Trauma and orthopaedics

Criteria for Return to Running After Surgical Repair of Acute Achilles Tendon Rupture: A Modified Delphi Consensus Study (2026)

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Type of publication:

Journal article

Author(s):

Gaspar, Maxime; Maffulli, Nicola; Memain, Geoffrey; *Carmont, Michael R; Hardy, Alexandre; Arnaud, Choplin.

Citation:

Sports Medicine. 2026 Jul 26.

Abstract:

BACKGROUND: The annual incidence of Achilles tendon ruptures has increased by almost 3%. Despite the large amount of data available on post-injury treatment, there is a lack of evidence-based criteria to guide return to running after surgery.

OBJECTIVE: The aim of this study was to reach a consensus among experts on the criteria for resuming running following surgery for Achilles tendon rupture.

METHODS: Thirty-five international Achilles tendon experts were invited to participate in this modified Delphi study. The study was conducted in three rounds, with a threshold of 75% agreement (or disagreement) required for an item to achieve consensus. Sixteen clinical criteria were submitted to the expert panel. A five-point Likert scale was used. The study was conducted between January and June 2025.

RESULTS: Eight criteria achieved consensus after three rounds: seven criteria reached consensus for inclusion, and one criterion reached consensus for exclusion (calf circumference symmetry). The seven criteria were (1) the absence of pain in daily life; (2) the absence of pain during and after rehabilitation sessions; (3) walking without limping; (4) the ability to walk on tiptoes; (5) the ability to perform ten single-leg heel rises; (6) good single-leg balance; and (7) the patient feeling psychologically ready to resume running.

CONCLUSION: An expert consensus on the criteria to return to running after surgery for Achilles tendon rupture has been developed. These criteria, agreed by experts, may inform clinical decision making regarding return to running, but they require prospective validation before they can be used as decision rules. Further studies are needed to refine these criteria and evaluate their impact on functional outcomes during the return-to-running phase.

DOI: 10.1007/s40279-026-02506-4

Trochanteric Buttress Plate Augmentation of the Proximal Femoral Nail for Unstable Intertrochanteric Fractures: A Randomized Controlled Trial (2026)

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Type of publication:

Randomised controlled trial

Author(s):

*Abdelaty Shalaby, Mohamed H; *Khafagy, Doaa G; Hosny, Mohamed M; Eltantawy, Ahmed E; Omran, Ali M.

Citation:

Cureus. 18(2):e104235, 2026 Feb.

Abstract:

BACKGROUND: Unstable intertrochanteric (IT) fractures pose a significant challenge in orthopedic surgery.

OBJECTIVE: To investigate the effectiveness of combining a trochanteric buttress plate (TBP) with a proximal femoral nail (PFN) for managing unstable IT fractures.

METHODS: This randomized controlled open-label study was performed on 90 patients with recent unstable IT fractures (Evans types 1c, 1d, 1e, or 2). Patients were randomly divided into two groups: Group A was treated with standard PFN fixation. Group B was treated with PFN integrated with TBP augmentation. Assessments were conducted at two weeks and monthly for six months. Functional outcomes were assessed using the modified Harris Hip Score (mHHS).

RESULTS: Operative time and blood loss were significantly higher in Group B (PFN+TBP) than in Group A (standard PFN) (P = 0.005 and 0.006, respectively). Postoperative mHHS was significantly higher in Group B at all follow-up intervals from two weeks to six months (P < 0.05).

CONCLUSIONS: The integration of the TBP with PFN for unstable IT fractures significantly improves functional outcomes without increasing major complications, despite a modest increase in operative time and blood loss.

DOI: 10.7759/cureus.104235

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One-Stage or Two-Stage Revision for Infected Shoulder Arthroplasty: A Head-to-Head Meta-Analysis of Comparative Studies (2026)

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Type of publication:

Systematic review

Author(s):

Selim, Amr; *Ibrahim, Abdelrahman; Abbas, Azhar; Sadiq, Salman; Farhan-Alanie, Muhamed M; *Ahmed, Mohammed Lyeeq; Rhee, Jae.

Citation:

JBJS Reviews. 14(7), 2026 Jul 01.

Abstract:

BACKGROUND: Periprosthetic joint infection (PJI) following shoulder arthroplasty is a devastating complication associated with substantial morbidity and revision burden. While 2-stage revision has traditionally been regarded as the gold standard for chronic shoulder PJI, single-stage revision has emerged as a potential alternative. The aim of this systematic review was to directly compare infection-related outcomes and complications between single-stage and 2-stage revision arthroplasties for shoulder PJI.

METHODS: This systematic review was prospectively registered with PROSPERO (CRD420251159566) and conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, EMBASE, and Web of Science were searched up to September 22, 2025. Comparative observational studies and randomized controlled trials (RCTs) evaluating single-stage vs. 2-stage revision for shoulder PJI in adults were eligible; no RCTs were identified. Primary outcomes were reinfection and infection control success; overall complications were secondary. Odds ratios (ORs) were calculated within each study and pooled using a random-effects model. Risk of bias was assessed with the Risk of Bias in Non-randomized Studies of Interventions tool, and the certainty of evidence was assessed using Grading of Recommendations Assessment,
Development and Evaluation.

RESULTS: Thirteen retrospective comparative studies involving 260 patients (127 single-stage and 133 two-stage) were included. Compared with 2-stage revision, single-stage revision showed a lower, but not statistically significant, odds of reinfection (OR 0.46, 95% confidence interval [CI] 0.21-1.04; p = 0.06; I2 = 0%) and overall complications (OR 0.52, 95% CI 0.18-1.53; p = 0.24; I2 = 0%) and a higher, but nonsignificant, odds of infection control success (OR 1.57, 95% CI 0.45-5.40; p = 0.48; I2 = 17%).

CONCLUSION: Single-stage revision demonstrated infection control and complication rates comparable with 2-stage revision for shoulder PJI. Although no statistically significant differences were observed, trends favored single-stage revision. Given that the certainty of the evidence was graded as low, these findings should be interpreted with caution, and high-quality RCTs are required to define optimal patient selection and surgical strategy.

LEVEL OF EVIDENCE: Therapeutic Level III.

DOI: 10.2106/JBJS.RVW.26.00055

Impact of surgical timing on wound complications following ankle fracture fixation: A 22-year retrospective cohort study (2026)

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Type of publication:

Journal article

Author(s):

Zahra, Wajiha; Gomaa, Abdul-Rahman; Babatunde, Jubril; Seifo, Mina; *Cool, Paul; *Pickard, Simon.

Citation:

Journal of Clinical Orthopaedics & Trauma. 76:103405, 2026 May.

Abstract:

Background: Ankle fractures are common injuries, with a significant proportion requiring surgical intervention. Despite established treatment principles, the optimal timing for open reduction and internal fixation (ORIF) remains debated. Concerns regarding wound infection risk have led some surgeons to delay fixation, while others advocate for early intervention. This study aimed to assess the impact of surgical timing on postoperative wound infections.

Methods: A retrospective review was conducted on 1130 patients with surgically treated closed ankle fractures at a single institution between 2000 and 2022. Patients were categorised into three groups based on time to surgery: Early (<48 h), Intermediate (48 h to 5 days), and Delayed (>5 days) with timing determined pragmatically according to soft-tissue condition, theatre availability, and both surgeon and patient preference. Postoperative complications, including superficial and deep wound infections, were recorded. The chi-squared test was used to assess associations between surgical timing and infection rates.

Results: There was no significant association between surgical timing and the incidence of superficial wound infections (p = 0.274). However, a significant difference was observed in deep wound infection rates (p = 0.014). Diabetes, particularly Type 1, was significantly associated with both superficial (p < 0.001) and deep infections (p = 0.019). Patients over 60 years had an increased risk of superficial infections (p = 0.016) but not deep infections (p = 0.261). Superficial wound infections required longer hospital stay (p < 0.001) due to the need for intravenous antibiotics and monitoring purposes, while the number of procedures significantly correlated with both superficial (p < 0.001) and deep infections (p < 0.001).

Conclusion: In this study, the timing to surgery did not influence postoperative superficial wound infection rates following ORIF for ankle fractures. However, differences were observed in deep wound infection rates. Patient-related factors including diabetes and age are predictors of wound complications. Length of hospital stay was longer in patients with infections.

Level of evidence: IV.

DOI: 10.1016/j.jcot.2026.103405

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A Prospective Study of the Operative Treatment of Clavicular Fractures (2026)

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Type of publication:

Journal article

Author(s):

Bhakar, Ranj; Chakrapani, Arjun S; Shaik, Arfaz; Alexander, Aaron; *Murugesan, Thivagar; Anbazhagan, Prasanna Kumar; Ghent, Dan.

Citation:

Cureus. 18(1):e102481, 2026 Jan.

Abstract:

Objective This study aimed to evaluate the functional and radiological outcomes associated with the operative management of displaced midshaft clavicular fractures using pre-contoured locking compression plates (LCPs), specifically in cases that met surgical indications such as fracture displacement, shortening, or comminution. Methodology In this prospective study, 30 adult patients with displaced midshaft or lateral clavicular fractures underwent open reduction and internal fixation (ORIF) with pre-contoured LCPs at a tertiary care center. Patients were followed clinically for six months postoperatively. Functional outcomes were assessed using the Constant-Murley Score (CMS), and radiological union was evaluated through serial radiographs. Data were analyzed using SPSS Statistics version 25.0 (IBM Corp., Armonk, NY), and results were reported as mean +/- standard deviation (SD). Results The mean age of the patients was 36.4 +/- 10.2 years, with 21 patients (70%) being male. The mean time to radiographic union was 12.8 +/- 2.3 weeks. At the final follow-up, the mean Constant-Murley Score (CMS) was 91.2 +/- 6.4, with 24 patients (80%) demonstrating excellent shoulder function. Complications were limited to two patients (6.7%), while three patients (10%) experienced superficial infections or implant-related irritation. There were no observed cases of nonunion or implant failure. Conclusions Operative fixation of displaced clavicular fractures using pre-contoured LCPs provides stable fixation, facilitates early mobilization, and results in excellent functional recovery with minimal complications. Surgical management may be considered in active adults with displaced fractures to help optimize outcomes.

DOI: 10.7759/cureus.102481

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A worldwide perspective on chronic Achilles tendon rupture: An ESSKA AFAS survey initiative (2026)

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Type of publication:

Journal article

Author(s):

Vide, Joao; Santos, Francisco; Dantas, Sofia; Seica, Emanuel; Caetano, Joao; Mendes, Daniel; Sousa, Manuel Resende; Anderson, Mette; Guelfi, Matteo; Hong, Choon Chiet; van Dijk, Pim; Spennacchio, Pietro; Cordier, Guillaume; van Dijk, Niek; Ling, Samuel; Hua, Yinghui; Vega, Jordi; Fernandes, Pedro; *Carmont, Michael.

Citation:

Knee Surgery, Sports Traumatology, Arthroscopy. 2026 Feb 06.

Abstract:

PURPOSE: Management of chronic Achilles tendon ruptures (CATR) varies according to patient and injury characteristics, but clear guidelines regarding the evaluation and treatment options are still lacking. This study aims to identify tendencies regarding the evaluation and management of CATR among foot and ankle orthopaedic surgeons. The research question is if there is any tendency regarding evaluation, preoperative planning, choice of surgical approach and technique for management of CATR.

METHODS: A web-based questionnaire was distributed through 56 national and international foot and ankle orthopaedic societies. Replies were pooled and analysed. A 'main tendency' was considered when 75% of the participants chose the same treatment method, a 'tendency' for 50%-75%, and 'no tendency' when less than 50% choose the same method.

RESULTS: A total of 667 orthopaedic surgeons from 60 countries participated. Most respondents were experienced, specialised foot and ankle surgeons; however, 68% managed fewer than five CATR annually. MRI was the predominant imaging modality selected for surgical planning (88%). Gap size (80%) is the principal determinant of technique selection, followed by time from injury (61%) and then patient age (57%). Open repair was the most common technique (66%). End-to-end repair for defects <2 cm was the only treatment tendency (68%). Rehabilitation strategies were heterogeneous, though plaster immobilisation in equinus (55%), walker boot use for partial weight-bearing (90%), and physiotherapy initiation at 4-6 weeks following surgery were common tendencies. Compared with acute ruptures, functional outcomes were perceived as slightly worse in CATR (54%).

CONCLUSION: This study confirms significant variation in CATR management internationally. While end-to-end repair is a consistent choice for gaps smaller than 2 cm, the variability observed in responses reflects the lack of evidence and clear treatment algorithms.

LEVEL OF EVIDENCE: Level IV.

DOI: 10.1002/ksa.70327

An Electromyographic Study Comparing Muscle Function During Supination and Pronation of the Forearm (2025)

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Type of publication:

Journal article

Author(s):

Kondi, Suresh; *Murugesan, Thivagar; Postans, Neil; Thumri, Paavana; Kantamaneni, Ketan; Ansari, Shahbaz; Pickard, Simon.

Citation:

Cureus. 18(1):e101255, 2026 Jan.

Abstract:

BACKGROUND: Forearm pronation and supination are fundamental movements essential for daily activities and clinical applications. While supinator and biceps brachii contribute to supination, and pronator quadratus and pronator teres facilitate pronation, the precise activation patterns and torque-dependent recruitment strategies of these muscles remain incompletely understood. Conflicting evidence exists regarding muscle contribution at varying load conditions, with implications for rehabilitation protocols, surgical planning, and prosthetic design.

PURPOSE: This study aimed to quantify and compare the electromyographic (EMG) activity of forearm rotator muscles during isometric contraction under progressively increasing torque loads during both supination and pronation movements.

METHODS: Four healthy right-handed subjects (3 males, 1 female; mean age 32.5 years) underwent simultaneous EMG and motion capture recording. Surface electrodes captured activity from biceps brachii, triceps, pronator teres, and pronator quadratus, while fine-wire electrodes measured supinator muscle activity. Participants maintained a neutral forearm position against applied loads of 1 kilogram positioned at increasing distances (10-35 cm) from the supination axis, creating progressively higher torques. EMG signals were filtered, rectified, normalized, and analyzed using root mean square values across three trials per loading condition.

RESULTS: During supination resistance, the supinator demonstrated higher activation at lower torques compared to the biceps brachii. As applied torque increased, the biceps brachii activity increased proportionally more than the supinator, indicating load-dependent recruitment. Triceps showed increased co-activation for joint stability. During pronation resistance, the pronator quadratus exhibited greater activity at lower torques relative to the pronator teres. With increasing torque, the pronator teres demonstrated relatively greater activation increases than the pronator quadratus. Both movement patterns demonstrated progressive recruitment of multi-joint muscles as torque demands increased.

CONCLUSIONS: This pilot EMG study (n=4) provides preliminary descriptive evidence suggesting that supinator and pronator quadratus primarily govern low-torque forearm rotation, while biceps brachii and pronator teres become increasingly dominant during high-torque demands. These observed patterns are consistent with a hierarchical muscle recruitment strategy optimized for mechanical efficiency and joint stability. Understanding these activation patterns may have potential clinical applications for rehabilitation protocol design following nerve injury or tendon rupture, surgical planning for nerve transfer procedures, and development of myoelectric prosthetic control algorithms.

DOI: 10.7759/cureus.101255

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Short-Term Functional Outcomes in Patients Undergoing Primary Total Knee Arthroplasty According to Their Body Mass Index (2026)

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Type of publication:

Journal article

Author(s):

Bhakar, Ranj; Chakrapani, Arjun S; Shaik, Arfaz; Alexander, Aaron; *Murugesan, Thivagar; Anbazhagan, Prasanna Kumar; Ghent, Dan.

Citation:

Cureus. 18(1):e101269, 2026 Jan.

Abstract:

OBJECTIVE: This study aimed to evaluate the association between body mass index (BMI) and short-term outcomes following primary unilateral total knee arthroplasty (TKA), including functional improvement, perioperative variables, and postoperative complications.

METHODOLOGY: A retrospective case-control study was conducted at a tertiary orthopedic center on 525 consecutive patients who underwent primary unilateral TKA for osteoarthritis between January 2019 and December 2023. Patients were classified according to World Health Organization (WHO) BMI criteria: normal (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (>=30.0 kg/m2). Collected data included demographics, American Society of Anesthesiologists (ASA) grade, Charlson Comorbidity Index (CCI), glycated hemoglobin (HbA1c), operative time, length of hospital stay, change in Knee Society Score (DELTAKSS) at 12 months, patient-reported outcome measures, satisfaction, revision surgery, and postoperative complications. Between-group comparisons were performed using one-way analysis of variance (ANOVA) for continuous variables and chi-square or Fisher's exact tests for categorical variables, with significance set at p < 0.05.

RESULTS: Baseline characteristics were comparable across BMI groups, except for higher ASA scores and HbA1c levels in obese patients (p < 0.05). Obese patients had significantly longer operative times (95.9 +/- 16.8 minutes) and hospital stays (4.8 +/- 1.2 days) than normal-weight patients (83.6 +/- 14.1 minutes; 3.9 +/- 1.0 days, p < 0.01). All BMI groups demonstrated significant improvement in DELTAKSS at 12 months, although the gain was lowest in obese patients (34.7 +/- 10.5 vs. 41.2 +/- 9.6; p = 0.012). Overall complications were highest in the obese group with 16 patients (9.1%), followed by nine patients (5.1%) in the overweight group and seven patients (4.0%) in the normal-weight group, with wound-related issues being the most common. Revision surgery occurred in one (0.6%) obese patient, and no mortality was reported.

CONCLUSION: Higher BMI was associated with longer operative times, prolonged hospital stays, increased wound complications, and slightly reduced functional improvement and satisfaction at 12 months after primary TKA. These findings highlight the importance of optimizing metabolic status before surgery and emphasize the need for individualized perioperative risk assessment in patients undergoing knee arthroplasty.

DOI: 10.7759/cureus.101269

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Functional and Radiological Outcomes Following Volar Locking Plate Fixation for Distal Radius Fractures: A Prospective Analytical Study (2025)

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Type of publication:

Journal article

Author(s):

Mohankumar, Mahesh; *Murugesan, Thivagar; Balamurugan, P; Venkadesh, A; Vishal, M; Muralikrishnan, R.

Citation:

Journal of Orthopaedic Case Reports. 15(12):421-429, 2025 Dec.

Abstract:

Introduction: Most frequent injuries of the Upper limb are a distal radius fracture (DRF). If they aren't handled well, they might cause problems for a long time. There are several techniques to treat this issue, but volar locking plate fixation has become increasingly prevalent since it may restore anatomical alignment, provide stable fixation, and allow for early movement. This study aimed to evaluate the functional and radiological results of distal end radius fractures treated with volar locking plate
fixation.

Materials and Methods: In this prospective analytical investigation, 60 patients with DRFs, ranging in age from 18 to 80 years, were enrolled. Patients were treated with open reduction and internal fixation using volar locking devices. Functional results are evaluated using the Gartland and Werley Demerit Point System and goniometry. Radial length, radial inclination, palmar tilt, and articular step-off were employed to quantify radiological outcomes. Follow-up evaluations were conducted at 2, 4, and 6 weeks, in addition to 6 months. We used the Statistical Package for the Social Sciences version 20 to analyze the data and discovered that P < 0.05 was significant.

Results: Patients exhibited substantial improvement in wrist function across all planes of motion, with plantar flexion rising from 31.6degree at 2 weeks to 67.8degree at 6 months, and dorsiflexion from 31.7degree to 66.4degree. Supination and pronation also became a lot better, becoming close to normal levels after 6 months. The radiographic restoration was good, with a mean radial length of 8.8 mm, an inclination of 17.6degree, and a palmar tilt of 8.9degree. There were very few complications (6.7% arthritis, 6.7% malunion).

Discussion: Our results support previous research showing volar plating offers robust fixation, restores anatomical alignment, and facilitates early mobility. Correlation study revealed that palmar tilt and articular congruity substantially impacted functional recovery, emphasizing the need of meticulous surgical reduction.

Conclusion: Volar locking plate fixation is an effective treatment for DRFs, characterized by low complication rates and excellent functional and radiological outcomes.

DOI: 10.13107/jocr.2025.v15.i12.6578

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The Profound Impact of the COVID-19 Pandemic on the Epidemiology of Quadriceps and Patellar Tendon Ruptures: Insights From a Single Trust in the United Kingdom (2025)

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Type of publication:

Journal article

Author(s):

*Murugesan, Thivagar; *Abdullmalek, Hidayatul Rasyidah Syida; *Kondi, Suresh; *Rehman, Hamood Ur; *Carmont, Mike; *Heaver, Catriona; *Okoro, Tosan.

Citation:

Cureus. 17(11):e98022, 2025 Nov.

Abstract:

Introduction Quadriceps and patellar tendon ruptures are uncommon but disabling injuries that require surgical repair. Changes in physical activity patterns during and after the COVID-19 pandemic may have influenced their occurrence. This study compares the incidence, demographics, and seasonal distribution of these injuries before and after the pandemic within a single UK NHS trust. Methods A retrospective review was performed of all patients undergoing primary repair of quadriceps or patellar tendon ruptures at the Shrewsbury and Telford NHS Trust from January 2014 to December 2024. The pre-COVID period (2014-2019) was compared with the post-COVID period (2021-2024), with 2020 excluded due to major service disruption and atypical clinical pathways during the first pandemic year. Annual incidence rates were calculated as cases per 100,000 population, using year-specific catchment population estimates from the Office for National Statistics (ONS). Demographic variables, injury characteristics, and seasonal patterns were extracted from electronic records. Between-period comparisons used the Mann-Whitney U test. No adjustment for age, BMI, or comorbidities was performed. Results A total of 203 patients were identified, including 95 pre-COVID and 108 post-COVID. The median age was 63 years (range 15-90), with a male-to-female ratio of 7.8:1. Injuries occurred most frequently in autumn (28%). The median annual incidence increased from 4.6 per 100,000 pre-COVID to 8.3 per 100,000 post-COVID (incidence rate ratio 1.8, p = 0.0073). The median number of cases per year rose from 16 to 27 between periods. Conclusion The incidence of surgically treated quadriceps and patellar tendon ruptures increased in the post-COVID period. Although the study does not adjust for potential confounders, the findings suggest an association between the post-pandemic era and higher injury rates. Further research with multivariable analysis is needed to clarify contributing factors.

DOI: 10.7759/cureus.98022

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