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Anterior cruciate ligament reconstruction achieved noninferior patient reported outcome measures while residual rotational instability depends on anterolateral ligament femoral tunnel position: A matched analysis

2026-03-25T03:04:27Z

Title: Anterior cruciate ligament reconstruction achieved noninferior patient reported outcome measures while residual rotational instability depends on anterolateral ligament femoral tunnel position: A matched analysis Authors: Byun, Junwoo; Jung, Min; Chung, Kwangho; Moon, Hyun-Soo; Jung, Se-Han; Kim, Sung-Hwan Abstract: Background: The efficacy of anterolateral ligament (ALL) reconstruction in low-demand patients remains unclear. Therefore, we aimed to analyse the outcomes of ALL reconstruction with anterior cruciate ligament (ACL) reconstruction in low-demand patients. Methods: Patients who underwent arthroscopic ACL reconstruction using the transportal technique between March 2010 and December 2022 with a minimum 2-year follow-up were retrospectively reviewed. Patients with preoperative high-grade pivot shifts (grades 2 and 3) were classified into two groups based on whether ALL reconstruction was performed. Matched cohort analysis, including noninferiority analyses for subjective and objective outcomes, was performed. Additionally, a subgroup analysis of postoperative outcomes was performed based on the position of the anterolateral ligament-femoral tunnel. Results: Twenty-nine patients were included in each group. No significant differences were found in the preoperative or postoperative variables. Patient-reported outcome measures (PROMs) met the noninferiority trial criteria, whereas the residual pivot shift did not. Subgroup analysis comparing results according to the femoral tunnel of the ALL resulted in a significantly higher proportion of patients with a residual pivot shift when the femoral tunnel was positioned anterior to the lateral epicondyle compared to posterior placement (P = 0.035 and 0.021 at 1 and 2 years postoperatively). Conclusions: ACL reconstruction without ALL reconstruction was noninferior for PROMs. However, residual rotational instability was affected by the ALL femoral tunnel position, which favours femoral tunnel posterior to the lateral epicondyle. Therefore, routine addition of ALL reconstruction in low-demand patients may not be necessary, and greater emphasis should be placed on precise ALL femoral tunnel positioning. (c) 2026 Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Risk factors and mortality for amputations in the diabetic foot: a nationwide cohort study

2026-03-31T00:52:39Z

Title: Risk factors and mortality for amputations in the diabetic foot: a nationwide cohort study Authors: Shim, Dong Woo; Lee, Wonwoo; Park, Kwang Hwan; Yoon, Yeo Kwon; Park, Minae; Park, Sojeong; Han, Seung Hwan; Lee, Jin Woo Abstract: Objective: To investigate risk factors and mortality associated with major amputations in people with diabetic foot ulcers (DFUs), and to differentiate them from minor amputations. Study design: We conducted a nationwide, retrospective longitudinal study using cohort data from the Korean National Health Insurance Service (2002-2020), including people with DFUs who underwent lower extremity amputation. People were categorized into minor and major amputation groups. Comparative analyses were conducted using variables available from health insurance data. Results: Among 40,809 people with DFU-related amputations, the major amputation group showed a higher proportion of males, older age, and lower income. Revascularization procedures and use of top-tier antibiotics were more common in the major group. Comorbidities such as end-stage renal disease (ESRD), dementia, cerebrovascular disease, and ischemic heart disease were also more frequent (P < 0.001). The major group had higher mortality (73.9 % vs. 52.2 %) and shorter survival (986 vs. 1209 days). Dementia, ESRD, and prior major amputation had the highest adjusted hazard ratios for mortality. Conclusions: Major amputation in people with DFUs is associated with advanced age, vascular disease, comorbidities, and increased mortality. In contrast, minor amputation is linked to better survival. Limb-sparing approaches may improve long-term outcomes in this high-risk population.

A Smaller Posterior Tibial Slope May Be Associated with an Increased Risk of Tears in the Anterior Horn of the Lateral Meniscus

2026-04-14T07:32:11Z

Title: A Smaller Posterior Tibial Slope May Be Associated with an Increased Risk of Tears in the Anterior Horn of the Lateral Meniscus Authors: Huh, Min-Hwan; Jung, Min; Chung, Kwangho; Moon, Hyun-Soo; Jung, Se-Han; Kim, Sungjun; Kim, Sung-Hwan Abstract: Background: While lateral meniscus anterior horn (LMAH) tears can increase peak contact pressure in the knee joint, limited research has explored the correlation between LMAH tears and posterior tibial slope (PTS), closely associated with knee joint kinematics. This study aimed to investigate the association between PTS and LMAH tears. It was hypothesized that patients with LMAH tears would exhibit lower PTS values compared to those without such tears. Methods: This study retrospectively included 35 patients with isolated LMAH tears and 83 patients with no pathological findings on magnetic resonance imaging (MRI) between January 2010 and October 2023. PTS was measured using the medial tibial plateau on lateral radiographs, while both the medial and lateral slopes were separately evaluated on MRI. Group comparisons and multi-variable logistic regression were performed, with inverse probability of treatment weighting (IPTW) applied to adjust baseline differences. Receiver operating characteristic (ROC) analysis was conducted to determine a threshold value. Tear types and treatment methods were also analyzed. Results: The mean PTS was significantly smaller in the LMAH tear group (LMAH tear group, 4.70 degrees +/- 2.16 degrees; control group, 6.58 degrees +/- 2.95 degrees, p < 0.001), while MRI-based medial PTS (LMAH tear group, 4.62 degrees +/- 2.43 degrees; control group, 4.81 degrees +/- 2.35 degrees; p = 0.702) and lateral PTS (LMAH tear group, 4.02 degrees +/- 2.24 degrees; control group, 4.78 degrees +/- 2.39 degrees; p = 0.115) showed no significant differences. In multivariable logistic regression, the adjusted odds ratio of PTS in the LMAH tear group was 0.76, indicating that for each 1 degrees decrease in PTS, the odds of an LMAH tear increased approximately 1.32 times (95% CI, 0.62-0.93; p = 0.009). After IPTW matching, mean PTS remained significantly smaller in the LMAH tear group (p = 0.006). The ROC curve analysis identified a PTS cutoff value of 4.49 degrees for distinguishing LMAH tear from controls, and PTS < 4.49 degrees was significantly associated with LMAH tear (odds ratio, 0.25; 95% CI, 0.11-0.60; p = 0.001). Tear types showed no significant differences in PTS, but treatment methods varied significantly, with repair more frequent in simple tears and meniscectomy in degenerative or complex tears. Conclusions: A smaller PTS be associated with an increased risk of LMAH tears.

C2-3 Interlaminar Bony Fusion Mitigates Long-Term Progression of Ossification of the Posterior Longitudinal Ligament Following Cervical Laminoplasty

2026-04-14T07:32:10Z

Title: C2-3 Interlaminar Bony Fusion Mitigates Long-Term Progression of Ossification of the Posterior Longitudinal Ligament Following Cervical Laminoplasty Authors: Kim, Namhoo; Suk, Kyung-Soo; Hong, Junseok; Lee, Jaenam; Park, Sub-Ri; Shin, Jae Won; Kwon, Ji-Won; Lee, Byung Ho; Park, Si-Young; Park, Jin-Oh; Moon, Seong-Hwan; Kim, Hak-Sun Abstract: Study Design Retrospective cohort study.Objectives To investigate the influence of spontaneous C2-3 interlaminar bony fusion on the long-term progression of ossification of the posterior longitudinal ligament (OPLL), and to assess its associated clinical and radiologic consequences following cervical laminoplasty.Methods Patients who underwent cervical laminoplasty for myelopathy due to multilevel OPLL involving the C2-3 level and were followed for >= 5 years were analyzed. Patients were classified according to the presence of C2-3 interlaminar fusion. OPLL progression (anteroposterior [AP] and sagittal diameters), cervical range of motion (ROM), and patient-reported outcomes were compared. Multivariable linear regression and linear mixed-effects modeling assessed the adjusted association between fusion status and OPLL progression over time, controlling for key covariates.Results Forty-nine patients met inclusion criteria. C2-3 interlaminar fusion independently predicted reduced AP (beta = -1.439, P = .0031) and sagittal (beta = -8.725, P = .0007) progression after adjustment for all confounders. Mixed-effects modeling confirmed a significantly flatter long-term progression trajectory in patients with interlaminar fusion. C2-7 ROM and patient-reported outcomes were comparable between groups.Conclusions Spontaneous C2-3 interlaminar fusion is associated with attenuation of postoperative OPLL progression without compromising overall cervical motion or clinical outcomes. These findings suggest that C2-3 interlaminar fusion may function as a stabilizing postoperative phenomenon rather than an unfavorable radiologic change following cervical laminoplasty in multilevel OPLL patients.