Venkatesan Sampath Kumar

Background: Distal femoral osteotomy is used to correct symptomatic genu valgum after distal femoral physeal closure, but comparative evidence between lateral opening-wedge osteotomy (LOW) and medial closing-wedge osteotomy (MCW) in adolescents is limited. We compared radiographic correction, recovery, and complications between the techniques. Methods: In this prospective randomised trial, 65 adolescents aged 12 to 18 years with idiopathic genu valgum and radiographic closure of the distal femoral physis were allocated 1:1 to LOW or MCW. Three participants were lost to follow-up, leaving 62 participants for the available-case analysis (LOW, n=32; MCW, n=30). In bilateral cases, only the first operated limb was analyzed. The primary outcome was signed mechanical axis deviation (MAD) at radiographic union; unadjusted comparisons were the primary focus, and covariate-adjusted analyses were supportive. Results: MAD at union was 6.8±6.2 mm after LOW and 2.4±5.3 mm after MCW (LOW minus MCW, 4.4 mm; 95% CI: 1.5-7.3; P =0.003). The supportive adjusted difference was 3.0 mm (95% CI: −0.4 to 6.5; P =0.08). Absolute deviation from neutral was 6.8±6.2 versus 4.0±4.1 mm (difference, 2.8 mm; 95% CI: 0.2-5.5; P =0.04). At union, mLDFA did not differ significantly; aLDFA favored MCW in the unadjusted analysis, but neither adjusted angular difference was significant. One-year Pedi-IKDC scores, pain, satisfaction, union time, hospital stay, and return to activity did not differ between groups. Unique symptomatic lateral plate/iliotibial-band irritation occurred in 4 of 32 LOW participants (13%) and 3 of 30 MCW participants (10%; P =1.00). Conclusions: MAD at radiographic union favored MCW, but the trial did not establish clinically meaningful superiority. The adjusted estimate was smaller and nonsignificant, and no sustained functional advantage was detected. Both techniques produced substantial correction with favorable short- to mid-term outcomes. Level of Evidence: Level I—therapeutic study.

Diagnosis of synovial sarcoma (SS) requires molecular confirmation of the SS18-SSX fusion by FISH or RT-PCR, but these methods are costly and limited in resource-constrained settings. Recently developed fusion-specific antibodies offer potential alternatives, but validation in resource-limited settings remains limited. We evaluated SS18-SSX fusion-specific (E9X9V) and SSX C-terminus (E5A2C) antibodies in 50 FISH-confirmed SS cases and 50 histologic mimics from a tertiary cancer center (July 2023 to June 2025). Nuclear staining was scored (0 to 8 scale, grade 0 to 3; grade ≥2 considered positive). Five SS cases had technically noninterpretable SS18-SSX staining and were excluded from the analysis. Sensitivity, specificity, and predictive values were calculated with 95% CIs. SS18-SSX showed 95.6% sensitivity (43/45 interpretable SS cases; 95% CI: 84.9-99.5%) and 100% specificity (50/50 controls). SSX C-terminus demonstrated 100% sensitivity (50/50 SS) but 94.0% specificity (47/50 controls), with false positivity in 3 mimics (medullary thymoma, spindle cell rhabdomyosarcoma, and MPNST). SSX C-terminus showed perfect sensitivity, such that a negative stain effectively excludes synovial sarcoma, whereas SS18-SSX showed perfect specificity, such that a positive stain confirms the diagnosis. Sequential interpretation of both antibodies is a reliable, lower-cost alternative to molecular testing in resource-limited settings, with FISH reserved for indeterminate results.

Objective: The aim of the study was to evaluate the role of ¹⁸ F-fluorodeoxyglucose (FDG) PET/computed tomography (CT) in monitoring treatment response and determining treatment end points in patients with extraspinal musculoskeletal tuberculosis (MSK-TB) receiving anti-tubercular therapy (ATT). Methods: In this prospective observational study, 62 patients with extraspinal MSK-TB underwent baseline ¹⁸ F-FDG PET/CT before ATT, with follow-up scans at 6, 12, and 18 months. Total lesion glycolysis (TLG), maximum standardized uptake value (SUVmax), and lesion-to-liver standardized uptake value ratio (SUVR) were recorded. Clinical, laboratory, and MRI findings were used as reference standards for healing. Receiver operating characteristic analysis identified PET/CT parameters associated with ATT beyond 18 months. Results: Fifty-one patients completed the final PET/CT follow-up. Significant reductions in TLG, SUVmax, and SUVR were observed during treatment (all P < 0.05). ROC analysis demonstrated that a ≤43% reduction in TLG, ≤46% reduction in SUVmax, and ≤26% reduction in SUVR between baseline and 6-month scans, and a ≤66% reduction in TLG, ≤36% reduction in SUVmax, and ≤30% reduction in SUVR between baseline and 12-month scans, were associated with the requirement for ATT beyond 18 months. The mean time to complete clinicoradiological healing was 19.23 ± 1.49 months, whereas the mean time to complete metabolic response on PET/CT was 18.54 ± 2.27 months, with no statistically significant difference ( P = 0.30). Conclusion: ¹⁸ F-FDG PET/CT is a valuable tool for monitoring treatment response in extraspinal MSK-TB. Early changes in PET/CT parameters may predict treatment duration, and PET/CT findings closely correlate with disease healing, supporting its use in guiding individualized ATT duration.

Background: As the use of artificial intelligence (AI) and large language models (LLMs) is increasingly adopted into scientific writing, it is important to understand AI's ability to produce clear and accurate content that is on par with human-authored content in the field of orthopaedics, including orthopaedic oncology. The aim of this study was to compare a series of editorials written by orthopaedic oncologists with those written by a single LLM (ChatGPT 4.0) using a variety of quality metrics. Methods: Volunteer orthopaedic oncologists submitted a 3- to 4-paragraph persuasive editorial on a topic of their choice in the field of musculoskeletal oncology. ChatGPT 4.0 was then prompted to write a corresponding editorial for each topic. Each editorial was evaluated by two blinded peer reviewers and graded using a 25-point scale on the following quality metrics: content, clarity, grammar, persuasiveness, and creativity. The evaluators were also asked to indicate whether they believed the editorials were written by humans or by AI. Results: A total of 20 editorials were submitted by human authors and matched with 20 prompted AI editorials. No notable difference in average total quality score for human versus AI submissions was observed. AI-generated articles scored markedly higher in grammar, but there were no notable differences in any other quality metric. Reviewers correctly identified author type 59% of the time. Discussion: LLMs such as ChatGPT can generate editorial content in orthopaedic oncology that matches human-written quality, suggesting a potential supportive role for AI in scientific communication, with implications for authorship standards, editorial practices, and peer review.

PURPOSE: Childhood cancer has high cure rates; however, data on long-term socioeconomic challenges faced by survivors, particularly in low- and middle-income countries, are limited. We aimed to identify issues related to educational disruption, employment, and financial hardship among childhood cancer survivors. METHODS: We conducted a cross-sectional study of survivors enrolled in the Childhood Cancer Survivorship Program at a tertiary cancer center in India (December 2020-March 2025). Eligible survivors were aged 21 years and younger at diagnosis and had completed therapy. Clinical and sociodemographic data were abstracted from records and structured proforma. Logistic regression with forward stepwise modeling was used to identify predictors of educational, financial, and employment challenges. RESULTS: We included 1,098 survivors. The median age was 16 years at evaluation, and 74.7% were male. Among those diagnosed at age 5-21 years (n = 764), 85% reported educational disruption (median 1.75 years). Relocation from the hometown for therapy (odds ratio [OR], 1.8; P = .01) and job loss within the family (OR, 2.1; P = .01) independently predicted educational disruption, whereas maternal education until or above high school was associated with lower odds of educational disruption (OR, 0.29; P = .001). Catastrophic health expenditure occurred in 91.3%. Younger age at diagnosis (OR, 1.03; P = .003) and relocation (OR, 1.61; P = .001) independently predicted higher treatment costs, ≥$3,385 US Dollars. Cancer-related employment difficulties affected 30.2% of working-age survivors, with older age at diagnosis (OR, 1.15; P < .001) and longer time since treatment completion (OR, 1.08; P = .02) being independent predictors. CONCLUSION: For Indian childhood cancer survivors, cure carries hidden costs of disrupted education, financial strain, and workplace barriers. Survivorship care in resource-constrained settings should integrate school reintegration, financial protection, and vocational support.

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