bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ezetimibe/Atorvastatin, a Treatment for Hyperlipidemia, Inhibits Supraspinatus Fatty Infiltration and Improves Bone-Tendon Interface Healing in a Rotator Cuff Tear Rat Model
Authors: Yoon Jong Pil , Park Sung-Jin , Kim Dong-Hyun , Choi Yoon Seong , Lee Hyun Joo , Park Eugene Jae Jin , Cho Chul-Hyun , Chung Seok Won 
Published: January 2025

Background: Multiple factors, such as muscle fatty infiltration (FI), tendon collagen content, and collagen arrangement, determine bone-tendon interface (BTI) healing after rotator cuff (RC) repair. Purpose: To evaluate the effects of systemic administration of ezetimibe-atorvastatin (EZE/ATZ) combination on muscle FI and tendon collagen density and arrangement in an RC repair rat model. Study design: Controlled laboratory study. Methods: A total of 26 male Sprague-Dawley rats were randomly divided equally into control and EZE/ATZ groups and subjected to RC tendon repair surgery. Postoperatively, the EZE/ATZ group rats received a combination of EZE (10 mg/kg/d) and ATZ (20 mg/kg/d) for 4 weeks, after which they were sacrificed. Oil Red O staining was used to assess FI in the supraspinatus muscle. The expression of biomarkers related to muscle atrophy and FI was measured using quantitative real-time polymerase chain reaction. For the qualitative and quantitative analysis of FI-related biomarkers, immunohistochemical staining was performed. Biomechanical and histological analyses were performed to evaluate the quality of BTI healing after RC repair. Results: The EZE/ATZ group showed significantly lower FI compared with the control group ( P < .001) and significantly downregulated expression of gene markers related to muscle atrophy and FI. On histological analysis, the EZE/ATZ group exhibited increased collagen type I contents, consistent collagen arrangement ( P = .005), and significantly higher collagen density ( P = .003) compared with the control group. Biomechanical analysis of the BTI healing revealed that the EZE/ATZ group had significantly increased ultimate strength ( P = .006) compared with the control group. Conclusion: Systemic EZE/ATZ administration suppressed supraspinatus FI by downregulating muscle atrophy–related and FI-related genes after RC repair. Additionally, EZE/ATZ use improved collagen biosynthesis, density, and arrangement at the BTI and significantly increased tensile strength. Clinical Relevance: The results of the current study strongly advocate the use of EZE/ATZ to improve shoulder function and tendon healing after RC repair.
Clinical Outcomes of Hip Abductor Repair Using Transosseous Sutures Versus Suture Anchors: A Systematic Review and Meta-analysis
Authors: Portela-Parra Eduardo , Sappey-Marinier Elliot , Julian Kaitlyn , Bini Stefano A. 
Published: January 2025

Background: Hip abductor tendon tears have been identified as a common cause of greater trochanteric pain syndrome. While abductor tendon tears are often managed surgically, the optimal tendon attachment technique remains controversial. Purpose: To compare the outcomes of hip abductor tendon repair between the suture anchor (SA) and transosseous suture (TS) techniques. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was performed in June 2023 in Embase, PubMed, and Web of Science databases. Studies reporting pre- and postoperative clinical outcomes of hip abductor repairs using SA or TS fixation with a minimum follow-up of 12 months were included in our analysis. From 608 studies initially identified, 21 studies (14 SA and 7 TS) with a total of 680 patients met the inclusion criteria. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist guided the reporting and data abstraction, and the quality of the studies was assessed using the methodological index for non-randomized studies checklist. The results were presented as a narrative summary using descriptive statistics such as ranges and agreement statistics. Results: Significant pre- to postoperative improvement in pain scores and functional outcomes were reported on all included studies. The mean improvement on the Harris Hip Score/modified Harris Hip Score was 32.5 (95% CI, 28.4-36.7) for the SA technique versus 21.9 (95% CI, 6.7-37.0) for the TS technique, while mean improvement in pain according to the visual analog scale was 5.1 ± 2.3 for SA and 4.8 ± 2.2 for TS ( P = .9). There was a trend toward statistical significance regarding retear rates, with higher rates for SA (6.7% ± 7.6%) versus TS (1.3% ± 4.7%) ( t[13.9] = 2.0; P = .06). Conclusion: We observed no significant difference between SA and TS regarding improvements in patient-reported hip outcome and pain scores. However, SA trended toward a higher retear rate. Future research should propose a classification scheme that considers tear size and morphology, the extent of associated muscle degeneration, and the distance of tendon retraction to provide more context for the understanding of expected functional outcomes.
Modular dual-mobility constructs outperformed large femoral heads in 299 revision total hip arthroplasties at mid-term follow-up
Authors: Carender Christopher N. , Bedard Nicholas A. , Fruth Kristin M. , Taunton Michael J. , Pagnano Mark W. , Abdel Matthew P. 
Published: January 2025

AimsThe purpose of this study was to directly compare the Modular Dual Mobility (MDM) Mobile Bearing Hip System (Stryker, USA) and large femoral heads (LFHs) in revision total hip arthroplasties (THAs) at mid-term follow-up, with specific emphasis on survival free of re-revision for dislocation, any re-revision, dislocation, and the risk of metal-related complications.MethodsWe identified 299 revision THAs performed at a single tertiary care academic institution from March 2011 to July 2014. Aseptic loosening of the acetabular component (n = 65), dislocation (n = 58), and reimplantation as part of a two-stage exchange protocol (n = 57) were the most common reasons for index revision. MDM constructs were used in 123 cases, and LFHs were used in 176 cases. Mean age was 66 years (28 to 93), mean BMI was 31 kg/m2 (18 to 55), and 45% (n = 136) were female. Mean follow-up was seven years (2 to 12).ResultsThe ten-year survival free of re-revision for dislocation was 99% (95% CI 95 to 100) in the MDM cohort and 91% (95% CI 84 to 96) in the LFH cohort, with a significantly increased risk of re-revision for dislocation in the LFH cohort (HR 7.1 (95% CI 1.3 to 40.8); p = 0.023). The ten-year survival free of any re-revision was 92% (95% CI 82 to 99%) in the MDM cohort and 84% (95% CI 74 to 90) in the LFH cohort with a significantly increased risk of any re-revision in the LFH cohort (HR 2.6 (95% CI 1.1 to 5.9); p = 0.024). The ten-year survival free of any dislocation was 95% (95% CI 85 to 99) in the MDM cohort and 87% (95% CI 78 to 92) in the LFH cohort with a significantly increased risk of any dislocation in the LFH cohort (HR 2.7 (95% CI 1.1 to 6.3); p = 0.028). There were no re-revisions or reoperations for metallosis or corrosion in the MDM cohort.ConclusionIn this head-to-head comparison, revision THAs with a MDM construct safely and effectively lowered the risk of re-revision for dislocation, any re-revision, and any dislocation compared to LFH at mid-term follow-up. There were no re-revisions or reoperations for metallosis or corrosion in the MDM cohort.Cite this article: Bone Joint J 2025;107-B(1):58–64.
Association between postoperative zonal fixation of hybrid tibial components in revision total knee arthroplasty and subsequent aseptic loosening
Authors: van Laarhoven Simon N. , Nota Sjoerd P. F. T. , van Hellemondt Gijs G. , Schreurs Berend W. , Wymenga Ate B. , Heesterbeek Petra J. C. 
Published: January 2025

AimsTibial fixation in revision total knee arthroplasty (rTKA) can present surgical challenges. It has been suggested that appropriate fixation in at least two of the three anatomical zones (epiphysis, metaphysis, and diaphysis) is essential for implant survival. However, supporting clinical data are lacking. In this retrospective case-control study, we investigated the relationship between zonal fixation of hybrid rTKA tibial components and re-revision total knee arthroplasty for aseptic loosening (rrTKA-AL).MethodsAll consecutive rTKAs with hybrid tibial components (May 2006 to December 2020) were screened for subsequent rrTKA-AL. A control group was randomly selected from the remaining cohort. Postoperative radiographs of rTKAs were scored in random order by three blinded observers for zonal fixation in the epiphysis (bone resection level below, at, or above fibular head; 0 to 2), metaphysis (number of sufficiently cemented zones; 0 to 4), and diaphysis (canal filling ratio (CFR); %). The intraclass correlation coefficient (ICC) was calculated to quantify the agreement between observers. Multivariate logistic regression analysis was performed to assess the relationship between zonal fixation and rrTKA-AL.ResultsOverall, 33 patients underwent a further rrTKA-AL from a total of 1,173 rTKAs where hybrid tibial components (2.8%) were used. Patients requiring rrTKA-AL had a significantly lower epiphyseal bone resection level (OR 0.43; 95% CI 0.23 to 0.76; p = 0.006), lower number of adequately cemented zones (OR 0.50; 95% CI 0.30 to 0.79; p = 0.004), but no difference in CFR (p = 0.858). Furthermore, patients needing rrTKA-AL had more frequently previous revisions (p = 0.047), a higher rate of a prior use of a stemmed tibial component (p = 0.011), and a higher Anderson Orthopaedic Research Institute classification (p < 0.001). Agreement of zonal fixation between observers was good (ICC 0.79 to 0.87).ConclusionPatients in need of subsequent rrTKA-AL had lower epiphyseal bone resection levels and a lower number of sufficiently metaphyseal cemented zones following rTKA. These results emphasize the importance of appropriate metaphyseal fixation at rTKA. With this information, orthopaedic surgeons can identify patients at greater risk for rrTKA-AL and optimize their surgical technique in revision knee arthroplasty surgery.Cite this article: Bone Joint J 2025;107-B(1):65–71.
National and regional trends in the prevalence of Perthes’ disease among the male population in South Korea
Authors: Kim Hong J. , Yoon Pil W. , Cho Euihwan , Jung Inyong , Moon Jun-Ki 
Published: January 2025

AimsWe evaluated the national and regional trends from 2013 to 2022, in the prevalence of Perthes’ disease among adolescent males in South Korea.MethodsThis retrospective, nationwide, population-based study included a total of 3,166,669 Korean adolescent males examined at regional Military Manpower Administration (MMA) offices over ten years. Data from the MMA were retrospectively collected to measure the national and regional prevalence per 100,000 and 95% CI of Perthes’ disease according to the year (1 January 2013 to 31 December 2022) and history of pelvic and/or femoral osteotomy in South Korea. Spearman’s correlation analysis was performed to assess the relationship between the Perthes’ disease prevalence and several related factors.ResultsThe prevalence of Perthes’ disease showed a gradually increasing trend for a ten-year follow-up period from 2013 to 2022 with a mean of 71.17 (95% CI 61.82 to 80.52) per 100,000, ranging from 56.02 (95% CI 48.34 to 63.71) in 2013 to 77.53 (95% CI 67.94 to 87.11) in 2019. The proportion of patients with a Stulberg classification ≥ III ranged from 50.57% in 2015 to 80.08% in 2019, showing a gradually increasing trend. Following the trend for Perthes’ disease, an increase in the proportion of pelvic and/or femoral osteotomies was observed, whereas conservative treatment decreased in adolescent males. For a ten-year follow-up period, the prevalence of Perthes’ disease was highest in provinces, followed by the metropolitan area and Seoul.ConclusionThe prevalence of Perthes’ disease in adolescent males increased over time from 2013 to 2022. In particular, the trend in the prevalence of Perthes’ disease with incongruent hips was significantly associated with overweight and obesity rates among male adolescents with a very high level of correlation.Cite this article: Bone Joint J 2025;107-B(1):42–49.
Do patients with minimally displaced distal radial fractures need a plaster cast?
Authors: Costa Matt L. , Appelboam Andy , Johnson Nick A. , Mechlenburg Inger , Gundtoft Per H. 
Published: January 2025

Traditionally, patients with a fracture of the distal radius are treated in a cast if they do not require surgery. If the fracture requires manipulation, the cast is moulded to hold the reduction and maintain normal anatomical alignment during healing. However, is a cast necessary for patients whose fracture does not require manipulation? Removable splints are an alternative treatment option. Such splints have the advantage that they can be adjusted to improve fit around the wrist as swelling reduces, and can be removed and reapplied for the purpose of washing or, in some cases, exercise. However, evidence for their safety and effectiveness in the management of distal radius fractures is lacking. DRAFT3 is a multicentre randomized non-inferiority trial and economic analysis designed to determine the safety and effectiveness of removable splints as an alternative to casts in the treatment of distal radius fractures that do not require manipulation.Cite this article: Bone Joint J 2025;107-B(1):7–9.
Assessing the effectiveness of suprascapular nerve block in the treatment of frozen shoulder
Authors: Bennett Jonathan , Patel Neal , Nantha-Kumar Nakulan , Phillips Veronica , Nayar Sandeep K. , Kang Niel 
Published: January 2025

AimsFrozen shoulder is a common and debilitating condition characterized by pain and restricted movement at the glenohumeral joint. Various treatment methods have been explored to alleviate symptoms, with suprascapular nerve block (SSNB) emerging as a promising intervention. This meta-analysis aimed to assess the effectiveness of SSNB in treating frozen shoulder.MethodsThe study protocol was registered with PROSPERO (CRD42023475851). We searched the MEDLINE, Embase, and Cochrane Library databases in November 2023. Randomized controlled trials (RCTs) comparing SSNB against other interventions were included. The primary outcome was any functional patient-reported outcome measure. Secondary outcomes were the visual analogue scale (VAS) for pain, range of motion (ROM), and complications. Risk of bias was assessed using the Cochrane risk of bias v. 2.0 tool.ResultsA total of 12 RCTs were identified (702 patients; mean age 55 years (30 to 72)). Eight RCTs were deemed “low” risk-of-bias and four raised “some concerns”. Comparator interventions included intra-articular steroid injection (IAI), hydrodistension, physiotherapy, and placebo injection with 0.9% saline. Seven studies compared SSNB to IAI, with SSNB resulting in greater improvement in the Shoulder and Pain Disability Index (mean difference -4.75 (95% CI -8.11 to -1.39); p = 0.006) and external rotation (mean difference 11.64 (95% CI -0.05 to 23.33); p = 0.050). In three studies, SSNB demonstrated better VAS (mean difference -0.31 (95% CI -0.53 to 1.79); p = 0.004) compared to physiotherapy (with or without placebo injection). One study favoured hydrodistension over SSNB in improving ROM and VAS. There was no significant difference in outcomes between SSNB administered under ultrasound guidance or using a landmark technique.ConclusionSSNB can be administered in the outpatient clinic with promising outcomes compared to IAI or physiotherapy based on level I evidence. It can therefore be considered as a first-line treatment option.Cite this article: Bone Joint J 2025;107-B(1):19–26.
Don’t mind the gap: reframing the Perren strain rule for fracture healing using insights from virtual mechanical testing
Authors: Tanveer Maham , Klein Karina , von Rechenberg Brigitte , Darwiche Salim , Dailey Hannah L. 
Published: January 2025

AimsThe “2 to 10% strain rule” for fracture healing has been widely interpreted to mean that interfragmentary strain greater than 10% predisposes a fracture to nonunion. This interpretation focuses on the gap-closing strain (axial micromotion divided by gap size), ignoring the region around the gap where osteogenesis typically initiates. The aim of this study was to measure gap-closing and 3D interfragmentary strains in plated ovine osteotomies and associate local strain conditions with callus mineralization.MethodsMicroCT scans of eight female sheep with plated mid-shaft tibial osteotomies were used to create image-based finite element models. Virtual mechanical testing was used to compute postoperative gap-closing and 3D continuum strains representing compression (volumetric strain) and shear deformation (distortional strain). Callus mineralization was measured in zones in and around the osteotomy gap.ResultsGap-closing strains averaged 51% (mean) at the far cortex. Peak compressive volumetric strain averaged 32% and only a small tissue volume (average 0.3 cm3) within the gap experienced compressive strains > 10%. Distortional strains were much higher and more widespread, peaking at a mean of 115%, with a mean of 3.3 cm3 of tissue in and around the osteotomy experiencing distortional strains > 10%. Callus mineralization initiated outside the high-strain gap and was significantly lower within the fracture gap compared to around it at nine weeks.ConclusionOvine osteotomies can heal with high gap strains (> 10%) dominated by shear conditions. High gap strain appears to be a transient local limiter of osteogenesis, not a global inhibitor of secondary fracture repair.Cite this article: Bone Joint Res 2025;14(1):5–15.
The use of chitosan-coated biochar for the improvement of heavy metals-contaminated soil and healthy food products
Authors: Hamzah Amir , Priyadarshini Rossyda , Lestari Sri Umi 
Published: January 2025

Soil health is a global concern related to food health issues, and the intensity of using agrochemicals contributes greatly to contamination by Pb (lead), Cd (cadmium), Cu (copper), Zn (zinc), and other heavy metals. Land contaminated with heavy metals is absorbed by plants and transferred to tissue, causing food to be unhealthy for consumption. Soil improvers such as biochar and chitosan have been widely used for improvement, but the use remains partial. In this context, granular coating technology is the right choice for overcoming soil problems. Chitosan-coated biochar technology is an effort to combine biochar and chitosan, which are made into granules and function as soil amendments. Therefore, this study aimed to obtain oil amendments that are effective in reducing heavy metals in soil. The target was for the soil to be healthy as well as produce healthy and safe food products. A completely randomized design was used with three replications. The production of granular chitosan biochar was then investigated on vegetable plants. Growth observations were carried out every week until the plants were about to be harvested, while soil and heavy metal analysis was conducted before and after planting. The observed data were analyzed using an Analysis of Variance (ANOVA) and Least Significant Difference (LSD) tests. The results showed that a chitosan-coated biochar dose of 20 t/ha increased plant growth in all observed parameters. The use of chitosan-coated biochar reduced Pb from 10.77 mg/kg to 6.73 mg/kg, Cd from 5.01 mg/kg to 2.56 mg/kg, and Cu from 71.22 mg/kg to 25.65 mg/kg.
Safety of 1 mcg/mL as the starting dose in cluster protocol for hymenoptera immunotherapy
Authors: Bemanian Mohammad Hassan , Arshi Saba , Nabavi Mohammad , Fallahpour Morteza , Shokri Sima , Sharifinejad Niusha , Bahrami Sima 
Published: January 2025

Background: Hymenoptera venom allergy is a potentially severe allergic reaction in the general population. The only preventative approach in these cases is venom immunotherapy (VIT), which follows different protocols. The recommended initial dose is 0.001–0.1 mcg of venom extract. However, few reports have declared the safety of 1 mcg venom as the starting dose.
Methods: The study was conducted on Iranian patients with a history of anaphylaxis to venom. Skin tests confirmed hypersensitivity to honeybee, yellow jacket, and/or paper wasp from subfamily Polistes using Apis melifera, Vespula spp, and Polistes spp venom extracts, respectively. Subsequently, the patients were treated with the cluster protocol.
Results: Twenty-two patients (17 males and 5 females, aged 28.3±11.8 years) were enrolled in the study. Skin prick tests and intradermal tests showed positive results for yellow jacket in 17 (77.3%) and 21 (95.4%) patients, honeybee in 14 (63.6%) and 17 (77.3%) patients, and wasp in 14 (63.6%) and 17 (77.3%) patients, respectively. Upon administering the initial dose of 1 mcg/mL, 40.9% (9 cases) of patients presented mild local reactions, including 7 with yellow jacket allergy, 5 with honeybee allergy, and 3 with wasp allergy. One patient with yellow jacket allergy had a mild systemic reaction. Patients with a positive skin test for wasp had significantly lower rate of reactions after the first dose of venom (p=0.026). Throughout the entire build-up phase, more than 90% (20 of 22) of patients experienced mild local reactions, followed by large local reactions (3 cases, 13.6%), mild systemic reactions (1 case at 1 mcg/mL dose), and moderate-to-severe systemic reactions (3 cases, 13.6%). Large local and moderate-to-severe systemic reactions were detected after injecting 50 mcg (each one case) and 100 mcg (each 2 cases) of venom extracts.
Conclusion: This study recommends 1 mcg/mL of the venom extract as a safe starting dose for VIT. This accelerated protocol could successfully reduce the time and costs of therapy for patients undergoing out-patient cluster VIT.
Anaphylaxis due to green beans (Phaseolus vulgaris): a new phenotype?
Authors: Menéndez Rivero Estela , Prados Castaño Manuel , Domínguez Romero Isabel María , Martínez Martínez María José , De La Losa Fernando Pineda 
Published: January 2025

Background: Anaphylaxis is a severe allergic reaction with increasing incidence in Europe. It is often caused by food, insect venom, and drugs. White, red, and green beans (Phaseolus vulgaris) are legumes of the Fabaceae family consumed worldwide. In Spain, beans are the third most consumed legume species after chickpeas and lentils. Allergy to different legumes is very frequent in children and represents the fifth cause of food allergy.
Objective: Demonstrate a new phenotype in patients with green bean anaphylaxis.
Material and Methods: We report a 20-year-old woman who experienced anaphylaxis after consuming cooked green beans and required emergency treatment. There were no associated cofactors such as medications, alcohol, or physical exercise. After the episode, she tolerated well nuts, garlic, chickpeas, peas, and soy. Prick-prick with raw and cooked green bean, ISAC, SDS-PAGE and IgE-Western blot were performed.
Results: The prick+prick test with raw and cooked green beans was positive. The sodium dodecyl sulfate–polyacrylamide gel electrophoresis–immunoglobulin E (SDS-PAGE/IgE)–western blot analysis with white and red beans as well as cooked and raw green beans showed identification of several proteins with a molecular weight of 25–75 kDa in the extract of raw beans. Only one protein with a molecular weight of approximately 10 kDa was recognized in cooked beans.
Conclusion: We present a case of anaphylaxis induced by green beans (Phaseolus vulgaris) because of a 10-kDa protein and tolerance to other legumes, which suggests a new phenotype.