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Journal articleWynell-mayow W, Hall T, Singh A, et al., 2026,
Interobserver reliability of coronal plane alignment of the knee (CPAK) phenotype classification: external validation using data from the osteoarthritis initiative
, Bone & Joint Open, Vol: 6, Pages: 1425-1435, ISSN: 2633-1462AimsCoronal Plane Alignment of the Knee (CPAK) phenotyping is gaining momentum in research and clinical practice to understand individualized knee alignments and predict knee balance in total knee arthroplasty (TKA). The nine CPAK classes are based on joint line obliquity (JLO) and arithmetic hip-knee-ankle angle (aHKA), which are calculated using the medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA). This study aims to assess CPAK classification reproducibility, and analyze what level of angular error is associated with CPAK misclassification.MethodsTwo readers labelled 75 long-leg radiographs (LLRs) from the Osteoarthritis Initiative database for analyses of CPAK inter-reader reproducibility. A single reader then labelled and classified phenotypes for an aggregate total of 1,128 LLRs. Finally, Monte Carlo simulations were run based on 1,128-patient phenotype distribution and the inter-reader reproducibility statistics to understand how CPAK agreement rates were affected by the reproducibility of MPTA and LDFA measurements.ResultsThere was excellent reproducibility in MPTA and LDFA measurements (mean absolute error: 0.41°/0.71°; and intraclass correlation coefficient: 0.96°/0.91°, respectively). These small angular deviations led to one-in-five disagreement in CPAK classification (20.0%; 95% CI 10.9% to 29.1%). An aHKA mean absolute error of < 0.1°, which is potentially unattainable, would be required to reduce inter-reader CPAK disagreement to below 95%.ConclusionCPAK phenotyping from long-leg radiographs may result in clinically significant rates of misclassification. CT imaging may improve reliability, particularly in cases where aHKA and JLO are near to discriminatory values.
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Journal articleMusbahi O, al-saadawi A, Sousi S, et al., 2026,
Incidence and risk factors for post-operative myocardial infarction following hip and knee arthroplasty
, Bone & Joint Open, ISSN: 2633-1462 -
Journal articleAlagha MA, Gupta R, Jordan C, et al., 2026,
The effect of impaction energy and bone quality on cementless femoral implant fixation and femoral periprosthetic fracture risk
, Bone & Joint Research, ISSN: 2046-3758 -
Journal articleBrkljac M, Bandeira E, Shrey S, et al., 2026,
Automated impaction in uncemented total hip arthroplasty: a systematic review and meta-analysis
, Bone & Joint Open, Vol: 7, Pages: 838-844, ISSN: 2633-1462AimsIntraoperative periprosthetic femoral fractures (IPFs) are a serious complication of total hip arthroplasty (THA), typically attributed to surgical technique. Manual impaction provides tactile feedback but varies with surgeon fatigue and experience. Automated impaction systems offer consistent energy delivery, potentially improving safety and efficiency. This study aimed, through a systematic review and meta-analysis, to compare the risk of IPF and operating times between automated and manual impaction during primary uncemented THA.MethodsWe performed a systematic review and random-effects meta-analysis of primary uncemented THA studies comparing automated and manual impaction techniques. Outcomes included IPFs and operating time. Pooled odds ratios (ORs) were calculated for IPF risk, and differences in mean operating time between techniques were analyzed using mean differences with 95% CIs.ResultsComparative data were available from five studies (n = 2,607 THAs). Meta-analysis included three studies (n = 2,377), with 1,408 hips in the automated group (14 IPFs) and 969 hips in the manual group (three IPFs). There was no significant difference in IPF risk between techniques (pooled OR 1.29; 95% CI 0.52 to 3.21; p = 0.59). Operating time was reported in three studies. The pooled mean difference suggested a shorter operating time with automated impaction (−1.34 minutes; 95% CI −15.60 to 12.92; p = 0.72).ConclusionAutomated impaction was not associated with a lower risk of IPF or operating time compared with manual techniques in primary uncemented THA. Fracture risk and efficiency may instead depend on femoral component–femur compatibility and implant sizing. Further randomized studies incorporating diverse femoral component designs and automated impaction systems, alongside formal economic evaluation, are required.
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Journal articleMusbahi O, Sousi S, Al-saadawi A, et al., 2026,
Accelerometer-Measured Post-Operative Physical Activity Confers a Significant Mortality Benefit Following Joint Arthroplasty
, Bone & Joint Research, ISSN: 2046-3758 -
Journal articleGompels BD, Subramanian A, Epanomeritakis IE, et al., 2026,
The Paediatric ACL National Audit (PANA) study: a multicentre review of UK practice and adherence to BOAST guidelines.
, Knee, Vol: 60BACKGROUND: Paediatric ACL injuries are increasingly common and present significant challenges. Inappropriate treatment can lead to long-term complications like instability, growth disturbance, and osteoarthritis. The Paediatric ACL National Audit (PANA) Study assesses UK practices and adherence to Best Orthopaedic Practice (BOAST) guidelines for managing these injuries, identifying opportunities to improve care for young patients. METHODS: PANA was a collaborative audit of 22 hospitals in England, Wales, and Scotland, measuring adherence to BOAST guidelines in treating paediatric ACL injuries. Orthopaedic surgeons and trainees collected data through a secure online questionnaire about service provision for skeletally immature patients, including diagnostic imaging, rehabilitation, post-operative follow-up, and surgical techniques. RESULTS: Our analysis revealed variability in adherence to the BOAST guidelines for ACL injuries in paediatric patients, with 65% of centres using acute knee pathways and 68% utilising collaborative imaging pathways. About 59% of centres conduct radiological growth monitoring, while only 30% report functional outcomes. Less than 50% report re-rupture rates, and 74% adhere to rehabilitation protocols. CONCLUSION: The rise in ACL injuries in the paediatric population highlights the need for standardised care delivery and reporting. Following the release of the BOAST guidelines in 2022, this nationwide audit has revealed discrepancies in UK practices. A multidisciplinary approach is essential for improving patient care and outcomes by standardising and promoting best practice.
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Journal articleMorton S, Manek R, Mohammadi N, et al., 2026,
Quantification of emergency operating theatre process performance: a systematic review of clinical studies
, British Journal of Anaesthesia, Vol: 136, Pages: 1546-1567, ISSN: 0007-0912BackgroundOperating theatre performance is an essential component of healthcare resource optimisation. Because of its time-critical nature, emergency operating theatre performance is a problem distinct to that of elective surgery. Process performance can be quantified through the related terms: productivity, efficiency, and effectiveness. This systematic review examined the metrics used to quantify emergency operating theatre performance and the methodological quality of the associated literature.MethodsPubMed, ISI Web of Knowledge, and Embase were searched from inception to December 2024 using Medical Subject Headings terms relating to metric, performance, and operating theatre. Studies were reviewed independently for inclusion and quality (ROBINS-I and GRADE). Only clinical studies are presented here.ResultsIn total, 32 clinical studies were included, and 19 performance metrics were identified (six efficiency; 10 effectiveness; three productivity). The median (range) performance metrics per study was 4 (1–7). Frequently reported metrics were out-of-hours operating (19 studies; 59%), delay (17 studies; 53%), and utilisation (13 studies; 41%). Eleven (34%) studies were low quality and 21 (66%) were very low quality. Twenty-six (81%) studies used insufficient metrics, 30 (94%) studies used non-generalisable metrics, 29 (91%) studies did not quantify trade-off between metrics, and 16 (50%) studies had insufficient scope of investigation. Interventions evaluated included reallocating theatre time (eight studies; 25%), increasing emergency theatre capacity (eight studies; 25%), and instituting acute care surgery services (six studies; 19%).ConclusionsCurrently, there is no widely recognised framework to assess the quality of emergency theatre performance study designs. There is a tendency within clinical studies to focus on effectiveness rather than efficiency, potentially reflecting clinicians’ focus on patient outcome. Systematic biases that reduce evidenc
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Journal articleLeslie D, Mullington CJ, 2026,
Cost-effectiveness of a transition from volatile anaesthesia to total intravenous anaesthesia to reduce carbon footprint: an economic modelling study.
, Anaesthesia, Vol: 81, Pages: 675-684INTRODUCTION: The UK NHS is committed to reaching net zero carbon emissions by 2040. Volatile anaesthetic agents are potent greenhouse gases and alternative intravenous methods exist. We aimed to predict the cost-effectiveness of a transition from volatile anaesthesia to total intravenous anaesthesia to reduce carbon emissions. METHODS: A general anaesthetic for a 40-year-old, 78-kg patient was modelled. Two volatile anaesthetic agents (desflurane and sevoflurane) were compared with propofol-remifentanil total intravenous anaesthesia. Total intravenous anaesthesia with and without processed electroencephalography was modelled. Cost-effectiveness was calculated as the cost per kg carbon dioxide equivalent saved by transition to total intravenous anaesthesia, benchmarked against the UK emission trading scheme carbon permit price of £41.84 (US$54.90, €47.28) per tonne carbon dioxide equivalent. RESULTS: Total intravenous anaesthesia was less carbon intensive than sevoflurane and desflurane (2.0 vs. 9.8 kg and 209.2 kg carbon dioxide equivalent, respectively). Total intravenous anaesthesia was more expensive than sevoflurane when processed electroencephalography was used (£13.03 (US$17.08, €14.72) vs. £9.76 (US$12.79, €11.03)) but cheaper when it was not (£5.31 (US$6.95, €6.00) vs. £9.76 (US$12.79, €11.03)). When processed electroencephalography was used, the incremental cost-effectiveness ratio of transitioning from sevoflurane to total intravenous anaesthesia was £416 (US$544, €470) per tonne carbon dioxide equivalent. Total intravenous anaesthesia (with and without processed electroencephalography) was cheaper than desflurane (£18.94 (US$24.77, €21.41)). DISCUSSION: Using our model parameters and the different carbon dioxide emissions and similar cost, transitioning from desflurane anaesthesia to total intravenous anaesthesia is cost-effective. Transitioning from sevoflurane an
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Journal articleMaslivec A, Allott N, Guest B, et al., 2026,
Functional assessment of ceramic-on-ceramic hip resurfacing arthroplasty : improvement in gait at 12 months.
, Bone Joint J, Vol: 108-B, Pages: 447-454AIMS: A ceramic-on-ceramic hip resurfacing implant (cHRA) was developed and introduced in a Medicines and Healthcare products Regulatory Agency (MHRA)-approved clinical investigation. This study aimed to examine function and physical activity levels of patients with a cHRA implant using subjective and objective measures, both preoperatively and 12 months postoperatively. METHODS: A total of 82 unilateral cHRA patients consented to this study as part of the larger MHRA-approved clinical investigation. In addition to their patient-reported outcome measures (PROMs), self-reported measures of physical activity and gait analysis were undertaken preoperatively (median 1.7 weeks (IQR 0.6 to 4.2)) and postoperatively (median 52.1 weeks (IQR 50.0 to 53.9)). These data were then compared with data from a group of 43 age-, sex-, and BMI-matched healthy controls. Kinetics and kinematics were recorded using an instrumented treadmill and 3D motion capture. Statistical parametric mapping was used for analysis. RESULTS: cHRA improved PROMs and self-reported physical activity from preoperative levels. cHRA improved top walking speed (5.75 km/hr (SD 1.04) vs 7.27 km/hr (SD 0.71)), achieved a more symmetrical ground reaction force profile (symmetry index value: 10.6% (SD 9.4) vs 0.9% (SD 2.1)), and increased hip range of motion (31.7° (SD 6.2°) vs 45.9° (SD 5.3°)) from preoperative levels. Postoperative data were not statistically distinguishable from the healthy controls in any domain. CONCLUSION: These short-term results of cHRA appear promising, with the potential to restore a near-normal gait pattern and overall quality of life.
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Journal articleGill SS, Prashar A, Kamath AG, et al., 2026,
Artificial intelligence in anterior cruciate ligament tear diagnosis: a bibliometric analysis of the 50 most cited studies
, Indian Journal of Radiology and Imaging, Vol: 36, Pages: 151-166, ISSN: 0971-3026IntroductionSince the 2000s, artificial intelligence (AI) publications in medicine have surged, particularly in orthopaedics and radiology. A key area is the diagnosis of anterior cruciate ligament (ACL) tears, where AI enhances detection and treatment strategies. This study aims to perform a bibliometric analysis of AI in ACL tear diagnosis, identifying pivotal studies to guide future research and clinical priorities.Materials and MethodsA bibliometric analysis was conducted using the Web of Science database. The top-50 articles were ranked by citation count and analyzed for basic characteristics and research focus. Trends in diagnostic advancements and AI model utilization were also assessed.ResultsThe most cited articles, published between 2017 and 2024, peaked in 2021 (n = 13). Citation counts ranged from 7 to 401 (median: 8.5 ± 7.0). China (n = 14) and the United States (n = 13) emerged as the leading contributors. The vast majority (90%) of models were based on convolutional neural networks (CNNs), with 80% undergoing internal validation. Only 5% of the included models utilized a radiomic framework.ConclusionThis bibliometric analysis examines the growing role of AI in ACL tear diagnosis, with a marked increase in research output from 2017 to 2024. Key barriers to the adoption of AI models include algorithmic bias, data privacy, explainability, cost-effectiveness, and interoperability. The underrepresentation of radiomic-based models, despite their diagnostic potential, highlights an avenue for future research. Advancing explainable AI, strengthening validation, and establishing standardized reporting guidelines will be essential to ensure clinical integration to improve patient outcomes.KeywordsACL - AI - anterior cruciate ligament - artificial intelligenceData Availability StatementAll relevant data supporting the findings of this study can be accessed within the Supplementary Digital Content att
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Journal articleMestriner MB, Reynolds A, Barrosso BG, et al., 2026,
The Rectus Femoris Tendon as a Graft for Combined ACL and Anterolateral Reconstruction: A Biomechanical Evaluation.
, Am J Sports Med, Vol: 54, Pages: 1027-1034BACKGROUND: The rectus femoris (RF) tendon may be an option for combined anterior cruciate ligament (ACL) and anterolateral (AL) reconstruction utilizing a double-stranded (DRF) tendon for the ACL and a single-stranded tendon (SRF) for AL reinforcement; however, biomechanical data remain limited. PURPOSE/HYPOTHESIS: This study aimed to biomechanically assess the DRF for ACL reconstruction using a patellar tendon (PT) graft and the SRF for AL reconstruction using an iliotibial band (ITB) graft. The hypothesis was that the biomechanical properties of the DRF graft would not differ from those of the PT graft, and the SRF graft would not differ from the ITB graft. STUDY DESIGN: Controlled laboratory study. METHOD: Eight fresh-frozen human knees were used: 2 male and 6 female, with a mean age of 49 years (range, 36-64 years). Each knee produced 4 grafts: DRF, SRF, PT, and ITB. Each graft was mounted in a materials test machine. The cross-sectional area was measured using alginate molding. After 10 preconditioning cycles to 250 N, each specimen was extended to failure at 100 mm/min. The Friedman test assessed differences between the 4 graft types using matched samples. The Dunn multiple-comparison test was used to examine differences among graft types. RESULTS: The ultimate strengths (N) of the grafts were as follows: DRF, 1978 ± 338; SRF, 1445 ± 584; PT, 1824 ± 557; ITB, 819 ± 268 (DRF and PT >ITB; P < .01). The elastic moduli (MPa) were as follows: DRF, 272 ± 59; SRF, 617 ± 153; PT, 318 ± 90; ITB, 631 ±4 31 (DRF and PT<SRF; P < .05). The ultimate tensile stresses (MPa) were as follows: DRF, 51 ± 12; SRF, 89 ± 28; PT, 62 ± 19; ITB, 56 ± 24 (SRF > DRF; P < .05). CONCLUSION: As hypothesized, the DRF graft exhibits mechanical properties that do not differ from those of the PT graft. Likewise, the SRF graft showed biomechanical properties that do not differ from those of the
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Journal articleGreenfield S, Samarth G, McGregor A, et al., 2026,
A systematic review and meta-analysis on partial foot amputation in diabetic foot ulcers
, Journal of Vascular Surgery, Vol: 83, Pages: 879-894, ISSN: 0741-5214Objective:Partial foot amputations (PFA) serve as a limb-preserving alternative to major amputations in diabetic patients with advanced foot disease. This systematic review aimed to analyse clinical outcomes, including major and minor re-amputation rates, wound healing, re-ulceration, and mortality following PFA in diabetic adults.Data Sources and Review Methods:A comprehensive search of MEDLINE and Embase databases was conducted following PRISMA guidelines. Studies reporting on diabetic patients undergoing PFA for dysvascular or infective causes were selected. Out of 2437 screened abstracts, 46 studies met the inclusion criteria, representing 32,496 patients. Data extraction was performed using Covidence, and study quality was assessed using the ROBINS-I Tool.Results:Major amputation rates following PFA ranged from 0%-10% for digit and metatarsal amputations, 8%-54% for transmetatarsal amputation (TMA), and 11%-44% for midfoot amputations. The random effects model estimated a major amputation rate of 23% (95% CI 15%-30%), with high heterogeneity (I²=90%). Minor re-amputation rates varied from 12%-33%, notably high after 1st metatarsal amputation. One-year all-cause mortality was 16% (95% CI 10%-22%), with wide variability across studies. Delayed wound healing and high re-ulceration rates were common, particularly following TMA, with re-ulceration rates reaching up to 69%.Conclusion:PFA in diabetic patients carries significant risks of re-amputation, delayed healing, and limb loss. Clinicians should ensure that these risks are communicated during shared decision-making with patients. Standardisation of post-operative care, including multidisciplinary approaches involving orthotists and structured rehabilitation protocols, could help improve outcomes. Further research is needed to explore optimised care strategies and long-term functional outcomes following PFA.
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Journal articleMullington CJ, Iacona GMV, Rolph AR, et al., 2026,
The cutaneous sympathetic blockade associated with labour epidural analgesia. Response to Br J Anaesth 2026; 136: 388-9.
, Br J Anaesth, Vol: 136, Pages: 1066-1067 -
Journal articleGarner AJ, Dandridge OW, Cobb JP, 2026,
Lateral unicompartmental knee arthroplasty is associated with nearer-normal gait characteristics and higher patient satisfaction compared to total knee arthroplasty.
, Bone Joint Res, Vol: 15, Pages: 148-156, ISSN: 2046-3758AIMS: Lateral unicompartmental arthroplasty (UKA-L) is a bone- and cruciate-preserving procedure in the treatment of isolated lateral compartment gonarthrosis, but relatively little is known of its associated gait characteristics and patient-reported outcomes. METHODS: A total of 20 individuals, at a mean 35 months (SD 37) post UKA-L, were measured on an instrumented treadmill. They were compared to age-, sex-, and BMI-matched healthy controls (n = 22) and individuals with unilateral total knee arthroplasty (TKA, n = 28) mean 44 months (SD 46) post-surgery (p = 0.382). Top walking speed, temporospatial parameters, and vertical ground reaction forces of gait were analyzed. Oxford Knee Scores (OKS) and EuroQol five-dimension questionnaire (EQ-5D) scores were compared. RESULTS: The UKA-L group walked at a mean speed of 7.0 km/hour (SD 0.6), which was 0.2 km/hour (3%) slower than the healthy control group (7.2 km/hour (SD 0.7); p = 0.681) but 26% faster than the TKA group (5.5 km/hour (SD 0.7), p < 0.001). UKA-L displayed nearer normal vertical ground reaction forces throughout the stance phase. TKA demonstrated significantly reduced maximum weight acceptance, increased mid-stance, and reduced push-off forces compared to healthy and UKA-L subjects (all p < 0.05). UKA-L recorded similar step and stride lengths to healthy controls, and were 12% and 10% longer than TKA, respectively (p < 0.05). UKA-L was associated with a mean OKS of 44 (SD 3) compared to 36 (SD 6) for TKA (p < 0.001), and mean EQ-5D of 0.90 (SD 0.09) vs 0.78 (SD 0.14) for TKA (p = 0.003). CONCLUSION: UKA-L restores healthy gait characteristics at top walking speeds. Compared to TKA, faster walking speeds, nearer-normal vertical ground reaction forces, longer stride lengths, and a more consistent gait pattern demonstrate the importance of functional cruciate ligaments to gait. UKA-L is associated with high patient satisfaction and good quality of life in the treatment of isolated lateral compar
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Journal articleHussein Hakami H, Sgambato BG, Banger MS, et al., 2026,
Upper limb compensatory strategies across tasks with an ultrasound-controlled prosthesis.
, Sci Rep, Vol: 16Upper-limb amputation often leads to compensatory trunk and shoulder movements, increasing the risk of secondary musculoskeletal complications. This issue is exacerbated by the limited wrist functionality in current prosthetic systems, which restrict natural movement patterns during daily activities. Here, we investigate how limitations in the degrees of freedom (DoF) of the prosthetic wrist influence compensatory upper body motion during functionally relevant tasks. Three transradial amputees, experienced in the use of both body-powered and myoelectric prostheses, were fitted with custom sockets and a prosthetic hand controlled via a 32-channel A-mode ultrasound interface. Eight able-bodied participants served as controls. All participants performed three standardized tasks-drinking, lightbulb insertion, and the Clothespin Relocation Test-while trunk and shoulder kinematics and kinetics were recorded using motion capture and surface electromyography. The results demonstrated task-dependent compensation, with the Clothespin Relocation Test eliciting the greatest trunk flexion and bilateral shoulder involvement. Distinct adaptive patterns emerged between dominant and non-dominant sides, with increased reliance on proximal joints as wrist DoFs were restricted. The findings highlight the need for prosthetic designs and rehabilitation strategies that are tailored to specific tasks and user movement patterns. Quantifying compensatory motion provides a foundation for developing user-centered control systems that enhance function and reduce long-term musculoskeletal strain.
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Journal articleSingh Gill S, Jones GG, Cobb J, et al., 2026,
The link between depression, analgesia usage and function in osteoarthritis: a propensity score-matched analysis from the osteoarthritis initiative cohort
, Bioengineering, Vol: 13, ISSN: 2306-5354Knee osteoarthritis (OA) affects around 37% of U.S. adults over 60, with over 25% expe-rience depressive symptoms (DSs), linked to worse pain and outcomes. Yet their impact on analgesic use and recovery remains unclear. This study aimed to assess if DSs influ-ence analgesic use and functional outcomes in knee OA. Using data from the Osteoar-thritis Initiative (n = 3680), we used a Machine Learning (ML)- based Gradient Boosting Machine (GBM) model to perform propensity score matching, matching pa-tients with knee OA and DSs (n = 487) to those without DSs (n = 487). Outcomes at baseline, 1 and 2 years included analgesic use, function (WOMAC), quality of life (KOOS-QoL), and physical health (SF-12 PCS). Regression and timepoint models com-pared follow-up with baseline. DSs alone were not associated with greater opioid use up to Year 2 (OR = 0.89, 95% CI: 0.45–1.73; p = 0.73). Among patients with DSs, SF-12 PCS improvement was less likely at Year 1, while decline was more likely up to Year 2. DSs in OA were linked to poorer physical health, but often greater functional gains than those in OA without DSs, and with no difference in opioid use. These findings highlight the need for multidisciplinary strategies, addressing both pain and psychosocial well-being.
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Journal articleKaria M, Behforootan S, Stoy L, et al., 2026,
The relationship between radiographic metrics and mechanical properties of the proximal femur
, Advances in Orthopedics, Vol: 2026, ISSN: 2090-3464Background: Bone mechanical properties, including strength and stiffness, influence intraoperative fracture risk and implant stability in hip arthroplasty. Surgeons frequently utilize radiographic metrics to evaluate bone quality and inform surgical strategies. This study investigates the correlation between radiographic bone metrics and mechanical properties of the femoral neck.Methods: Femoral neck cortical bone samples from 23 patients undergoing elective hip arthroplasty were subjected to mechanical compression testing to measure elastic modulus and ultimate strength. Density was also measured. Radiographic metrics, including cortical thickness index, canal flare index, canal-bone ratio, and canal-calcar ratio, were determined from preoperative radiographs. The correlations between these metrics and bone mechanical properties were analysed using linear regression, with intra- and inter-observer reliability assessed.Results: Analysis included 19 of the 23 participants. Whilst cortical thickness index measurements demonstrated a weak positive correlation with bone density (R2 = 0.291; p = 0.013) and ultimate strength (R2 = 0.279; p = 0.015), canal-bone ratio showed a weak negative correlation with both factors (R2 = 0.291; p = 0.013 and R2 = 0.279; p = 0.015, respectively). Both cortical thickness index and canal-bone ratio demonstrated excellent inter and intra-observer reliability. Neither canal flare index nor canal-calcar ratio correlated with any mechanical properties, and none of the radiographic metrics correlated with elastic modulus.Conclusions: Cortical thickness index and canal-bone ratio correlate weakly with bone strength and density, but not with elastic modulus. Given their limited utility, radiographs should be used with caution in surgical decision-making regarding impaction force and implant fixation strategy.
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Journal articleDronkers EAC, Clunie GM, Iacovidou A, et al., 2026,
Management of subglottic stenosis with the “Maddern procedure”: long term follow‐up outcomes
, The Laryngoscope, Vol: 136, Pages: 243-250, ISSN: 0023-852XObjectiveFull-thickness resection and skin grafting of the laryngotracheal junction, the “Maddern Procedure,” can be used to treat patients with recalcitrant laryngotracheal stenosis. We report the long-term surgical outcomes of this procedure.MethodsA consecutive series of 27 females with idiopathic, iatrogenic, or vasculitic subglottic stenosis who underwent the Maddern procedure between 2012 and 2023 were retrospectively reviewed. Airway outcome was assessed using the Modified Medical Research Council Dyspnea (mMRC) Scale. Secondary outcomes included voice, swallowing, mucus management, complications, and the need for subsequent airway surgery.ResultsMost patients had idiopathic subglottic stenosis (n = 20, 74.1%), followed by vasculitic (n = 4, 14.8%) and intubation-related (n = 3, 11.1%) etiologies. Patients had an average of 7.3 (SD 3.4) endoscopic procedures before undergoing the Maddern procedure. Mean pre-Maddern inter-treatment interval was 7.5 months (SD 3.4). The median follow-up was 6.6 years (interquartile range 0.75–11.3). The mMRC dyspnea scale improved from 2.7 (SD 0.73) to 0.52 (SD 0.85). The five-year recurrence-free rate was 63%. It differed between etiologies, ranging from 83% for idiopathic stenosis to 67% for intubation-related and 0% for vasculitis-related stenoses. During the first 4 years after Maddern, 67% of patients reported daily cough and the need to use nebulizers regularly.ConclusionThe Maddern procedure is an effective and durable option for patients with idiopathic subglottic stenosis. Careful screening of patients with presumed idiopathic subglottic stenosis for possible underlying auto-immune conditions remains important when considering patients for this procedure.Level of EvidenceLevel 4.
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Journal articleBoughton O, Green C, Haider Rizvi SZ, et al., 2026,
Screw-Less U-Rod Pelvic Fixation in Early-Onset Scoliosis
, Techniques in Orthopaedics, Vol: Publish Ahead of Print, ISSN: 0885-9698 -
Journal articleMusbahi O, Pouris K, Hadjixenophontos S, et al., 2025,
Machine Learning for patient selection in corticosteroid decision making in knee osteoarthritis: a feasibility model
, World Journal of Methodology, Vol: 15, ISSN: 2222-0682Background:Relieving pain is central to the early management of knee osteoarthritis, with a plethora of pharmacological agents licensed for this purpose. Intra-articular corticosteroid injections are a widely used option, albeit with variable efficacy. Aim:To develop a machine learning model that predicts which patients will benefit from corticosteroid injections.Methods:Data from two prospective cohort studies (OAI and MOST) was combined. The primary outcome was patient-reported pain score following corticosteroid injection, assessed using the WOMAC pain scale, with significant change defined using Minimally Clinically Important Difference and Meaningful Within Person Change. A machine learning algorithm was developed, utilising Linear Discriminant Analysis, to predict symptomatic improvement, and examine the association between pain scores and patient factors by calculating the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and F2 score.Results:A total of 330 patients were included, with a mean age of 63.4 (SD: 8.3). The mean WOMAC pain score was 5.2 (SD: 4.1), with only 25.5% of patients achieving significant improvement in pain following corticosteroid injection. The machine learning model generated an accuracy of 67.8% (95 CI: 64.6% – 70.9%), F1 score of 30.8%, and an AUC score of 0.60. Conclusion:The model demonstrated feasibility to assist clinicians with decision-making in patient selection for corticosteroid injections. Further studies are required to improve the model prior to testing in clinical settings.
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