Tag: statistics

Jt Dis Relat Surg. 2026 Jul 23;37(3):822-837. doi: 10.52312/jdrs.2026.2951. Epub 2026 Jul 23.

ABSTRACT

OBJECTIVES: This study aims to evaluate the effects of BPC-157, synthetic thymosin beta-4 (TB-500), and their combination on Achilles tendon healing using biomechanical, histopathological, histochemical, and immunohistochemical analyses in a rat model.

MATERIALS AND METHODS: Thirty-two male Sprague-Dawley rats, each aged 12 weeks and weighing approximately 330 g, underwent standardized Achilles tendon transection and repair and were randomly assigned to four groups, with eight rats in each group: control, BPC-157 (10 µg/kg/day), TB-500 (60 µg/kg/day), and combined BPC-157 + TB-500 (BPC + TB). Treatments were administered intraperitoneally for four weeks postoperatively. At four weeks, tendons were harvested for biomechanical testing or histological evaluation. Maximum load to failure was assessed biomechanically. Histological and histochemical analyses included hematoxylin-eosin, Masson trichrome, Alcian blue, and Sirius red staining and were evaluated using Bonar and Movin scoring systems. Expression of collagen types I and III was assessed immunohistochemically and semiquantified using H-score analysis.

RESULTS: Biomechanical testing revealed higher maximum load to failure values in the BPC-157 and TB-500 groups compared to controls, reaching statistical significance in the TB-500 group (p < 0.05). Histopathological evaluation demonstrated significantly lower total Bonar scores in the TB-500 group (p = 0.016) and significantly lower total Movin scores in the TB-500 and BPC + TB groups (p = 0.017 and p = 0.040, respectively) relative to controls, indicating improved tendon architecture, collagen alignment, and reduced degenerative changes. The BPC-157 group showed numerically lower scores without reaching statistical significance for total scores. Sirius red birefringence analysis showed increased type I collagen organization and altered type III collagen distribution in treatment groups, particularly in the TB-500 group, suggesting progression toward matrix maturation. Immunohistochemical analysis revealed no significant differences in collagen type I expression among groups, whereas collagen type III expression differed significantly, consistent with histochemical findings. Combined BPC-157 and TB-500 treatment did not confer additional benefits compared to either agent alone.

CONCLUSION: In this exploratory rat model study, both BPC-157 and TB-500 were associated with improved histopathological parameters and extracellular matrix organization during early Achilles tendon repair, with TB-500 additionally demonstrating a significant biomechanical advantage at four weeks. The absence of additive effects with combination therapy may reflect convergence on shared downstream pathways; however, this hypothesis requires further experimental confirmation. These preliminary findings indicate that both peptides warrant further investigation as candidate adjuncts to tendon repair, pending dose-optimization and longer-term studies.

PMID:42542926 | DOI:10.52312/jdrs.2026.2951

Jt Dis Relat Surg. 2026 Jun 12;37(3):785-799. doi: 10.52312/jdrs.2026.2795. Epub 2026 Jun 12.

ABSTRACT

OBJECTIVES: This study aims to evaluate the dose-dependent protective effects of punicalagin (PUN) in a rat model of Steroid-induced osteonecrosis of the femoral head (SONFH).

MATERIALS AND METHODS: Twenty-four male Wistar albino rats were randomly assigned to four groups (n = 6 per group): control, osteonecrosis (ON), ON treated with 10 mg/kg PUN, and ON treated with 40 mg/kg PUN. Osteonecrosis was induced using lipopolysaccharide and methylprednisolone. Femoral heads were evaluated using micro-computed tomography (CT), histopathological examination, and immunohistochemical analysis of cleaved caspase-3. Serum oxidative stress and antioxidant parameters including malondialdehyde (MDA), reduced glutathione (GSH), superoxide dismutase (SOD), and catalase (CAT) were measured.

RESULTS: The primary outcome measure, the percentage of empty lacunae, was significantly higher in the ON group compared to controls (p = 0.01), showing a numerical reduction in the 40 mg/kg PUN group. Histopathological evaluation demonstrated a significant reduction in pyknotic cells in the high-dose PUN group compared to the ON group (p < 0.05). Furthermore, PUN treatment reduced the incidence of osteonecrosis (2/6 vs. 6/6; p < 0.01) and improved trabecular architecture. Immunohistochemical analysis showed decreased caspase-3 expression specifically in trabecular bone and adipocytes in the high-dose PUN group (p < 0.01), while downward trends were observed in bone marrow and endothelial cells. Micro-CT analysis confirmed a significant reduction in bone mineral density in the ON group compared to controls (p = 0.02). Regarding oxidative stress, although no statistically significant differences were observed, numerical trends toward reduced lipid peroxidation (p = 0.61) and a strong trend toward enhanced antioxidant capacity (GSH; p = 0.07) with a moderate-to-large effect size were noted.

CONCLUSION: Punicalagin may exert dose-dependent protective effects against SONFH in rats, primarily associated with reduced apoptotic activity and partial preservation of bone microarchitecture. While systemic oxidative stress markers show numerical improvements, the marked reduction in osteocyte apoptosis and necrotic incidence suggests that PUN represents a promising adjunctive strategy for mitigating steroid-related bone injury.

PMID:42542923 | DOI:10.52312/jdrs.2026.2795

Jt Dis Relat Surg. 2026 May 4;37(3):777-784. doi: 10.52312/jdrs.2026.2927. Epub 2026 May 4.

ABSTRACT

OBJECTIVES: In this study, we aimed to compare the clinical and radiological outcomes of patients undergoing arthrodesis and trapeziectomy with ligament reconstruction and tendon interposition (T + LRTI) for thumb carpometacarpal (CMC) osteoarthritis and to investigate whether patient-specific decision-making could offer advantages over LRTI or arthrodesis as a surgical approach.

PATIENTS AND METHODS: Between August 2014 and January 2025, a total of 40 patients who underwent surgical treatment for thumb CMC osteoarthritis were retrospectively analyzed. The patients were divided into two groups as the T + LRTI group (n = 22) and arthrodesis group (n = 18). Clinical outcomes were assessed using the Visual Analog Scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), grip strength (kg), and pinch strength (kg) measurements.

RESULTS: Of the patients, 7 were male and 33 were female with a mean age of 62.9 ± 6.5 years in T + LRTI group, 60.1 ± 7.4 years in arthrodesis group (range, 40 to 75 years). Both groups demonstrated significant improvement in VAS and QuickDASH scores postoperatively (p < 0.001). The mean postoperative VAS scores were 2.7 ± 2.0 in the T + LRTI group and 1.9 ± 0.9 in the arthrodesis group (p = 0.267), while QuickDASH scores were 26.4 ± 17.3 and 19.1 ± 3.2, respectively (p = 0.085). No significant differences were observed in grip strength (p = 0.358), palmar pinch (p = 0.104) and key pinch strength (p = 0.097) between the groups. The overall complication rate was 12.5% in both groups, indicating no statistically significant difference (p = 0.642).

CONCLUSION: Our study results suggest that both T + LRTI and arthrodesis provide effective and comparable pain relief and functional outcomes in the surgical management of thumb CMC osteoarthritis and can be considered reliable surgical options.

PMID:42542922 | DOI:10.52312/jdrs.2026.2927

Jt Dis Relat Surg. 2026 Jul 23;37(3):768-776. doi: 10.52312/jdrs.2026.2776. Epub 2026 Jul 23.

ABSTRACT

OBJECTIVES: This study aims to evaluate the effects of medial openwedge high tibial osteotomy (OWHTO) on gait analysis outcomes in patients with medial compartment osteoarthritis and varus alignment of the knee.

PATIENTS AND METHODS: This prospective, observational study included a total of 22 patients who underwent biplanar medial OWHTO between February 2023 and March 2024 were included. Gait analysis was performed preoperatively and at the sixth postoperative month using the DIERS formetric 4D system. Early postoperative (6 months) gait parameters, angular parameters (tibial slope and correction angle), and joint kinematics were evaluated. Patient-reported outcomes were obtained using the Oxford Knee Score (OKS) to assess pain and physical function before and after the procedure.

RESULTS: Of a total of 22 patients included in the study, 4 were male and 18 were female with a mean age of 55.41 ± 5.86 (range, 47 to 63) years. Postoperatively, patients’ walking speed (0.83 ± 1.12 m/s), step length (0.58 ± 0.73 m), and cadence (82.72 ± 92.05 steps/min) increased significantly (p < 0.001). The tibial slope angle showed a mean increase of 1.93° (p < 0.001). The mean correction angle was 7.53°. The mean knee flexion increased significantly from 35.05° ± 8.74° preoperatively to 52.96° ± 13.21° postoperatively (p < 0.001). Knee extension improved minimally but significantly from -7.55° ± 1.18° to -6.03° ± 0.05° (p = 0.046). Ankle dorsiflexion increased significantly (p < 0.001), whereas changes in plantar flexion were not statistically significant. The OKS score increased significantly from 18.30 preoperatively to 41.50 at the sixth postoperative month (p < 0.001).

CONCLUSION: Medial OWHTO results in early improvements in walking speed, step length, and cadence, as well as enhanced knee flexion kinematics and patient-reported outcomes. These findings indicate that OWHTO is an effective surgical option contributing to the improvement of gait patterns in the early postoperative period.

PMID:42542921 | DOI:10.52312/jdrs.2026.2776

Jt Dis Relat Surg. 2026 Jul 13;37(3):756-767. doi: 10.52312/jdrs.2026.2866. Epub 2026 Jul 13.

ABSTRACT

OBJECTIVES: This study aims to evaluate the clinical and objective biomechanical outcomes at a minimum 10-year follow-up following open double-Tajima repair combined with a structured functional loading protocol.

PATIENTS AND METHODS: Between January 2011 and December 2014, a total of 47 consecutive non-competitive adults (Tegner Activity Scale ≤ 4) with acute unilateral Achilles tendon rupture treated with open double-Tajima repair and an eight-week functional loading protocol were included in this retrospective cohort study. The primary outcome was the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Secondary outcomes included isokinetic dynamometry (peak torque at 30°/s and total work at 120°/s for plantar flexion and dorsiflexion), joint position sense, and ankle/calf circumference. Between-limb comparisons were performed.

RESULTS: Of the patients, 35 were male and 12 were female with a mean age at the time of surgery of 36.7 ± 6.6 (range, 22 to 55) years. The mean follow-up was 132.4 ± 13.5 (range, 120 to 168) months. The rupture involved the dominant limb in 29 patients (61.7%) and the non-dominant limb in 18 patients (38.3%). The primary outcome (AOFAS score) showed no statistically significant between-limb difference: the median score was 91.0 (IQR, 91.0 to 93.0) on the operated limb versus 93.0 (IQR, 91.0 to 93.0) on the contralateral limb (median difference: 0.00 points; 95% confidence interval [CI]: -1.00 to 1.00; p = 0.92). No statistically significant between-limb differences were detected across the secondary outcomes, including peak torque at 30°/s, total work at 120°/s, joint position sense, and ankle/calf circumference (p ≥ 0.09 for all). The complication rate was 4.3% (2/47): one partial rerupture managed conservatively and one superficial wound infection treated with oral antibiotics. No complete reruptures were observed.

CONCLUSION: Open double-Tajima repair combined with a structured functional loading protocol seems to be associated with clinically acceptable long-term outcomes in this cohort of non-competitive adults. However, given the retrospective, single-cohort design without an independent comparison group or formal equivalence framework, these findings should be interpreted as descriptive long-term observations.

PMID:42542920 | DOI:10.52312/jdrs.2026.2866

Jt Dis Relat Surg. 2026 Jul 24;37(3):714-722. doi: 10.52312/jdrs.2026.2784. Epub 2026 Jul 24.

ABSTRACT

OBJECTIVES: This study aims to evaluate the reliability of cervical vertebral maturation (CVM) staging in determining skeletal maturity in patients with adolescent idiopathic scoliosis (AIS), focusing on the effect of professional experience among orthopedic surgeons.

PATIENTS AND METHODS: Between January 2023 and January 2025, this reliability and agreement study included a total of 72 patients aged between nine and 16 years who were diagnosed with AIS. Intra- and inter-rater reliability were analyzed using weighted kappa (κ) statistics with standard errors (SEs) and 95% confidence intervals (CIs). A total of 72 full-spine lateral radiographs were independently assessed by 10 raters with varying levels of orthopedic expertise, including medical students, residents, consultants, and spinal surgeons. None of the raters had prior experience with the CVM classification. Each rater performed CVM staging twice with a four-week interval between assessments.

RESULTS: Of the patients, 33 were male and 39 were female with a mean age of 13.07 ± 1.97 (range, 9 to 16) years. Overall intra-rater reliability was substantial (κ = 0.64, SE = 0.032, 95% CI: 0.569-0.714), and overall inter-rater reliability was moderate (κ = 0.52). Although spinal surgeons showed slightly higher intra-rater reliability overall, inter-rater reliability declined between assessments (first assessment κ = 0.61 vs. second assessment κ = 0.34). Consultants exhibited the highest inter-rater agreement (κ = 0.62), whereas residents showed improvement between assessments (κ = 0.40 vs. 0.52); however, no significant difference observed between groups.

CONCLUSION: The reliability of CVM staging for assessing skeletal maturity in AIS patients does not significantly differ across levels of orthopedic expertise. While CVM staging has potential as a radiation-sparing method, the overall moderate agreement, particularly among physicians without prior experience, indicates that reliability is not significantly influenced by professional experience.

PMID:42542916 | DOI:10.52312/jdrs.2026.2784

Jt Dis Relat Surg. 2026 Jul 13;37(3):705-713. doi: 10.52312/jdrs.2026.2698. Epub 2026 Jul 13.

ABSTRACT

OBJECTIVES: This study aims to evaluate the mid-term clinical and functional outcomes of juxta-epiphyseal fractures of the proximal phalanx in pediatric patients.

PATIENTS AND METHODS: Between July 2013 and December 2023, a total of 23 pediatric patients treated for juxta-epiphyseal fractures of the proximal phalanx were retrospectively analyzed. Functional outcomes were assessed using four subtests of the Jebsen-Taylor Hand Function Test. To compare the Jebsen-Taylor Hand Function Test, a control group of healthy children (n = 23) from the outpatient clinic was formed. Patients were treated either with closed reduction and splinting or with closed reduction followed by Kirschner wire (K-wire) fixation according to fracture displacement and stability. Radiographs were evaluated for residual deformity and malunion using Campbell’s lines.

RESULTS: Of a total of 23 patients, 13 were male and 10 were female with a mean age of 7.24 ± 2.21 (range, 6 to 13) years. The fifth digit was the most commonly affected (n = 14), followed by the fourth (n = 5), middle (n = 2), and thumb (n = 2). In 15 patients, the injury occurred on the non-dominant hand. No malunions were detected. One patient demonstrated a pseudo-claw deformity. Hand function tests revealed statistically significant delays in patients with dominant-hand injuries compared to healthy controls (p < 0.05). Seven patients reported a change in hand dominance after injury.

CONCLUSION: Our study results suggest that appropriate reduction techniques, including closed or K-wire-assisted fixation, offer favorable outcomes with minimal complications. However, functional impairment can be more notable, when the dominant hand is involved. Taken together, these findings emphasize the need for early intervention, close follow-up, and consideration of hand dominance during recovery planning.

PMID:42542915 | DOI:10.52312/jdrs.2026.2698

Jt Dis Relat Surg. 2026 Jun 17;37(3):688-696. doi: 10.52312/jdrs.2026.2570. Epub 2026 Jun 17.

ABSTRACT

OBJECTIVES: This study aims to compare the biomechanical performance of three different surgical fixation techniques in the treatment of proximal humerus fractures with medial metaphyseal defects.

MATERIALS AND METHODS: A total of 24 synthetic humerus bone models were used and equally divided into three groups (n = 8 per group). A standardized unstable proximal humerus fracture model with a medial metaphyseal cortical defect extending to the surgical neck was created using a three-dimensional (3D)-printed osteotomy guide. Group 1 received fixation with a lateral anatomical locking plate. Group 2 was treated with a combination of a lateral anatomical plate and a medial buttress plate (dual plating). Group 3 underwent fixation with an intramedullary nail (IMN); in this group, four specimens had distal locking with an endopin (Group 3a), and the other four with static screws (Group 3b). All specimens were subjected to axial loading until failure. Forces at the onset of failure and complete failure were recorded, and fracture patterns were documented.

RESULTS: In Groups 1 and 2, transverse fractures consistently occurred at the level of the most distal screw of the lateral plate. In Group 3, failure was observed either proximally or distally at the nail tip, including butterfly fragment formation and metaphyseal collapse. Group 2 exhibited the highest resistance to axial loading, followed by Group 1 and Group 3, with statistically significant differences between all groups (p = 0.043, p = 0.0003, p < 0.00001). No significant difference was found between subgroups 3a and 3b (p > 0.05).

CONCLUSION: Our study results indicate that double plating provides the greatest axial stability in proximal humerus fractures with medial metaphyseal defects, supporting its use in fracture patterns with medial column deficiency. However, as fixation choice should be guided by patient-specific factors and surgical feasibility, these findings should be interpreted in the context of experimental conditions and loading limitations.

PMID:42542913 | DOI:10.52312/jdrs.2026.2570

Jt Dis Relat Surg. 2026 May 15;37(3):649-657. doi: 10.52312/jdrs.2026.2794. Epub 2026 May 15.

ABSTRACT

OBJECTIVES: This study aims to evaluate the efficacy and safety of a comprehensive, multidisciplinary perioperative blood management (PBM) protocol in patients with Hemophilia A undergoing total joint arthroplasty (TJA).

PATIENTS AND METHODS: Between December 2014 and November 2024, a total of 29 male patients (mean age: 33.38 ± 8.62 years; range, 20 to 55 years) with hemophilic arthropathy (HA), all diagnosed with Hemophilia A, who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA) were retrospectively analyzed. All patients received a standardized PBM protocol, including preoperative factor Ⅷ sensitivity testing, individualized factor replacement, restrictive fluid management, ultrasound-guided regional anesthesia, and tranexamic acid administration. Primary outcomes included total blood loss (TBL) and hemoglobin (Hb) drop. Secondary outcomes included operation time, length of hospital stay (LOS), and perioperative complications.

RESULTS: All 29 procedures were successfully completed under our PBM protocol. For the entire cohort, the median TBL was 630.52 (range, 470.95 to 939.64) mL, and the mean Hb decrease on postoperative Day 5 was -41.83 ± 22.81 g/L. The median operative time was 122.0 (range, 91.0 to 182.5) min, and the median LOS was 23.0 (range, 19.0 to 31.0) days. Simultaneous double TJA showed higher TBL and transfusion rates than single TJA, but the outcomes remained within safe clinical limits. Furthermore, THA was associated with significantly shorter operation time (p = 0.008) and lower total FⅧ consumption (p = 0.036) compared to TKA, despite similar TBL (p = 0.860). No major complications, such as inhibitor development, hemorrhage or venous thromboembolism were observed.

CONCLUSION: A standardized, multidisciplinary PBM protocol ensures surgical safety in patients with end-stage HA. Despite the underlying hemorrhagic diathesis, optimized factor replacement and comprehensive anesthetic strategies can achieve surgical outcomes comparable to the general population. These findings support the broader clinical application of comprehensive PBM for high-risk hemophilic surgical cases.

PMID:42542909 | DOI:10.52312/jdrs.2026.2794

Jt Dis Relat Surg. 2026 Jul 10;37(3):637-648. doi: 10.52312/jdrs.2026.2311. Epub 2026 Jul 10.

ABSTRACT

OBJECTIVES: This study aims to compare the efficacy of conventional rehabilitation alone, conventional rehabilitation combined with balance acupuncture (BA) and conventional rehabilitation plus BA and unconscious proprioception training in chronic ankle instability (CAI) patients.

PATIENTS AND METHODS: This single-center, parallel-group, assessor-blinded randomized-controlled trial included a total of 120 CAI patients between October 2022 and October 2024. The patients were randomly assigned to control (n = 40), BA (n = 40), and combination therapy (CT, (n = 40) groups. All groups received six weeks of intervention (6 days/week): the control group received conventional rehabilitation, the BA group received conventional rehabilitation + BA and the CT group received conventional rehabilitation + BA + unconscious proprioception training. Unconscious proprioception training was defined as dual-task training using the MOTOmed system with cognitive distraction to shift focus away from conscious movement control. Assessments were conducted before and after treatment using a three-dimensional gait analysis system, a balance function testing and training system, and the Star Excursion Balance Test (SEBT).

RESULTS: There was no statistically significant difference in age and sex among the groups (p > 0.05). In addition, disease duration and number of previous sprains were comparable among the groups (p > 0.05). Following the six-week intervention, all three groups showed significant improvements in gait parameters, balance function and SEBT scores compared to baseline (p < 0.05). The CT group exhibited significantly greater improvements in gait speed, cadence, movement length, movement ellipse area and SEBT scores than the BA group (p < 0.05), whereas the BA group outperformed the control group in all outcome measures (p < 0.05). No adverse reactions were reported in any group.

CONCLUSION: The integration of BA and unconscious proprioception training may offer additional benefits for improving gait and balance in CAI patients compared to conventional rehabilitation plus BA or conventional rehabilitation alone. Based on these preliminary findings, the combined approach shows potential clinical value for targeted populations with CAI.

PMID:42542908 | DOI:10.52312/jdrs.2026.2311