Jia-Lin Wu

Purpose: To evaluate whether a medial open‐wedge high tibial osteotomy (MOWHTO) influences the change in the joint‐line convergence angle (JLCA) in the contralateral knee. Methods: Whole‐leg radiographs of patients who underwent MOWHTO between January 2016 and December 2024 were reviewed, with a minimum follow‐up period of 1 year. Radiographic measurements were analyzed to assess the preoperative and postoperative changes (Δ) in both lower limb parameters, especially JLCA. Patients were divided into 2 groups based on their preoperative (pre‐) JLCA levels at the contralateral knee ( ^ck ). Group I consisted of knees with a pre‐JLCA ^ck of ck of ≥2.0°. Statistical analyses, including paired t tests, χ ² test, Fisher's exact test, Spearman's correlation, and simple linear regression analysis, were performed using R software. The minimal clinically important difference (MCID) was calculated as one‐half of the standard deviation of pre‐JLCA ^ck . Univariable and multivariable logistic regression were performed to identify factors independently associated with MCID achievement of ΔJLCA ^ck . P value < .05 was considered statistically significant. Results: A total of 102 knees were included, with 63 knees in group I and 39 knees in group II. Postoperatively, the JLCA ^ck significantly decreased from 1.8° (95% confidence interval: 1.5°‐2.0°) to 1.3° (95% confidence interval: 1.1°‐1.5°) ( P value = .04). Compared with group I, group II showed a significantly greater reduction in JLCA ^ck after MOWHTO (0.8°, exceeding an MCID threshold of 0.6°, P < .01), whereas group I showed a reduction of 0.3° ( P < .01). In the multivariable logistic regression model, pre‐JLCA ^ck ≥ 2° was independently associated with MCID achievement (odds ratio: 7.14, 95% confidence interval 2.60‐21.89, P < .001). Conclusions: MOWHTO significantly contributed to a reduction in postoperative JLCA in both the contralateral and operated knees. Additionally, a greater pre‐JLCA ^ck was associated with a larger ΔJLCA ^ck . Level of Evidence: Level III, retrospective study.

Purpose: To assess the precision of patient‐specific instrumentation (PSI) in medial open wedge high tibial osteotomy (MOWHTO) based on medial proximal tibial angle (MPTA) and evaluate cartilage regeneration and clinical outcomes. Methods: From August 2018 to December 2022, patients undergoing PSI‐guided MPTA‐based MOWHTO were included, with a minimum follow‐up period of 2 years. Exclusion criteria included MOWHTO without PSI, surgical planning not based on MPTA, bilateral knee surgery, procedure changes during surgery, and loss of follow‐up. Accuracy was classified into 3 categories: high, acceptable, and low accuracy based on the correction error (≤1°, 1°‐2°, and >2°, respectively). Paired‐sample t‐tests compared preoperative and postoperative alignment and clinical scores, while rank sum and Fisher's exact tests assessed arthroscopic findings. Results: Radiological and clinical assessments were conducted on 39 patients. Cartilage regeneration was assessed by arthroscopy in 30 knees during implant removal. The error between preoperative planning and postoperative MPTA was at 0.1° ± 1.7° (95% CI: −0.5 to 0.6). The number of knees having the high, acceptable, and low accuracy was 21 (54%), 9 (23%), and 9 (23%) ( p ‐value = .03) respectively. No significant changes were observed in posterior tibial slope. The KOOS showed a significant improvement after surgery compared to the preoperative score, from 47 ± 18 to 74 ± 14 with 100% patients exceeding the threshold for minimal clinically important difference. The mean weight‐bearing line percentage significantly improved 19.5% ± 10.1% to 59.0% ± 7.3%, and the mean MPTA was corrected from 84.7° ± 1.8° preoperatively to 92.6° ± 2.1° postoperatively. A second‐look arthroscopy revealed significant cartilage regeneration on the medial femoral condyle surfaces. Conclusions: The use of PSI in MPTA‐based MOWHTO resulted in highly and acceptably accurate correction in the majority of cases, preservation of the PTS, and improved clinical outcomes in all patients. Furthermore, MOWHTO promotes cartilage regeneration at MFC following a 2‐year follow‐up. Level of Evidence: Level IV, retrospective study.

The nonunion and delayed union of bones are common challenges in orthopedic surgery, even when bone alignment is correct and sufficient mechanical stability is provided. To address this, artificial bone grafts are often applied to fracture gaps or defect sites to promote osteogenesis and enhance bone healing. In this study, we developed an alginate-based hydrogel incorporating gold nanoparticles (AuNPs) to enhance cell proliferation and facilitate bone healing through a photothermal effect induced by near-infrared (NIR) laser irradiation. The temperature was controlled by adjusting the AuNP content. The hydrogel’s properties were characterized and cell viability was assessed. Our results indicate that while the incorporation of AuNPs slightly disrupted the hydrogel’s cross-linking network at low concentrations, cell viability remained unaffected across both low and high AuNP contents. These findings suggest that this photothermal hydrogel holds great promise for orthopedic applications to improve bone healing.

Superior capsular reconstruction is a surgical technique for the treatment of massive irreparable rotator cuff tears. Different types of grafts have been used. Human dermal allograft has the advantage of avoiding autograft harvest‐site morbidity but may elongate with graft loading, resulting in eventual superior humeral head migration. The purpose of this Technical Note is to describe an arthroscopic technique using the long head of the biceps tendon rerouting in superior capsular reconstruction with nonirradiated human acellular dermis for irreparable rotator cuff tears. Technique Video: video See video under supplementary data.

Pelvic and acetabular fractures are challenging for orthopedic surgeons, but 3D printing has many benefits in treating these fractures and has been applied worldwide. This study aimed to determine whether 3D printing can shorten the length of hospital stay (LHS) in nongeriatric male adult patients with these fractures. This is a single-center retrospective study of 167 nongeriatric male adult participants from August 2009 to December 2021. Participants were divided into two groups based on whether they received 3D printing assistance. Subgroup analyses were performed. Pearson’s correlation and multivariable linear regression models were used to analyze the LHS and the parameters. Results showed that 3D printing-assisted surgery did not affect LHS in the analyzed patients. The LHS was positively correlated with the Injury Severity Score (ISS). Initial hemoglobin levels were negatively associated with LHS in patients aged 18–40 and non-major trauma (ISS < 16) patients. In 40–60-year-old and non-major trauma patients, the duration from fracture to admission was significantly associated with LHS. This study indicates that 3D-assisted technology for pelvic or acetabular fracture surgery for nongeriatric male adults does not influence the LHS. More importantly, the initial evaluation of patients in the hospital was the main predictor of the LHS.

Acetabular or anterior pelvic ring fractures are rare but extremely complicated and challenging injuries for orthopedic trauma surgeons. Three-dimensional (3D) printing technology is widely used in the management of these two fracture types for surgical benefits. Our study aimed to explore whether 3D printing-assisted acetabular or pelvic surgery is beneficial in terms of shortening the length of hospital stay (LHS) and intensive care unit (ICU) stay (ICU LS) for older patients. This retrospective study included two groups of 76 participants over 60 years old who underwent operations with (n = 41) or without (n = 35) guidance by 3D printing. The Mann–Whitney U test was used to analyze continuous variables. Chi-square analysis was applied for categorical variables. Univariable and multivariable linear regression models were used to analyze the factors associated with LHS. The median LHS in the group without 3D printing assistance was 16 (12–21) days, and the median ICU LS was 0 (0–2) days. The median LHS in the group with 3D printing assistance was 17 (12.5–22.5) days, and the median ICU LS was 0 (0–3) days. There was no significant difference in LHS associated with 3D printing assistance vs. that without 3D printing among patients who underwent open reduction and internal fixation for pelvic or acetabular fractures. The LHS positively correlated with the ICU LS whether the operation was 3D printing assisted or not. For fracture surgery in older patients, in addition to the advancement of surgical treatment and techniques, medical teams require more detailed preoperative evaluations, and more personalized medical plans regarding postoperative care to achieve the goals of shortening LHS, reducing healthcare costs, and reducing complication rates.

Bacterial infection remains a great risk in medical implantation surgery. In this paper, we found that degradable metals may be a feasible alternative option of antibacterial implantation materials. It is known that the spalling mechanism of magnesium (Mg) during degradation leads to Mg ions-induced alkaline environment, which is harmful to planktonic bacteria. In this study, we showed that alkaline pH environment is almost harmless to those adhesive bacteria protected in well-formed biofilms. Moreover, experimental results demonstrated that the biofilm formed in the place where Mg spalls are destroyed, releasing the covered bacteria to be planktonic in the alkaline environment. As a result, the colonization of biofilms continues to shrink during the degradation of Mg. It implies that if degradable metal is employed as implantation material, even if bacterial infection occurs, it may be possibly cured without second surgery.

Platelet-rich fibrin (PRF) is a natural fibrin meshwork material with multiple functions that are suitable for tissue engineering applications. PRF provides a suitable scaffold for critical-size bone defect treatment due to its platelet cytokines and rich growth factors. However, the structure of PRF not only promotes cell attachment but also, due to its density, provides a pool for cell migration into the PRF to facilitate regeneration. In our study, we used repeated freeze drying to enlarge the pores of PRF to engineer large-pore PRF (LPPRF), a type of PRF that has expanded pores for cell migration. Moreover, a biodegradable Mg ring was used to provide stability to bone defects and the release of Mg ions during degradation may enhance osteoconduction and osteoinduction. Our results revealed that cell migration was more extensive when LPPRF was used rather than when PRF was used and that LPPRF retained the growth factors present in PRF. Moreover, the Mg ions released from the Mg ring during degradation significantly enhanced the calcium deposition of MC3T3-E1 preosteoblasts. In the present study, a bone substitute comprising LPPRF combined with a Mg ring was demonstrated to have much potential for critical-size bone defect repair.