Bjoern Vogt

Purpose: The reliability and efficiency of a dedicated 3D planning software were evaluated for magnetic resonance imaging (MRI)‐based measurement of femoral torsion, tibial torsion, knee version and whole‐lower extremity torsion compared with manual assessment. Methods: In this retrospective observational reliability study, torsional MRI scans of both lower extremities from 100 healthy volunteers were analysed. Measurements were performed according to Strecker and Waidelich using manual and digital assessment with mediCAD® 3D. One manual and two digital measurement rounds were performed by one experienced orthopaedic surgeon and one inexperienced orthopaedic resident. Inter and intraobserver reliability was assessed using intraclass correlation coefficients with 95% confidence intervals. Agreement was evaluated using Bland–Altman plots and equivalence testing with a predefined ±3° margin. Measurement times of the first and last 10 measurements of each series were compared. Results: The cohort included 50 males and 50 females, with a mean age of 26.7 ± 5.8 years. All parameters demonstrated good to very good reliability. Manual interobserver reliability was highest for femoral torsion (ICC: 0.99; 95% CI: 0.98–0.99; p < 0.001). Digital interobserver reliability ranged from ICC 0.94 to 0.98 in the first digital round and from ICC 0.89 to 0.98 in the second digital round, all p < 0.001. Manual‐to‐digital agreement ranged from ICC 0.90 to 0.98 for both observers. Bland–Altman analysis showed mean digital interobserver bias within approximately 2°. All comparisons were equivalent within the predefined ±3° margin. The largest efficiency gain occurred in the inexperienced observer, with median time decreasing from 200 to 150 s, corresponding to a 25% reduction ( p < 0.001). Conclusion: The 3D planning software demonstrated good to very good inter and intraobserver reliability for MRI‐based lower extremity torsional assessment. It improved efficiency, particularly for the inexperienced observer, and, through automated calculations and guided workflow, supports standardised preoperative planning. Level of Evidence: Level III.

Increased posterior tibial slope (PTS) is a known risk factor for anterior cruciate ligament (ACL) deficiency and graft failure after ACL reconstruction (ACLR). Although many studies investigated different aspects related to the PTS, there is still a lack of comprehensive recommendations and practical guidelines, especially with regard to radiographic analysis, surgical indication and surgical technique. The aim of this narrative review is to present such recommendations, based on the existing literature (evidence Level 3–4), supplemented by the expert opinions of the Osteotomy Committee of the German Knee Society. A review of the literature was conducted to summarize the current evidence concerning biomechanical background, radiological measurement, indication for surgical correction and surgical techniques. Results were presented to a panel of surgeons with recognized expertise in the treatment of ACL injuries and wide experience in surgical correction of the PTS, and consensus was formed by informal discussion. These recommendations were developed and included: (1) measuring the PTS should be performed on long lateral radiographs using the mechanical axis, with attention to a correct rotational alignment (exact superimposition of the posterior tibial condyles). (2) Indication for surgical correction does not depend on a single fixed cut‐off value of the PTS. It should be based on an individual risk assessment (e.g., degree of anterior tibial translation and instability, meniscal integrity, number and quality of previous ACLR, trauma mechanism: contact vs. non‐contact, contralateral injury). (3) For correction of pathologic PTS, different surgical techniques of anterior tibial closing wedge osteotomies have been reported without clear superiority of one technique. However, an infratuberositary approach is recommended, because it has been shown to be technically easier and safer. Level of Evidence: Level V, narrative review and expert opinion.

Background and purpose: We aimed to evaluate the prognostic value of radiographic factors in predicting femoral head–neck remodeling, cam deformity, and local growth disturbances in slipped capital femoral epiphysis (SCFE) treated with internal fixation (IF) with or without simultaneous closed reduction.Methods: A retrospective multicenter study on 217 SCFE patients (228 hips) treated with IF in 10 institutions was performed. Hip morphology was assessed using preoperative, postoperative, and end of growth (EG) radiographs and radial MRI scans. Evaluated parameters included: epi-metaphyseal distance, Southwick angle (SA), head–neck offset (HNO), femoral neck varus deformity, and shortening. Depending on the presence of bony adaptation (BA; defined as rounded anterior metaphyseal edge and posterior callus formation, typically indicating slip onset > 4 weeks) at diagnosis hips were divided into Group A (n = 96; without BA) and Group B (n = 132; with BA).Results: At EG, Group A demonstrated better slip correction, more favorable femoral neck remodeling, and lower risk of residual cam deformity than Group B (15% vs 58%, risk difference –43%, 95% confidence interval –54 to –32). Remodeling occurred in most cases in both groups, but normal values were not uniformly reached. Femoral neck varus deformity and shortening were observed in both groups and attributed to disease-specific growth plate damage rather than transphyseal fixation.Conclusion: Radiographic signs of BA at diagnosis can predict the risk of cam deformity at EG. Cases without BA have a favorable prognosis, whereas slips with BA have a higher risk of residual deformity. Signs of BA demonstrated a higher predictive value (0.84) than SA > 40° (0.60) or negative HNO < –5 mm (0.57).

Background: Positional plagiocephaly (PP) is a common cranial asymmetry of infancy. Its treatment options include conservative management and helmet therapy. However, the efficacy of each, particularly at achieving a normal cranial shape, remains uncertain.Purpose: This study aimed to compare the efficacy of conservative management and helmet therapy for PP.Methods: We retrospectively analyzed 199 infants with PP treated in 2015–2024. A total of 72 patients with a minimum treatment duration of 90 days and minimum plagiocephaly severity level of 2 (Children's Healthcare Atlanta Plagiocephaly Severity Scale) were included. Of them, 36 received conservative management and 36 received helmet therapy. Each infant underwent three-dimensional surface scanning of the cranium (StarScanner).Results: The mean±standard deviation age at treatment initiation was 31.9±6.6 weeks in the helmet group versus 21.0±5.7 weeks in the conservative management group (P<0.001). The average treatment duration was 21.9 (interquartile range [IQR], 15.3–31.4) weeks vs. 20.6 (IQR, 14.1–26.6) weeks (P=0.171), respectively. The monthly correction speed of the cranial vault asymmetry index (CVAI) was comparable between groups (0.66±2.09 vs. 0.64±0.55, P=0.964). Plagiocephaly degree was reduced to level 1 in 9 of 36 patients (25%) who received helmet therapy versus 4 of 36 patients (11%) in the conservative management group (P=0.220), whereas a reduction in severity level was observed in 24 of 36 (67%) versus 15 of 36 (42%), respectively (P=0.058). In the helmet group, an earlier treatment initiation was significantly associated with a greater severity level reduction (r=-0.480, P=0.003). A longer treatment duration showed a trend toward a greater reduction in CVAI (r=0.331, P=0.052). In the conservative management group, both earlier treatment initiation (r=-0.537, P<0.001) and longer treatment duration (r=0.381, P=0.022) correlated significantly with improved outcomes.Conclusion: Conservative management and helmet therapy reduced cranial asymmetry with no significant difference in correction speed. An early treatment initiation was the strongest predictor of improvement, while a longer treatment duration was associated with better outcomes. A trend toward a greater reduction in severity level was observed with helmet therapy, suggesting its potential benefits in more severe cases.

Developmental dysplasia of the hip (DDH) is a common neonatal musculoskeletal disorder. In Germany, sonographic screening is recommended at 1–10 days of life for neonates with specific risk factors. This study aims to determine reference values for early sonographic screening and to evaluate associated risk factors. Between 2007 and 2022, 3383 neonates (6766 hips) underwent hip ultrasound according to Graf. Of these, 967 neonates were screened universally (2007–2015) and 1900 based on predefined risk factors (2015–2022). DDH was defined as ≥type IIc, according to Graf. A subgroup of 20 neonates with borderline alpha angles (51–52°) was followed up after 3–6 weeks. The mean alpha angle was 61.2° ± 5.3° (range 50.5–71.9°), and beta angle 70.8° ± 8.6° (range 53.6–88.0°). DDH prevalence was 2.5% in the universal and 3.2% in the risk-based cohort (p = 0.350). Logistic regression revealed associations with abnormal birth presentation (OR = 3.09, p < 0.001) and female sex (OR = 3.77, p < 0.001), not with Cesarean section or familial predisposition. In the follow-up subgroup, all hips showed a sufficient maturation to an alpha angle of 61.0° (range 57–66°). This study provides reference values for early DDH screening and confirms abnormal birth presentation and female sex as relevant risk factors.