were performed 3, 6, 12, and 24 months after surgery. Complications such as recurrent subluxation/dislocation, synostosis, heterotopic ossification, traumatic arthritis, and stiffness were examined at the follow-up visits. Results: The analysis included 27 patients. The mean follow-up duration was 29.9 (range 24–44) months. At the 3-, 6-, 12-, and 24-month follow-up, the mean flexion–extension arcs were 88.7° ± 14.7°, 107.9° ± 11.9°, 128.3° ± 15.5°, and 130.9° ± 15.3°; the mean supination–pronation arcs were 143.7° ± 9.9°, 160.4° ± 7.6°, 165.0° ± 6.0°, and 167.9° ± 4.9°; the mean DASH scores were 18.7 ± 5.7, 4.5 ± 6.1, 2.7 ± 6.5, and 2.0 ± 6.8; and the mean MEPS were 79.1 ± 10.3, 90.2 ± 8.3, 94.8 ± 6.6, and 95.9 ± 5.7, respectively. At the 24-month follow-up, 26 patients had excellent and 1 patient had good results according to MEPS. Only one patient had a complication: they exhibited stiffness and did not have a 30–130° flexion–extension arc at 24 months postoperatively. Conclusions: The EUA findings, rather than fragment size alone, may be a good indicator of whether the CP needs to be repaired. Midterm follow-up results implied that coronoid-first repair through an anterior approach yields satisfactory functional outcomes with minimal complications. Level of evidence: Therapeutic level II. [ABSTRACT FROM AUTHOR]

The presence of clear high-grade rotatory subluxation, in addition to an odontoid fracture, is a definite indication for surgery. However, the presence of a more subtle subluxation—Grades 1, 2, or 3—can often be overlooked, and as a result, prognostic associations with second cervical vertebrae (C2) fractures are rare. In light of this, we assessed the failure rate of conservative management in patients with both an odontoid fracture and a concurrent first and second cervical vertebrae (C1‒C2) rotatory subluxation. A retrospective, cohort (nested case-control) study of patients with odontoid C2 fractures with or without C1‒C2 joint rotatory subluxation was performed. Patients were classified according to the type of odontoid fracture (Alonzo classification) and the presence of C1‒C2 subluxation (Feldings classification). The number of patients who were initially treated with collars and then underwent surgery due to conservative treatment failure was analyzed. We performed logistic regression analysis to determine the odds ratio and generate a receiver operating characteristic curve of the association between the degree of subluxation and failure of conservative treatment. One hundred fifteen patients with C2 fractures that were treated conservatively with or without C1‒C2 rotatory subluxation. Of all 115 patients, 29 (25%) experienced treatment failure and required surgery. A statistically significant correlation was found between treatment failure and the presence of rotatory subluxation (odds ratio 10), compared with patients without C1‒C2 subluxation. In our series, C2 Alonzo fractures with a C1‒C2 rotatory subluxation had a 10-fold increased risk of secondary displacement and subsequent need for surgery. Further research on this association could improve the management of these conditions. [ABSTRACT FROM AUTHOR]

Background: MPFL reconstruction in children with open physis may be challenging, as a major concern during the surgery is to preserve the distal femoral physis. The purpose of this study was to compare the complication rate and the patient-reported outcomes in skeletally immature patients who underwent MPFL reconstruction using an anatomic (A) or non- anatomic (NA) surgical technique. Methods: For this systematic review, the authors adhered to the PRISMA guidelines. The literature search was conducted from inception to 31 May 2024. Three databases were used: Pubmed, Scopus and Cochrane library. We included skeletally immature patients who underwent MPFL reconstruction for chronic or recurrent patellar instability. The included studies should describe the surgical technique, report clinical outcomes and complications. Patients with closed physis, prior ipsilateral knee surgery, concomitant surgical procedures except for lateral retinacular release, multiligament knee injury, congenital or acute patellofemoral instability, hyperlaxity or less than 12 months follow up were excluded. Risk of bias was assessed using ROBINS-I, MINORS and MCMS scores. Results: Data from 304 procedures were collected, of which 208 were performed using an anatomic technique and 96 using a non-anatomic technique. Patient age at the time of surgery ranged from 8 to 17 years. The follow-up time ranged between 12 and 116.4 months. Postoperative Kujala (−0.73, p = 0.55) and Tegner (−0.70, p = 0.80) scores were better in the anatomic group compared to the non-anatomic one. Higher rates of recurrent instability (OR 0.91; 95%CI 0.44–1.86, p = 0.85), redislocation (OR 1.21; 95%CI 0.42–3.51, p = 0.8), subluxation (OR 0.73; 95%CI 0.29–1.83, p = 0.62), a positive apprehension test (OR 0.92; 95%CI 0.27–3.13, p = 0.89), stiffness (decreased ROM) (OR 1.63; 95%CI 0.33–1.72, p = 0.54) and reoperation (OR 1.16; 95%CI 0.35–3.80, p = 0.8) were reported in papers using the anatomic technique. Conclusions: The findings of this systematic review reveal that there is no significant difference between anatomic and non-anatomic MPFL reconstruction techniques in terms of patient-reported outcomes and complications. Thus, the choice of surgical technique might be left up to surgeon's preference. Further high-quality, pediatric-oriented studies with long-term follow–up are needed to better guide clinical decision-making. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to investigate the incidence and prognosis of retinal injury in patients with lens dislocation caused by blunt eye trauma. Methods: We retrospectively analyzed 53 patients who underwent lensectomy and vitrectomy for contusive lens dislocation and had no preoperative retinal injuries. Patients were categorized according to the presence of retinal injury discovered intraoperatively. The clinical features of 53 eyes were assessed during a 3‐month postoperative follow‐up. Results: Retinal injuries were observed intraoperatively in 28 patients (52.8%), predominantly in peripheral regions, with a single retinal tear being the most common type. Total lens dislocation was more frequent than subluxation in the group with retinal injuries. The intraocular pressure (IOP) at the 3‐month follow‐up was significantly lower than the initial IOP in both groups, with no significant differences between them. The corrected distance visual acuity (CDVA) significantly improved in both groups without significant differences. Conclusion: Half of the patients without preoperative retinal injuries were found to have injuries during surgery. Total lens dislocation carried a greater risk of retinal injuries than subluxation. The improvement in CDVA after prompt retinal injury treatment did not significantly differ from that in patients without retinal injury, highlighting the importance of prompt intervention. [ABSTRACT FROM AUTHOR]

Background: Controversy exists regarding the origin of femoral torsion, and specific treatment rules regarding the optimal position of femoral osteotomy in patients with recurrent patellar subluxation and excessive femoral torsion are scarce. Purpose: To establish a novel classification system for such patients, and to compare clinical and radiological outcomes after distal derotational femoral osteotomy (DDFO) between femoral torsion at proximal (neck and shaft) and distal levels. Methods: Between January 2014 and June 2019, patients who underwent DDFO were retrospectively reviewed. The segmental torsion analysis was performed to establish a novel classification system, and classify included patients into two groups: 35 patients in proximal torsion group and 38 patients in distal torsion group. These patients were followed-up for at least 3 years. Clinical evaluations included functional outcomes, physical examinations, quality of life, activity level, satisfaction, and complications. Radiological outcomes included patellofemoral osteoarthritis, congruence, and alignment. Results: Type I was defined as the proximal torsion. Type II was defined as the distal torsion. Proximal torsion group had lower postoperative femoral torsion (12.6 ± 2.6° vs. 14.8 ± 3.6°; P =.004) and higher surgical correction angle (21.6 ± 5.0° vs. 19.1 ± 3.0°; P =.009). All clinical and radiological outcomes improved significantly in both groups, but proximal torsion group had significantly higher quality of life (EQ-5D-5L: 0.96 ± 0.06 vs. 0.91 ± 0.07; P =.003. EQ-VAS: 92.0 ± 6.0 vs. 88.7 ± 5.8; P =.021) and Tegner activity score (5.2 ± 1.5 vs. 4.5 ± 1.4; P =.040), and fewer patellofemoral osteoarthritis (8.6% vs. 26.3%; P =.048). Two patients in the distal torsion group had subjective patellar instability. The percentage of patients with anterior knee pain was higher in the distal torsion group. Conclusion: A novel classification system for patients with recurrent patellar subluxation and excessive femoral torsion based on segmental femoral torsion analysis was established. DDFO was more appropriate for patients with proximal torsion, yielding higher surgical correction angle, and better clinical and radiological outcomes. Study design: Cohort study; Level of evidence, 3. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the effect of thumb metacarpal osteotomy on dorsal subluxation of the carpometacarpal (CMC) joint and compare the effects of early and advanced osteoarthritis (OA). Methods: We retrospectively reviewed 42 thumbs of 37 patients who underwent metacarpal osteotomy with a postoperative extension angle of 90° or more between January 2018 and October 2021 and were followed up for more than 2 years. The thumbs were classified into two groups: early OA (Eaton stage I or II) and advanced OA (Eaton stage III). We measured the reduction ratio, which was defined as the ratio of improvement in dorsal subluxation, at 3 months and 1 year postoperatively, and at the latest follow-up. We statistically compared the reduction ratio between the two groups and investigated the factors affecting the reduction ratio using correlation analysis. Results: The reduction ratio was significantly higher in the early OA group than in the advanced OA group at 3 months after surgery, whereas no significant difference was found between the two groups at 1 year after surgery and at the latest follow-up. A significant positive correlation was detected between the reduction ratio and the postoperative extension angle. Conclusions: First metacarpal osteotomy reduces dorsal subluxation in both early- and advanced-stage CMC OA. This procedure yields immediate marked reduction in early-stage OA, while improvement of the subluxation progressed gradually in advanced-stage OA. Level of Evidence: Level IV (Therapeutic) [ABSTRACT FROM AUTHOR]

Background: Somatosensory tinnitus (ST) is associated with activation of the auditory pathway by trigeminal or cervical afferents. Objective: This is a cross‐sectional observational study that aims to verify the association of ST with TMD, bruxism, migraine and psychosocial aspects. Methods: This study was conducted at the Tinnitus Outpatient Clinic of the Clinical Hospital Complex of the Federal University of Paraná. Specific ST characteristics, were evaluated according to the last consensus for the diagnosis of ST. Two groups with 39 individuals each one were formed, the ST group (STG) and the comparison group (CG). TMD was classified according to the Diagnostic Criteria for Temporomandibular Disorders and migraine by the International Classification of Headaches. The presence of probable sleep and awake bruxism was associated with individual's reports and clinical inspections. The applied questionnaires investigated oral behaviours (OB), sleep quality (SQ), psychosocial aspects (PA), central sensitization (CS), tinnitus impact on quality of life (TIQF), and graded chronic pain scale (GCPS). Results: The STG showed a significant association with modulation manoeuvres and trigger points; myalgias and arthralgia; disc displacement with and without reduction; subluxation; bruxism; and presence of migraine. For the same group, we found a significant association with OB, PA, CS, TIQF and GCPS. There was no significant difference between groups regarding SQ. Conclusion: There is a significant association between the presence of ST and the occurrence of TMD, probable sleep and awake bruxism, and migraine. There is also a greater impairment of OB, PA, CS and TIQF. [ABSTRACT FROM AUTHOR]

The extensor carpi ulnaris (ECU) is primarily responsible for extension and ulnar deviation at the wrist. Secondary to repetitive loading of, or acute trauma to the flexed, supinated and ulnarly deviated wrist, the ECU tendon can be a common source of ulnar-sided wrist pain. Common pathology includes ECU tendinopathy, tenosynovitis, tendon instability, and tendon rupture. Extensor carpi ulnaris pathology commonly occurs in athletes and patients with inflammatory arthritis. Given the multitude of available methods to treat ECU tendon pathology, the aim of our study was to outline operative management of ECU tendon pathology, with emphasis on reviewing techniques for addressing ECU instability. We acknowledge a continuing debate between anatomical and nonanatomical techniques for ECU subsheath reconstruction. However, use of a portion of the extensor retinaculum for nonanatomical reconstruction is commonly used and demonstrates successful outcomes. Future comparative studies on ECU fixation are required to increase data on patient outcomes, to further define and standardize these techniques. [ABSTRACT FROM AUTHOR]

Background: Medial patellofemoral ligament (MPFL) reconstruction is a commonly employed surgical approach for recurrent patellar dislocation. However, the impact of elevated body mass index (BMI) on postoperative complication rates remains controversial. Purpose: To compare the clinical, radiographic, and functional outcomes of patients with normal BMI (18.5-24.9 kg/m2) and those with elevated BMI (≥25 kg/m2) who underwent MPFL reconstruction for recurrent acquired lateral traumatic patellar dislocation. Study Design: Cohort Study; Level of evidence, 3. Methods: A total of 70 patients who underwent MPFL reconstruction for recurrent patellar dislocation were included in this study. Patients with recurrent patellar dislocation were categorized into 2 groups based on their BMI: the normal BMI group and the elevated BMI group. Functional scores (Lysholm, International Knee Documentation Committee [IKDC], Tegner, and Kujala scores) and radiological measurements (patellar tilt angle, patellofemoral trochlear congruence, lateral patellofemoral angle, and lateral patellar displacement) were evaluated both preoperatively and at the last follow-up. The occurrence of postoperative complications at the last follow-up was also recorded. Differences in functional scores and radiological parameters before and after surgery were analyzed with paired-samples t tests or Wilcoxon signed-rank tests. Comparisons between groups were conducted using independent-samples t tests or the Kolmogorov-Smirnov test. Results: In the normal BMI group, there were 13 male patients and 27 female patients, with a mean follow-up duration of 26.15 ± 13.16 months. The mean age in this group was 21.93 ± 7.94 years. The elevated BMI group consisted of 12 male patients and 18 female patients, with a mean follow-up duration of 27.50 ± 15.79 months and a mean age of 23.30 ± 8.43 years. At the final follow-up, the incidence of surgical failure (patellar redislocation or subluxation and necessitating secondary surgery) was significantly higher in the elevated BMI group (6 out of 30 patients; 20.0%) compared with the normal BMI group (1 out of 40 patients; 2.5%) (P <.05). Both groups demonstrated significant improvement in postoperative Lysholm, IKDC, Tegner, and Kujala scores compared with the preoperative period (P <.05). Notably, the normal BMI group had significantly higher preoperative Lysholm and Tegner scores compared with the elevated BMI group (P <.05). Furthermore, the elevated BMI group exhibited less improvement in Tegner and Kujala scores compared with the normal BMI group (P <.05). Postoperative radiological parameters in both groups returned to the normal range (P <.05). There were no statistically significant differences between the 2 groups in terms of radiological parameters and their corresponding differences. Conclusion: Our study demonstrated statistically significant increases in postoperative clinical scores for both groups, although the intergroup differences varied. Specifically, patients with elevated BMI demonstrated poorer preoperative Lysholm and Tegner scores. The postoperative improvement in radiological parameters was equally good between the 2 groups. [ABSTRACT FROM AUTHOR]

Category: Hindfoot; Other Introduction/Purpose: The Evans osteotomy is a lateral column lengthening procedure of the calcaneus that is commonly used in the correction of flexible flatfoot deformities. Currently, there is no consensus on whether fixation is necessary when performing this osteotomy. The primary aim of this study was to determine the nonunion rate of an unfixed Evans osteotomy with use of an allograft wedge performed in patients undergoing flexible flatfoot reconstruction. The secondary aim was to report on the incidence and magnitude of calcaneocuboid (CC) joint subluxation. Methods: a retrospective chart review was done for a consecutive series of 145 feet in 137 patients who underwent Evans osteotomy as part of a flatfoot reconstruction with allogenic bone graft between January 2013 and October 2017, by a single fellowship-trained foot and ankle surgeon. Of those, 118 cases were available for analysis at a mean follow up of 62.5 weeks (SD 56.9). No fixation was used in any case. Time to union, estimated by clinical and plane radiographic evaluation was recorded, along with standard measures of deformity correction and CC joint subluxation. Results: There was only one nonunion 1/118 (0.84%) at final follow up. The mean time to union was 10.9 weeks (SD 1.56). Postoperative calcaneocuboid joint subluxation occurred in 50.8% of feet, with a mean of 1.51 mm, SD 2.3 mm and no correlation with wedge size (r=0.05, p=0.55). The mean wedge size was 7.1 mm, SD 1.4 mm (range, 5-12 mm). There was no correlation between wedge size and change in lateral column length (r=0.13, p=0.16). There was significant change between pre and postoperative calcaneal pitch, talonavicular uncoverage percentage, anteroposterior and lateral talo-first metatarsal angle, medial and lateral column height, and lateral column length (p < 0.05). Conclusion: Evans osteotomy without fixation for symptomatic flatfoot deformity resulted in an exceptionally low nonunion rate. CC joint subluxation occurred frequently but was small in magnitude, a finding that may be related to the relatively small size of the wedges used. [ABSTRACT FROM AUTHOR]

Background: A 27-year-old postnatal female presented with musculoskeletal pain, but on examination was found to also have migraines, problems with memory, energy and focus, anxiety, low energy and difficulty sleeping. She reported waking up feeling stiff, sore and unrested. Intervention: The patient was placed on a twelve-week care plan during which time she was checked and adjusted twice a week and adjusted using a Torque Release Technique analysis while vertebral subluxation correction was performed utilising an Integrator Instrument Assisted, manual methods (HVLA), SOT pelvic blocking, pelvic drop table drop piece and a toggle board techniques. Outcomes: The patient reported significant improvement outcomes across all measures, especially quality and quantity of sleep, focus, anxiety, and ability to handle stress. This was concomitant with a complete resolution of migraines and neck pain, and a significant reduction in headache and other musculoskeletal pain. Conclusion: Assisting new mothers in regaining adaptability postpartum may be a significant aspect of chiropractic care. An aspect of subluxation during this time may include poor sleep quality and quantity, which may impact other areas of life, including migraine, headache, energy, focus and mental health. [ABSTRACT FROM AUTHOR]

Background: Disordered and inadequate sleep is a growing public health concern. One of the most common sleep disorders is obstructive sleep apnoea, a condition that interrupts sleep through multiple episodes of airway collapse and subsequent decrease in oxygen saturation. With many of the treatments being invasive and the outcomes unreliable, there is a significant need for alternative and effective management options for individuals with OSA. The following case report details the effective management of obstructive sleep apnea in a young adult with chronic pain from previous injuries, with Chiropractic care. Intervention: The patient underwent a course of Chiropractic care during which he was adjusted two to three times per week using full spine adjusting, Diversified Technique with manual adjusting. Outcomes: At the completion of his care plan, his CPAP machine reported a 50% decrease in his apnea episodes, and his sleep quality had increased significantly. This was accompanied by notable increases in spinal range of motion tests, resolution of his cervical syndrome, and a decrease in musculoskeletal pain. Conclusion: This case report indicates that Chiropractic care may be useful in managing sleep apnea, but further research is required to confirm the mechanisms and strength of this effect. [ABSTRACT FROM AUTHOR]

Background: A 22-year-old female presented for Chiropractic care with chief complaints related to the frequency and severity of her epileptic episodes. These were severe and life-interrupting, preventing her from engaging in educational, social, employment or exercise activities, and ordinary care including pharmaceutical interventions had not solved this problem. Intervention: The patient was placed on an initial care plan of three visits per week and then adjusted down as per her nervous system's ability to adapt. During this time she was adjusted using the Torque Release Technique and was advised to use a Denneroll posture correction device at home. Outcomes: The patient's seizures ceased, allowing her to engage in exercise, and social activities and, thanks to increased mental clarity, begin searching for employment. Conclusion: In this case, Chiropractic care was the only change to the patient's care regime, and we suggest that Chiropractic care is associated with the cessation of her seizures. [ABSTRACT FROM AUTHOR]

Narrative: Here I continue my presentation of an overview of sacral listings conceptualised by Gonstead. I provide the clinical rationale for listings of the sacral base which have clinical utility for sacral adjusting. In particular I address the 'base anterior' listing. These additional concepts take into account developmental anomalies such as lumbarisation and sacralisation. [ABSTRACT FROM AUTHOR]

Narrative: This paper presents meticulous clinical instruction on the advanced-level diagnosis and treatment of presentations involving the cranial ventricles through highly targeted cranial adjusting. The importance and clinical relevance of the Shimizu reflex is demonstrated along with impeccable approaches to relevant head and neck musculature. The technique of choice is the NeuroImpulse Protocol,™ a low force and gentle technique which is specific in its application. Throughout the text, important clinical points are highlighted. This paper is taken from Module 9 of the NeuroImpulse learning materials© and manual and provides the busy practitioner with a clean and tidy clinical approach to cranial adjusting in the young. [ABSTRACT FROM AUTHOR]

Context: This paper further examines the idea of subluxation as it is used commonly within conventional Chiropractic practice and builds on previous papers in which I identify the majority of Chiropractors as realists who describe clinical subluxation using fuzzy dialogue and achieve successful clinical outcomes through patient interdependency. Here I show how consideration of an aspect of Quantum Mechanics can resolve technical issues, namely the absence of physical dimensions, regarding the identification of subluxation. Discussion: Our minds will accept as reality something for which our senses receive inputs which can be matched to a mental model. I propose that Chiropractors should forget the idea of Newtonian science which demands agreement to confirm something exists and instead accept that as a clinical lesion subluxation is ethereal and will exist when and where a trained Chiropractor finds clinical evidence to say it exists. The idea of superposition from Quantum Mechanics allows two Chiropractors to identify a subluxation in one patient's spine in different locations yet still render effective clinical intervention. Conclusion: The discipline of Chiropractic deserves better than an unethical flat-earth argument against 'life force, innate intelligence, vitalism and subluxation' in a world where our rhetoric should be moving into the realm of Quantum entanglement and the commentariat should be working harder to make sense of Chiropractic's clinical realities in a way that will advance and not retard the discipline. I find Quantum Mechanics to allow such forward thinking. I propose Chiropractors should start thinking of subluxation as a quantum thing with all the questionable dimensions that a quantum thing carries. [ABSTRACT FROM AUTHOR]

Introduction Total knee arthroplasty (TKA) is the most effective treatment of late osteoarthritis (OA) and is considered among the most successful surgical procedures in general. However, about 20% of patients remain dissatisfied. An important aspect of TKA is the proper choice of implant type – posterior stabilized (PS) or cruciate retaining (CR). Both have their indications for use based on intraoperative functional examination, but no objective radiological criteria have yet been developed. The aim of this study was to investigate the relationship between the posterior subluxation of the tibia on preoperative radiograms and implant type used. Material and methods A series of 52 patients undergoing TKA were included in the study. All patients were over 50 years old, had clinically and radiologically confirmed primary OA of grade IV on the Kellgren-Lawrence scale and were undergoing a primary total knee replacement (TKR) with a PS or CR design. Preoperative lateral radiographs were analysed retrospectively. The tibial translation ratio was calculated as a percentage of subluxation in the length of the tibial plateau. Results There were no significant differences between implant types in regard to investigated parameters. However, there was a significant difference between the groups CR and PS in regard to age (68.5 [60.0–72.0] vs. 72.5 [68.0–75.0], p = 0.006). Conclusions This study revealed that preoperative tibial translation does not significantly correlate with the choice of implant type and so probably not with posterior cruciate ligament (PCL) function and efficiency either. Additionally, this study showed that PCL insufficiency is related to the age of the patients, because of the more frequent choice of the PS implant type for the surgery in older patients than in the case of the CR implant type.

Bow Hunter's syndrome (BHS) is a very rare condition in which there is rotational vertebral artery (VA) insufficiency. The association of BHS with rotational atlantoaxial instability is extremely rare. We are reporting a case of pediatric BHS who presented with features of VA insufficiency on neck rotation. Careful evaluation revealed rotational C1-C2 instability. Provocative digital subtraction angiography and dynamic neck computed tomography were the mainstay of our diagnostic armamentarium. Our case emphasizes the fact that VA abnormalities need special consideration in young patients with craniovertebral junction instability and a high degree of suspicion is necessary in most instances for accurate diagnosis. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the short- and medium-term outcomes of hip dislocation in infants who failed Pavlik harness therapy and were subsequently treated with brace, closed reduction (CR) or open reduction (OR) before 6 months of age. Methods: Fifty infants (66 hip dislocations) who failed Pavlik harness therapy between 2000 and 2018 and were treated with a rigid abduction brace or undergoing a CR or OR/cast were evaluated. All demographic data obtained from the medical system, developments and complications during the follow-up and treatment process were recorded and evaluated. Results: Fifty infants (66 hips) with dislocated hips failed Pavlik harness therapy. Of these, 9 infants (12 hips) underwent rigid abduction splint therapy: 9 hips were successful, 2 hips had CR and 1 had OR. Thirty-eight infants (51 hips) had index CR, of which 3 (3 hips) failed and had OR. Radiographs of 49 hips (44 patients) were normal at the final evaluation. Pavlik harness therapy starting after 3 weeks (P = 0.028) and unilateral dislocations (P = 0.028) increased the risk of needing operating room. There was an association between OR and avascular necrosis (P = 0.025), but not between OR and other complications—dysplasia and re-dislocation/subluxation (P = 0.257 and P = 0.508, respectively). Conclusion: Closed treatment of hip dislocation is possible in most babies who fail Pavlik treatment. Babies who are started on Pavlik therapy after 3 weeks of age may be at increased risk of needing an operating room. Level of Evidence: IV. [ABSTRACT FROM AUTHOR]

A male, Division II collegiate football player presented with an extracondylar lateral patellar dislocation with inversion of the patella on its vertical axis following impact with the ground on the medial side. The patient was sedated for closed patellar reduction. He returned to full participation after 6 weeks of a progressive strength program. Extracondylar patellar inversion is not often associated with severe force or a direct blow, but the case described occurred after a high-impact tackle to the ground. This is also the only published case of a collegiate athlete returning to collision sport after sustaining an inverted extracondylar patellar dislocation. Despite the deformity and emergent nature of an inverted patellar dislocation, having patients complete early mobilization activities, including range of motion, and aggressive strengthening and functional progressions may facilitate a quick and safe return to highly intensive and competitive physical activity. [ABSTRACT FROM AUTHOR]

The article presents a study on a primary care practice situated in Yorkshire, England with the aim of reviewing the management of traumatic dental injuries (TDI) within the practice. Topics discussed include the materials and methods used in the study, findings on the dentists' confidence in managing TDIs, and the introduction of a combination of staff training and practice measures to the practice.

This study presents a detailed case analysis of a 40-year-old male patient with hemophilia A and severe chronic elbow arthropathy, exploring the surgical challenges and outcomes within the context of the current literature. The patient, with a history of multiple comorbidities including Hodgkin's lymphoma and cardiomyopathy, exhibited significant joint damage and functional impairment. A comprehensive approach was employed, collecting all relevant clinical data, including radiographic and MRI findings, to inform treatment decisions. Clinical findings and treatment decisions are presented as they occurred in real time, simulating the clinical reasoning process. Subsequent references to the clinical and instrumental findings as well therapeutic interventions are discussed in light of the current literature to reinforce the decision-making framework. This report underscores the importance of multidisciplinary care in optimizing patient outcomes and contributes to the ongoing discourse on the management of advanced musculoskeletal conditions in hemophilic patients. The findings emphasize the necessity for early intervention and specialized care to mitigate complications and improve long-term prognosis. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Level of Evidence The purpose of this study is to investigate whether increased anterior tibial subluxation (ATS) and differences between ATS in the lateral and medial compartments (ATSL−M) are associated with primary anterior cruciate ligament (ACL) reconstruction (ACLR) failure.PubMed, Scopus, Embase and Web of Science were systematically searched from their inception through 21 November 2023. The focus was on comparative studies reporting ATS in patients who experienced primary ACLR failure, in contrast to patients after primary ACLR with no evidence of graft failure. A random‐effects model was employed to calculate the overall standardized mean difference between the two groups.A total of eight studies involving 963 patients were included in the final review. Three studies (64 cases and 171 controls) measured ATS on radiographs. The failed ACLR group exhibited a significantly increased ATS on radiographs compared to the control group (p < 0.001). Six studies (324 cases and 488 controls) measured lateral ATS on magnetic resonance imaging and five of them (285 cases and 374 controls) also measured medial ATS. The average values of lateral and medial ATS, as well as ATSL−M, were calculated and compared between the two groups. The failed ACLR group demonstrated significantly increased lateral (p < 0.001) and medial ATS (p < 0.001), the average value of lateral and medial ATS (p < 0.001) and ATSL−M (p = 0.039) compared to the control group.Increased ATS and ATSL−M are associated with primary ACLR failure. The measurement of tibiofemoral position shows promise for its application in preoperative planning and postoperative management of ACLR.Level III. [ABSTRACT FROM AUTHOR]

Purpose: To confirm which method provides lower rate of recurrent instability and superior clinical outcomes. Method: We searched PubMed, Embase and Web of Science for the trials involving one intervention or both for patellar instability: medial patellofemoral ligament reconstruction (MPFLR) with and without tibial tubercle osteotomy (TTO). The postoperative Kujala score, Lysholm score, Tegner scores and the rate of recurrent instability (dislocation or subluxation) were analyzed as the primary clinical outcome parameters in a random or fixed effects meta-analysis. Results: In total, 43 articles met inclusion criteria after full-text review. A total of 2046 patients were analyzed. The overall mean age was 20.3 years (range, 9.5–60.0 years), with a mean follow-up time of 3.2 years (range, 1–8 years). The mean Kujala scores in MPFLR and MPFLR + TTO were 89.04 and 84.44, respectively. There was significant difference in Kujala scores between MPFLR and MPFLR + TTO (MD = 4.60, 95%CI: 1.07–8.13; P = 0.01). The mean Lysholm scores in MPFLR and MPFLR + TTO were 90.59 and 88.14, respectively. There was no significant difference in Lysholm scores between MPFLR and MPFLR + TTO (MD = 2.45, 95%CI: -3.20-8.10; P = 0.40). The mean Tegner scores in MPFLR and MPFLR + TTO were 5.30 and 4.88, respectively. There was no significant difference in Tegner scores between MPFLR and MPFLR + TTO (MD = 0.42, 95%CI: -0.39-1.23; P = 0.31). At final follow-up, the rates of recurrent instability in MPFLR and MPFLR + TTO were 3% and 4%, respectively. There was no significant difference in the rates between MPFLR and MPFLR + TTO (OR = 0.99, 95%CI: 0.96–1.02; P = 0.4848). Conclusion: MPFLR and MPFLR + TTO are effective and reliable treatments in the setting of patellofemoral instability. MPFLR seems to show a better performance in functional outcomes than MPFLR + TTO. Moreover, their rates of recurrent instability are very low, and no significant difference exists. [ABSTRACT FROM AUTHOR]

Background: Biomechanical analysis of the sagittal alignment of the lumbar spine and pelvis on radiographs is common in clinical practices including chiropractic, physical therapy, scoliosis-related thoraco-lumbo-sacral orthosis (TLSO) management, orthopedics, and neurosurgery. Of specific interest is the assessment of pelvic morphology and the relationship between angle of pelvic incidence, sacral slope, and lumbar lordosis to pain, disability, and clinical treatment of spine conditions. The current state of the literature on the reliability of common methods quantifying these parameters on radiographs is limited. Methods: The objective of this systematic review is to identify and review the available studies on the reliability of different methods of biomechanical analysis of sagittal lumbo-pelvic parameters used in clinical practice. Our review followed the recommendations of the preferred reporting items for systematic reviews and meta-analyses (PRISMA). The design of this systematic review was registered with PROSPERO (CRD42023379873). Results: The search strategy yielded a total of 2387 articles. A total of 1539 articles were screened after deduplication and exclusion by automation tools, leaving 473 full-text articles that were retrieved. After exclusion, 64 articles met the inclusion criteria. The preponderance of the evidence showed good to excellent reliability for biomechanical assessment of sagittal lumbo-pelvic spine alignment. Conclusions: The results of this systematic review of the literature show that sagittal radiographic analysis of spinal biomechanics and alignment of the human lumbo-pelvic spine is a reliable tool for aiding diagnosis and management in clinical settings. [ABSTRACT FROM AUTHOR]

It is often difficult to achieve adequate bone coverage of the cup in total hip arthroplasty in cases of severe developmental dysplasia of the hip (DDH). This study aimed to evaluate the relationship between subluxation percentage of Crowe classification and cup center‐edge (cup‐CE) angle to investigate whether subluxation percentage according to the Crowe classification is a useful indicator for cementless cup placement. Cementless cup placement was simulated in 77 women with DDH in 91 hips (Crowe I, 35 hips; Crowe II, 35 hips; and Crowe III, 21 hips) using computed tomography‐based computer simulation software. The cups were placed at the anatomic hip center (AHC) and 10‐mm high hip center (HHC). The relationship between the subluxation percentage and cup‐CE angle was evaluated using Spearman's rank correlation coefficient. In addition, the cutoff values for the subluxation percentage that satisfied a cup‐CE angle ≥0° were determined using the receiving operating characteristic curve. The cup‐CE angle was negatively correlated with the subluxation percentage in both AHC and 10‐mm HHC (correlation coefficient ρ = −0.542 [p < 0.01] and −0.704 [p < 0.01], respectively). The cutoff values for subluxation percentage that satisfied a cup‐CE angle ≥0° were 56.1% and 73.6% for AHC and 10‐mm HHC, respectively. Cementless cup placement in AHC is difficult in cases with the subluxation percentage ≥56.1%, and HHC reconstruction or femoral structural autograft technique should be considered as an alternative. Moreover, placement at 10 mm above AHC is difficult in cases with subluxation percentage ≥73.6%. [ABSTRACT FROM AUTHOR]

(1) Background: The kinematic characteristics of disc prosthesis undergoing complex motion are not well understood. Therefore, examining complex motion may provide an improved understanding of the post-operative behavior of spinal implants. (2) Methods: The aim of this study was to develop kinematic tests that simulate multiplanar motion and combined rotational–translational motion in a disc prosthesis. In this context, five generic zirconia-toughened alumina (BIOLOX®delta, CeramTec, Germany) ball and socket samples were tested in a 6 DOF spine simulator under displacement control with an axial compressive force of 100 N in five motion modes: (1) flexion–extension (FE = ± 7.5°), (2) lateral bending (LB = ± 6°), (3) combined FE-LB (4) combined FE and anteroposterior translation (AP = 3 mm), and (5) combined LB and lateral motion (3 mm). For combined rotational–translational motion, two scenarios were analyzed: excessive translational movement after sample rotation (scenario 1) and excessive translational movement during rotation (scenario 2). (3) Results: For combined FE-LB, the resultant forces and moments were higher compared to the unidirectional motion modes. For combined rotational–translational motion (scenario 1), subluxation occurred at FE = 7.5° with an incremental increase in AP translation = 1.49 ± 0.18 mm, and LB = 6° with an incremental increase of lateral translation = 2.22 ± 0.16 mm. At the subluxation point, the incremental increase in AP force and lateral force were 30.4 ± 3.14 N and 40.8 ± 2.56 N in FE and LB, respectively, compared to the forces at the same angles during unidirectional motion. For scenario 2, subluxation occurred at FE = 4.93° with an incremental increase in AP translation = 1.75 mm, and LB = 4.52° with an incremental increase in lateral translation = 1.99 mm. At the subluxation point, the incremental increase in AP force and lateral force were 39.17 N and 38.94 N in FE and LB, respectively, compared to the forces in the same angles during the unidirectional motion. (4) Conclusions: The new test protocols improved the understanding of in vivo-like behavior from in vitro testing. Simultaneous translation–rotation motion was shown to provoke subluxation at lower motion extents. Following further validation of the proposed complex motion testing, these new methods can be applied future development and characterization of spinal motion-preserving implants. [ABSTRACT FROM AUTHOR]