Search Results (2,309)

Arthroscopic knee surgery represents a cornerstone of modern orthopedic practice, yet nationwide data from Eastern Europe remain scarce. This study provides the first comprehensive assessment of arthroscopic knee procedures in Romania over a seven-year period (2017–2023), focusing on anterior cruciate ligament (ACL) reconstruction trends and related interventions. Using national hospital discharge data, all arthroscopic knee procedures were identified and analyzed by year, sex, age group, region, and hospital type. A total of 76,804 procedures were recorded, including 26,888 reconstructions (O15301/O15303) and 29,979 meniscectomies (O13404). ACL reconstructions increased from 1560 cases in 2017 (7.9/100,000 inhabitants) to 1865 in 2023 (9.8/100 k), with a marked decline in 2020 (5.3/100 k) due to the COVID-19 pandemic and full recovery thereafter. Men predominated in ACL reconstructions (74%; 8226 males vs. 2854 females), whereas meniscectomy peaked in middle-aged adults (50–54 years: 48.7/100 k). Surgical activity was highly centralized, with five counties performing over two-thirds of all ACL reconstructions. Approximately 89% of procedures were conducted in public hospitals. These findings reveal substantial progress but also persistent regional and demographic inequities. Strengthening access, standardizing indications for degenerative meniscal surgery, and establishing a national ACL registry could support equitable, evidence-based advancement of arthroscopic care in Romania. Full article

Intraoperative ultrasound (IOUS) has developed from a rudimentary adjunct into a versatile modality that now plays a crucial role in neurosurgery. Offering real-time, radiation-free and repeatable imaging at the surgical site, it provides distinct advantages over intraoperative magnetic resonance (MRI) and computed tomography (CT) in terms of accessibility, workflow integration and cost. The clinical spectrum of IOUS is broad: in cranial surgery it enhances the extent of resection of gliomas and metastases, supports dissection in meningiomas and enables localization of MRI-negative pituitary adenomas; in spinal surgery, it guides resection of intradural and intramedullary tumors, assists in myelotomy planning and confirms decompression in degenerative conditions such as cervical myelopathy and ossification of the posterior longitudinal ligament. IOUS also offers unique insights into cerebrospinal fluid disorders, including arachnoid webs, cysts, syringomyelia and Chiari malformation, where it visualizes cord compression and CSF flow restoration. In trauma and oncological emergencies, it provides immediate confirmation of decompression, directly influencing surgical decisions. Recent innovations, including contrast-enhanced ultrasound, elastography, three-dimensional navigated systems and experimental integration with artificial intelligence and robotics, are extending its functional scope. Despite heterogeneity of evidence and operator dependence, IOUS is steadily transitioning from an adjunctive tool to a cornerstone of multimodal intraoperative imaging, bridging precision, accessibility and innovation in contemporary neurosurgical practice. Full article

Objectives: This study aimed to systematically compare the diagnostic accuracy of magnetic resonance imaging (MRI) and transvaginal ultrasound (TVUS) for deep infiltrating endometriosis (DIE) and to evaluate their impact on surgical decision-making. Methods: We carried out a systematic review of studies (2015–2025) comparing MRI and TVUS for DIE in the same patients, with surgical/histological confirmation used as the reference standard. The primary outcomes were sensitivity and specificity by lesion site; the secondary outcomes included the reported impact on surgical decision-making and treatment planning. Results: Nine studies met the inclusion criteria. For rectosigmoid lesions, the sensitivity was 79–94% for TVUS and 86–94% for MRI, with a high specificity for both (84–95%). TVUS demonstrated strong diagnostic accuracy for posterior compartment disease, but its sensitivity was notably lower for uterosacral ligament and bladder lesions (25–83%). MRI showed higher sensitivity for anterior and multi-compartmental lesions (75–94%), reflecting its superior anatomical coverage. Imaging informed surgical planning, ensuring the inclusion of subspecialists such as colorectal or urological surgeons. It also guided the extent of resection and need for radical versus conservative procedures. Conclusions: TVUS and MRI are complementary imaging modalities in the diagnosis and staging of DIE. TVUS offers high specificity and remains particularly effective for posterior compartment disease, whereas MRI provides broader anatomical coverage and higher sensitivity for anterior and multi-compartmental involvement. Importantly, integrating imaging into preoperative planning improves multidisciplinary coordination, optimises preparedness, and guides resection. This is the first review to systematically compare MRI and TVUS for DIE with an emphasis on lesion-level accuracy and the impact on surgical decision-making. Full article

Rehabilitation after anterior cruciate ligament reconstruction cannot be reduced to a linear, time-based sequence of protection, strength, and return to sport. Persistent asymmetries, quadriceps inhibition, and variable re-injury rates highlight that recovery is a complex adaptive process in which outcomes emerge from dynamic interactions between biological, neural, and psychological subsystems. Grounded in complexity science and chaos theory, this editorial reframes rehabilitation as the regulation of variability rather than its suppression. The Control–Chaos Continuum provides a practical structure to translate this concept into progressive exposure, where clinicians dose uncertainty as a therapeutic stimulus. Adaptive periodization replaces rigid stages with overlapping macro-blocks that respond to readiness, feedback, and context. Neuroplastic mechanisms and ecological dynamics justify the deliberate introduction of controlled “noise” to foster coordination, confidence, and resilience. Ultimately, the goal is not perfect control but stable performance under variability—the ability to function “at the edge of chaos.” This conceptual perspective articulates a clinically actionable framework—linking the Control–Chaos Continuum with adaptive periodization—to guide non-linear decision-making and safe return-to-sport. Full article

Age-related changes in facial ligaments contribute to altered facial shape and soft tissue descent. Radiofrequency (RF) has been utilized for skin rejuvenation by promoting collagen fiber contraction and synthesis through increased expression of heat shock proteins (HSPs). The primary component of ligamentous collagen fibers undergoes structural modifications with age, exhibiting increased fragmentation and a reduced collagen type I/III ratio. This study aimed to investigate whether RF irradiation alleviates senescence-related changes in facial ligaments through HSP70-mediated molecular remodeling using a UV-induced photoaging rat model. In senescent fibroblasts, RF enhanced the interaction between HSP70 and IκBα kinase (IKK)γ while reducing IκBα phosphorylation, which was associated with decreased nuclear factor-kappa B (NF-κB) activation. These RF-mediated changes were attenuated by an HSP70 inhibitor, suggesting that RF reduces NF-κB activity via HSP70 modulation. RF also suppressed expression levels of matrix metalloproteinases and SMAD7 in senescent fibroblasts. Consistent with in vitro findings, RF increased the interaction between HSP70 and IKKγ while decreasing IκBα phosphorylation and NF-κB activity in the UV-induced photoaging (senescent) facial ligaments of rat models. Furthermore, RF enhanced the collagen type I/III ratio and increased collagen fiber density within the ligaments. Scanning electron microscopy revealed that RF irradiation increased collagen fiber bundle diameter and enhanced the helical structure of those fibers. Overall, RF mitigates senescence-related changes in facial ligaments through HSP70 modulation. Considering that facial ligament laxity contributes to soft tissue descent, facial ligament-targeting approaches may promote a more youthful facial structure. RF demonstrates the possibility in reducing senescence-associated changes within facial ligaments. Full article

This study aimed to evaluate the diagnostic accuracy of T2 mapping on low-field (0.31 T) MRI for detecting low-grade knee chondropathy, using arthroscopy as the reference standard. Fifty-two patients (mean age 48.1 ± 17.2 years) undergoing arthroscopy for anterior cruciate ligament or meniscal tears were prospectively enrolled, excluding those with previous surgery, infection, or high-grade chondropathy (Outerbridge III–IV). MRI was performed with a 0.31 T scanner using a 3D SHARC sequence, and T2 relaxometric maps were generated for 14 cartilage regions per knee according to the WORMS classification. Arthroscopy, performed within one month by two blinded surgeons, served as the gold standard. A total of 728 regions were analyzed. T2 mapping differentiated healthy cartilage (grade 0) from early chondropathy (grades I–II) with an optimal cut-off of 45 ms and moderate discriminative accuracy (AUC = 0.714 for Reader 1 and 0.709 for Reader 2). Agreement with arthroscopy was good (κ = 0.731), with excellent intra-reader (ICC = 0.998) and good inter-reader reproducibility (ICC = 0.753). Most degenerative changes were located at the femoral condyles (59%). Low-field T2 mapping showed good diagnostic performance and reproducibility in detecting early cartilage degeneration, supporting its potential as a cost-effective and accessible quantitative biomarker for the assessment of cartilage integrity in clinical practice. Full article

Osteochondral lesions of the talus (OLTs) present a significant clinical challenge, often leading to pain, dysfunction, and joint degeneration. Traditional treatments, including microfracture and grafting, have limitations in their ability to fully restore osteochondral integrity. Recent advances in tissue engineering have introduced heparin-conjugated fibrin hydrogel (HCFH) as a promising scaffold for regenerative therapy. By supporting mesenchymal stem cell (MSC) proliferation and controlled growth factor release, HCFH enhances cartilage and bone repair. A 21-year-old female presented with chronic right ankle pain and instability following a sports injury, with MRI revealing an osteochondral lesion in the lateral dome of the talus and an anterior talofibular ligament injury. Treatment included autologous MSC isolation, HCFH synthesis, arthroscopic debridement, microfracture, and implantation of MSC-loaded HCFH, while postoperative rehabilitation involved four weeks of restricted weight-bearing- and physiotherapy. At 12 months, her visual analog scale (VAS) score decreased from 60 to 40, indicating clinical improvement, and her American Orthopaedic Foot and Ankle Society (AOFAS) score increased from 69 to 77. Serial MRI scans showed progressive cartilage regeneration with near-complete defect filling. This case highlights the potential of MSC-loaded HCFH in treating OLTs. The observed improvements in pain relief, function, and cartilage regeneration suggest that this technique may overcome the limitations of conventional treatments. Further studies with larger cohorts and long-term follow-up are necessary to confirm its clinical efficacy. Full article

Converting a medial unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) presents challenges in bone preservation, alignment, and soft-tissue balance. Robotic assistance enables three-dimensional CT-based planning, precise bone preparation, and real-time ligament balance assessment, thereby supporting a bone-preserving approach. We describe a stepwise workflow using the Mako system (Stryker) to convert a failed medial UKA to a condylar-stabilizing (CS) Triathlon TKA within a functional alignment framework. Pre-explantation registration on the in situ components maintains accuracy despite potential metallic artifacts. The polyethylene insert is briefly removed solely to access reference surfaces, then registration landmarks are acquired directly on the metal components along the marked central sagittal axis. The insert is reinserted to enable dynamic intraoperative balance evaluation. After component removal, a small medial tibial or femoral defect can be filled with autologous cancellous bone graft from the resected bone surfaces. Definitive cementless components are implanted without stems or augments, and the patella is resurfaced. This technique provides a reproducible robotic workflow for UKA-to-TKA conversion in selected cases with preserved bone stock and stable soft-tissue balance and facilitates accurate and reproducible conversion with optimal bone preservation. Full article

Periodontal regeneration remains one of the most demanding challenges in oral bioengineering due to the structural complexity of the periodontium and the inflammatory microenvironment accompanying disease. Conventional surgical and pharmacological therapies often fail to achieve full restoration of bone, ligament and cementum, prompting the development of cell-based and biomaterial-assisted approaches. This review summarizes current advances in cellular technologies for periodontal regeneration, emphasizing the biological rationale, material design and delivery methods shaping next-generation treatments. We discuss stem-cell-based strategies employing periodontal ligament, dental pulp and mesenchymal stem cells, their paracrine and immunomodulatory roles, and how their therapeutic potential is enhanced through integration into engineered scaffolds. Recent progress in hydrogel systems, microspheres, decellularized matrices and 3D bioprinting is analyzed, highlighting how structural cues, bioactive nanoparticles and gene-modified cells enable multi-tissue regeneration. Emerging delivery and biofabrication techniques, from manual seeding to automated and in situ printing, are reviewed as key determinants of clinical translation. The convergence of bioprinting precision, immune-responsive biomaterials and personalized cellular constructs positions periodontal bioengineering as a rapidly maturing field with strong prospects for functional restoration of diseased oral tissues. Full article

Background: FDA-approved artificial sweeteners (ASs) are widely used in food products due to their low-calorie content and high sweetness. However, growing evidence links them to adverse metabolic effects, including stroke and coronary heart disease. The musculoskeletal system, as a key metabolic target organ, has gradually gained attention, but the potential impact of ASs on its health remains unclear. Objective: This systematic review aims to assess the effects of ASs on bone and muscle, explore the underlying biological mechanisms and provide guidance for future research. Methods: A comprehensive literature search was conducted in PubMed, Embase, and Web of Science using relevant keywords from inception to 25 June 2025. Studies written in English, available in full text, and investigating FDA-approved ASs in relation to the musculoskeletal system were included. Two independent reviewers screened and selected the eligible studies. The findings were summarized using a narrative synthesis approach. Results: A total of 15 studies (12 preclinical, 3 clinical), covering aspartame, acesulfame potassium, sucralose, and saccharin were included from an initial pool of 662 articles identified across PubMed (168), Embase (368), and Web of Science (126). Among them, twelve studies focused on skeletal effects, four on muscles, and two on joints; three studies reported multiple outcomes. No studies investigated ligaments or tendons. Conclusions: Based on our search, this review provides a narrative synthesis of the available evidence on ASs influencing skeletal structure, development, biomechanical strength, and skeletal muscle metabolism. Potential mechanisms involve gut microbiota, oxidative stress, and signaling pathways such as SIRT1/FOXO3a and PGC-1α/UCP3. Further research is warranted to clarify these mechanisms and to assess the chronic health effects of long-term AS exposure on the musculoskeletal system in human populations. Full article

Background/Objectives: Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by calcification and ossification of ligaments and tendons, primarily affecting the spine. While often asymptomatic, DISH in the cervical spine can cause dysphagia and, more rarely, vocal cord paralysis due to compression of the recurrent laryngeal nerve at the cricothyroid joint. Here, we report cases of unilateral vocal fold paresis in two patients with DISH. Case Presentation: Our first case is an 80-year-old male presented with two months of dysphonia. Strobovideolaryngoscopy found left vocal fold paresis with glottic insufficiency. Computed Tomography (CT) imaging showed DISH with large anteriorly projecting osteophytes in the cervical spine causing rightward deviation of the laryngeal structures and compressing the cricothyroid joint. Second, a 30-year-old female with Turner Syndrome and subglottic stenosis who developed progressively worsening dysphonia over 6 months, characterized by diminished voice projection and clarity. Strobovideolaryngoscopy revealed a mild-to-moderate right vocal fold paresis. CT of the neck demonstrated multiple right-sided osteophytes projecting into the right tracheoesophageal groove, along the course of the right recurrent laryngeal nerve, in the absence of significant disc degeneration. Discussion and Conclusions: On our review of the literature, no other similar instances of unilateral vocal fold paresis were found. We present these cases to emphasize the need for early recognition and treatment to prevent symptom progression of DISH. Full article

Background/Objectives: Outcomes following Anterior Cruciate Ligament (ACL) reconstruction vary widely among patients, yet existing classification techniques often lack transparency and clinical interpretability. To address this gap, we developed a multi-modal framework that integrates gait dynamics with patient-specific characteristics to enhance personalized assessment of ACL reconstruction outcomes. Methods: Participants, both post-ACL reconstruction and healthy controls, were equipped with inertial measurement unit (IMU) sensors on bilateral wrists, ankles, and the sacrum during standardized locomotion tasks. Using the Phase Slope Index (PSI), we quantified causal relationships between sensor pairs, hypothesizing that (1) PSI-derived metrics capture discriminative biomechanical interactions; (2) task-specific differences in segment coordination patterns influence model performance; and (3) recovery duration modulates classifier confidence and the structure of high-dimensional data distributions. Classification models were trained using PSI features, and permutation-based sensor importance analyses were conducted to interpret task-specific biomechanical contributions. Results: PSI-based classifiers achieved 96.37% accuracy in distinguishing ACL reconstruction outcomes, validating the first hypothesis. Permutation importance revealed that jogging tasks produced more focused importance distributions across fewer sensor pairs while improving accuracy, confirming task-specific coordination effects (hypothesis two). Visualization via t-SNE demonstrated that longer recovery durations corresponded to reduced model confidence but more coherent feature clusters, supporting the third hypothesis. Conclusions: By integrating causal gait metrics and patient recovery profiles, this approach enables interpretable and high-performing ACL outcome prediction. Quantitative evaluation measures—including model confidence and t-SNE cluster coherence—offer clinicians objective tools for personalized rehabilitation monitoring and data-driven return-to-sport decisions. Full article

Objectives: Previous studies have suggested the potential for semitendinosus (ST) tendon regeneration following harvesting for anterior cruciate ligament (ACL) reconstruction. This retrospective cross-sectional (observational) study aims to evaluate ST tendon regeneration using high-resolution ultrasound (US), with special reference to morphological and structural changes in the muscle–tendon unit. Methods: Twenty-four patients who had undergone ST tendon harvesting at least 24 months prior were evaluated. Ultrasound assessment included neotendon (NT) detection, thickness, echotexture, insertion site, dynamic gliding, myotendinous junction (MTJ) shifting, and muscle cross-sectional area (CSA), compared with the healthy contralateral side. Results: ST tendon regeneration was detected in 19/24 patients (79%). In regenerated tendons, NT thickness was significantly greater than the native tendon (3.40 ± 1.38 mm vs. 2.40 ± 0.27 mm; mean difference 0.98 mm; p = 0.005. Subgroup analysis revealed that fibrillar-like NTs were associated with a smaller MTJ shift (3.91 ± 1.14 cm vs. 7.75 ± 2.43 cm; p = 0.001) and higher muscle CSA preservation (0.85 ± 0.10 vs. 0.55 ± 0.09; p < 0.001). A strong inverse correlation was found between MTJ displacement and muscle CSA (ρ = −0.96; p < 0.001). Patients without NT regeneration (n = 5) exhibited more pronounced MTJ retraction (11.0 ± 1.0 cm) and muscle hypotrophy (CSA ratio 0.41 ± 0.07), although these results were descriptive. Conclusions: High-resolution US is an effective, non-invasive method for assessing ST tendon regeneration from a qualitative and quantitative perspective. Our findings indicate possible changes in the architecture and position of the regenerated tendon, the MTJ, and the muscle belly, which may reflect structural remodeling of the muscle–tendon unit. Full article

Background: While gravity-assisted ankle stress AP (GAASA) images have proven effective in evaluating deep deltoid ligament injuries, their efficacy in assessing syndesmosis injuries remains unclear. We aimed to investigate the diagnostic performance of GAASA images in detecting syndesmosis injuries. Methods: This study reviewed records of patients aged 16+ with unilateral ankle fractures in a single-center ER from 2022 to 2023. Three orthopedic surgeons evaluated standard AP and lateral X-rays, ankle mortise, and GAASA and bilateral ankle CT images in blinded sessions for syndesmosis injuries. Evaluations were repeated to assess the inter- and intra-rater reliability. Results: A total of 121 patients with suspected syndesmosis injuries were included in this study. The average age of the patients was 49.9 ± 16.6 years. Syndesmosis injuries were present in 32.2% of cases. The inter-observer reliability was the highest for GAASA images (κ = 0.701) and mortise radiographs (κ = 0.735), and lowest for CT images (κ = 0.426). GAASA images had a sensitivity of 82% and specificity of 68%. Mortise images had 55% sensitivity and 81% specificity. GAASA images showed better discriminatory power for syndesmosis injuries compared to mortise and CT images. Conclusions: GAASA images demonstrated superior sensitivity and better negative predictive values in detecting syndesmosis injuries compared to mortise radiographs and CT images. While GAASA may serve as a useful adjunct for evaluating syndesmosis injuries, its interpretation requires careful clinical correlation, and it should not be considered a replacement for standard imaging in all cases. GAASA may be of particular value in emergency or resource-limited settings where CT is not readily available, offering a practical option for ruling out injury in many patients. Full article

Spinodoid nanocubes, inspired by spinodal decomposition, feature bicontinuous dual-phase architectures with high interfacial area, offering a promising platform for tuning nanoscale mechanics. In the present study, classical molecular dynamics simulations are carried out to investigate the mechanical properties and deformation behaviors of Au/Cu dual-phase spinodoid nanocubes. It is revealed that the ligament size of the spinodoid structure strongly influences material strength. As ligament size decreases, the strength of nanocubes increases until reaching a critical threshold, beyond which further refinement induces softening. This transition is governed by the semi-coherent interfaces through two competing mechanisms: for ligament sizes above the critical threshold, interfaces primarily impede dislocation motion, thereby strengthening the material; for smaller ligaments, interfacial plasticity, such as atomic rearrangements within the interface, provides a dominant softening mechanism. These findings highlight the critical role of characteristic length scale in determining the strength of nanocubes, and offer guidance for tailoring the mechanical performance of nanoscale dual-phase materials through structural design. Full article