Orthopaedic Research

Walking (or gait) speed is recognised as a robust indicator of health status, functional capacity, and physiological reserve across the lifespan; however, its objective measurement remains underused in routine musculoskeletal physiotherapy practice. This commentary argues that gait speed is underutilised in musculoskeletal physiotherapy despite its strong prognostic and functional relevance, and proposes its cautious adoption as a functional vital sign to support more objective, standardised, and interpretable rehabilitation decision making. Evidence from an orthopaedic population undergoing total hip and knee arthroplasty illustrates the persistent gap between surgical success and functional recovery, as reflected in sustained deficits in walking speed relative to healthy benchmarks. Methodological issues in gait speed assessment are considered, and the potential future role of wearable sensors and digital health technologies in capturing real-world locomotor performance is highlighted. Overall, the evidence suggests that gait speed can provide an objective, low-cost, and scalable measure that integrates multiple domains of musculoskeletal function. Therefore, the routine integration of gait speed into physiotherapy assessment may help to quantify functional impairment, support personalised rehabilitation, reduce practice variation, and align musculoskeletal care with contemporary adaptive and digitally enabled healthcare models.

Osteoblast senescence constitutes one of the major mechanisms in bone degeneration and is under tight regulation by metabolism and oxidative stress. While hypoxia has recently emerged as an important microenvironmental factor influencing the function of bone cells, its role in osteoblast senescence and metabolic regulation has yet to be defined. The present work entails hypoxia-modulated osteoblast senescence at one level, transcriptomic and metabolomic sequencing, and two levels, in vitro MC3T3-E1 and in vivo AAV-shAtp6v1a mouse models. In transcriptome profiling, hypoxia-responsive genes were identified, whereas non-targeted metabolomics was used to uncover metabolic alterations induced by ATP6V1A knockdown. Oxidative stress and mitochondrial function were assessed by qRT-PCR, Western blotting, SA-β-Gal staining, ROS detection, JC-1 mitochondrial potential, and immunofluorescence. Micro-CT, H&E, Masson, and immunohistochemistry studies were performed to investigate bone structure and protein expression in vivo. Hypoxia markedly mitigated osteoblast senescence, decreasing p53 and p21 expressions and the number of SA-β-Gal-positive cells. It reduced intracellular ROS levels and increased HK2 and LDH expression, decreased ATP, and increased lactate, hinting at a shift toward glycolysis. Transcriptome analysis identified ATP6V1A as one of the major hypoxia-downregulated genes. Knockdown of ATP6V1A reduced ROS levels, inhibited p21 expression, improved mitochondrial function. Metabolomics disclosed remapping pathways in glycolysis, lipid, and amino acid metabolism. This study identifies a "Hypoxia-ATP6V1A-Oxidative Stress-Metabolic Remodeling-Anti-Senescence" axis, demonstrating that hypoxia delays osteoblast senescence by downregulating ATP6V1A, suppressing oxidative stress, and reprogramming metabolism, providing new insights and potential therapeutic targets for bone degenerative diseases.

Abstract Medial pivoting motion has been identified as the primary kinematic pattern throughout flexion of the native knee joint. The recently introduced coronal plane alignment of the knee (CPAK) classification categorizes knees into nine alignment-based phenotypes, yet the relationship between these phenotypes and their respective kinematic behavior remains poorly documented, particularly in less common valgus phenotypes. Therefore, this study aimed to perform a detailed analysis of the pivoting motion of the CPAK type III knees during ex vivo simulated squatting. Considering the more lateral weight-bearing axis in the valgus phenotype, we hypothesized that weight-bearing motion is associated with lateral pivot motion.We retrospectively analysed a previously collected dataset of sixty-nine native fresh-frozen cadaveric knees subjected to squatting motion (35°-100°) on a physiological knee joint simulator. Seventeen CPAK Type III knees were identified based on full-leg computed tomography scans. Next, we discerned between medial and lateral pivoting throughout the range of motion based on the location of the instantaneous center of rotation (ICOR) to the center of the tibial plateau. Furthermore, we screened for possible associations between CPAK’s coronal lower limb alignment features and lateral pivoting. All 17 CPAK type III knees exhibited a lateral center of rotation during squatting, with 8 demonstrating lateral pivoting as the predominant pattern over more than half of the flexion range. This study showed that a lateral pivot motion pattern occurred during squatting in approximately half of the CPAK type III specimens, from mid to deep flexion (58.5°-100°) when tested in a loaded knee simulator. The current study offers essential data and insights to be considered for subsequent research on the role of native valgus knee kinematics in optimizing TKA outcomes.

Isolated posterior malleolar fracture is a rare condition, and this fracture is usually overlooked and diagnosed as an ankle sprain owing to a lack of awareness and difficulty in diagnosis.Posterior ankle impingement syndrome (PAIS) is relatively common in athletes and is usually caused by trauma or overuse. The impingement occurs due to repeated compression of a bony or soft tissue. Here, we report a rare case of a 17-year-old rugby player presenting with posterior ankle impingement caused by nonunion of an isolated posterior malleolar fracture. This patient was treated using a posterior ankle arthroscopic excision. At 16 weeks postoperatively, his ankle and hallux pain disappeared, and he returned to sports activities with no morbidities related to the surgical procedure. Based on a computed tomography scan, the bone fragment causing the impingement was resected, and the union of the residual posterior malleolar fragment was verified.

Surrounding the predictive value of clinical measurements and assessments for future athletic injury, most researchers have not differentiated between contact and noncontact injuries. We assessed the association between clinical measures and questionnaire data collected before sport participation and the incidence of noncontact lower extremity (LE) injuries among Division III collegiate athletes. Prospective cohort study. University setting, National Collegiate Athletic Association Division III. Here, 488 Division III freshmen athletes were recruited to participate in the study during their preseason physical examinations. Prospective incidence of noncontact LE injury. Athletes completed questionnaires to collect demographics and musculoskeletal pain history. Clinical tests, performed by trained examiners, included hip provocative tests, visual appraisal of a single-leg squat to identify dynamic knee valgus, and hip range of motion. Injury surveillance for each athlete's collegiate career was performed. The athletic training department documented each athlete-reported new onset injury and documented the injury location, type, and outcome (days lost, surgery performed). Univariable generalized estimating equation models were used to analyze the relationship between each clinical measure and the first occurrence of noncontact LE injury. An exchangeable correlation structure was used to account for repeated measurements within athletes (right and left limbs). Of the 488 athletes, 369 athletes (75%) were included in the final analysis. Sixty-nine noncontact LE injuries were reported. Responding yes to, "Have you ever had pain or an injury to your low back?" was associated with an increased risk of noncontact LE, odds ratio = 1.59 (95% confidence interval = 1.03, 2.45; P = .04). No other clinical measures were associated with an increased injury risk. A history of prior low back pain or injury was associated with an increased risk of sustaining a noncontact LE injury while participating in National Collegiate Athletic Association Division III athletics.

This chapter defines and describes musculoskeletal (MSK) conditions and the impact they have on patients. It explains the principles of using electrical stimulation (ES), especially to overcome problems of muscle atrophy, weakness and pain. It presents the evidence for effectiveness in a range of conditions, including pre- and post-operative lower limb joint replacement, shoulder surgery and osteoarthritis. The chapter also provides clinical guidance for the therapeutic use of ES with MSK patients.

Objective This study aimed to investigate the surgical approaches, clinical efficacy, and indications of a novel acetabular anatomical locking plate for acetabular fractures involving the quadrilateral plate. Methods Patients with acetabular fracture treated with the novel acetabular quadrilateral anatomical locking plates in our department from December 2017 to June 2020 were collected. According to the fracture types, a 1:1 matched-pair analysis was carried out and patients treated with reconstruction plates were selected. These 2 groups of patients were included in the observation group and control group, respectively, and ultimately each group included 11 patients. The time between injury and definitive surgery, surgical approaches, operation time, intraoperative blood loss volume, intraoperative blood transfusion volume, postoperative blood transfusion volume, fracture union time, reduction loss, and postoperative complications were recorded. The fracture reduction quality and hip function were respectively evaluated by Matta’s grading system and the modified Merle D’Aubigne-Postel grading system. A comparison was made to observe whether the 2 groups had differences in the preceding clinical parameters. Results As for the observation group, the mean operation time was 327.82 ± 137.46 min (range: 120～580 min; median: 323 min), the mean intraoperative blood loss volume was 1745.46 ± 2103.98 mL (range: 300～7000 mL; median: 1000 mL), and the mean intraoperative blood transfusion volume was 1526.18 ± 1617.46 mL (range: 0～5130 mL; median: 900 mL), and the mean postoperative blood transfusion volume was 254.55 ± 439.01 mL (range：0～1400 mL; median：0 mL). During the follow-up period ranging from 9 to 28 months, 1 incision lipoliquefaction, 1 heterotopic ossification, and 1 traumatic arthritis were recorded. According to Matta’s grading system, 4 anatomic reductions, 6 imperfect reductions, and 1 poor reduction were recorded, and the rate of satisfactory reduction quality was 90.91%. According to the modified Merle D’Aubigne-Postel grading system, 5 excellent, 4 good, 1 fair, and 1 poor were recorded, and the rate of satisfactory hip function was 81.82%. As for the control group, the mean operation time was 273.18 ± 99.15 min (range: 120～450 min; median: 270 min), the mean intraoperative blood loss volume was 1122.73 ± 469.77 mL (range: 300～1500 mL; median: 1500 mL), and the mean intraoperative blood transfusion volume was 608.55 ± 363.71 mL (range: 0～1086 mL; median: 758 mL), the mean postoperative blood transfusion volume was 281.82 ± 430.86 mL (range：0～1000 mL; median：0 mL). During the follow-up period ranging from 9 to 42 months, 2 instances of traumatic arthritis and 1 femoral head necrosis were recorded. According to Matta’s grading system, 2 anatomic reductions, 6 imperfect reductions, and 3 poor reductions were recorded, and the rate of satisfactory reduction quality was 72.73%. According to the modified Merle D’Aubigne-Postel grading system, 1 excellent, 7 good, 0 fair, and 3 poor were recorded, and the rate of satisfactory hip function was 72.73%. All the patients obtained fracture union, and no reduction loss was recorded. According to statistical analysis, there were no significant differences between the 2 groups in the time between the injury and definitive surgery, surgical approaches, intraoperative blood loss volume, intraoperative blood transfusion volume, postoperative blood transfusion volume, rate of satisfactory reduction quality, hip function score, and rate of satisfactory hip function. Conclusions Through 3 kinds of anterior approaches, the novel anatomical locking plate can be used to fix acetabular fractures involving the quadrilateral plate including anterior wall fractures, anterior column fractures, transverse fractures, and double-column fractures, which can obtain satisfactory fracture reduction quality, limit the medial displacement of the quadrilateral plate effectively, restore the postoperative hip function well, and obtain a comparable clinical efficacy as the reconstruction plate.

Background and Aims:Bowel smooth muscle experiences mechanical stress constantly during normal function, and pathologic mechanical stressors in disease states. We tested the hypothesis that pathologic mechanical stress could alter transcription to induce smooth muscle phenotypic class switching.Methods:Primary human intestinal smooth muscle cells (HISMCs), seeded on electrospun aligned poly-ε-caprolactone nano-fibrous scaffolds, were subjected to pathologic, high frequency (1 Hz) uniaxial 3% cyclic stretch (loaded) or kept unloaded in culture for 6 hours. Total RNA sequencing, qRT-PCR, and quantitative immunohistochemistry defined loading-induced changes in gene expression. NicheNet predicted how differentially expressed genes might impact HISMCs and other bowel cells.Results:Loading induced differential expression of 4537 genes in HISMCs. Loaded HISMCs had a less contractile phenotype, with increased expression of synthetic SMC genes, proinflammatory cytokines, and altered expression of axon guidance molecules, growth factors and morphogens. Many differentially expressed genes encode secreted ligands that could act cell-autonomously on smooth muscle and on other cells in the bowel wall.Discussion:HISMCs demonstrate remarkably rapid phenotypic plasticity in response to mechanical stress that may convert contractile HISMCs into proliferative, fibroblast-like cells or proinflammatory cells. These mechanical stress-induced changes in HISMC gene expression may be relevant for human bowel disease.