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Aims: Orthopaedic surgery requires grafts with sufficient mechanical strength. For this purpose, decellularized tissue is an available option that lacks the complications of autologous tissue. However, it is not widely used in orthopaedic surgeries. This study investigated clinical trials of the use of decellularized tissue grafts in orthopaedic surgery. Methods: Using the ClinicalTrials.gov (CTG) and the International Clinical Trials Registry Platform (ICTRP) databases, we comprehensively surveyed clinical trials of decellularized tissue use in orthopaedic surgeries registered before 1 September 2022. We evaluated the clinical results, tissue processing methods, and commercial availability of the identified products using academic literature databases and manufacturers’ websites. Results: We initially identified 4,402 clinical trials, 27 of which were eligible for inclusion and analysis, including nine shoulder surgery trials, eight knee surgery trials, two ankle surgery trials, two hand surgery trials, and six peripheral nerve graft trials. Nine of the trials were completed. We identified only one product that will be commercially available for use in knee surgery with significant mechanical load resistance. Peracetic acid and gamma irradiation were frequently used for sterilization. Conclusion: Despite the demand for decellularized tissue, few decellularized tissue products are currently commercially available, particularly for the knee joint. To be viable in orthopaedic surgery, decellularized tissue must exhibit biocompatibility and mechanical strength, and these requirements are challenging for the clinical application of decellularized tissue. However, the variety of available decellularized products has recently increased. Therefore, decellularized grafts may become a promising option in orthopaedic surgery. Cite this article: Bone Joint Res 2023;12(3):179–188.

Abstract Introduction This study evaluated the validity of the AP3 × ML3 reduction quality classification, which applies the concept of positive medial cortical support. Methods A total of 120 trochanteric fractures classified as AO Foundation/Orthopedic Trauma Association 31A1 and A2 were retrospectively analyzed. The validity of the AP3 × ML3 classification was evaluated by comparison with the Baumgaertner reduction quality criteria. When using the AP3 × ML3 classification, reduction quality was divided into three classes based on the degree of anterior cortical contact between the proximal and distal fragments. Reduction quality was also divided into three classes when using the Baumgaertner criteria. The frequency of mechanical complications, including cut­out, delayed union, and excessive migration of the lag screw, was retrospectively assessed. Intra-observer and inter-observer reliability was assessed using the intraclass correlation coefficient (ICC). Results Mechanical complications included 4 cases of cutout (3.3%) and 1 of delayed union (0.8%). Mechanical complications occurred for all levels of reduction quality in both classifications, except for the acceptable of the Baumgaertner criteria. When reduction quality was rated as good, acceptable, and poor the incidence of mechanical complications was 2.5%, 5.7%, and 16%, respectively, under the AP3 × ML3 classification and 3.3%, 0%, and 15.0%, respectively, under the Baumgaertner criteria. The ICC was 0.80 for intra-observer reliability and 0.57 for inter-observer reliability when using the AP3 × ML3 classification and 0.85 and 0.34, respectively, when using the Baumgaertner criteria. Conclusion The AP3 × ML3 classification was reliable and easy to use compared with the widely used Baumgaertner reduction quality criteria. Level of evidence 4

Abstract Purpose The effect of open‐wedge high tibial osteotomy (OWHTO) on the preoperative neutral alignment of the knee is unknown. The purpose of this study was to clarify the clinical outcome of OWHTO with neutral alignment, defined as within 4 degrees of varus. Methods This retrospective study included 72 knees with varus that underwent medial OWHTO. The knees were divided according to the preoperative hip‐knee‐ankle angle into a neutral alignment group (≤ 4° of varus alignment) and a varus alignment group (> 4° of varus alignment). The Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Forgotten Joint Score‐12 (FJS‐12) were evaluated preoperatively and during at least 2 years of follow‐up postoperatively. Results There were no significant differences between the preoperative FJS‐12 (17.9 versus 23.7; p = 0.16) and postoperative FJS‐12 (57.3 versus 60.6; p = 0.52) or KOOS subscale scores (p > 0.05) in the neutral alignment group or the varus alignment group. Each group had a mean change in the KOOS subscale scores that exceeded the minimum clinically important difference. Conclusion The short‐term clinical results of OWHTO for neutral alignment were as favourable as those for varus malalignment. Level of evidence IV.

Abstract Purpose Prolongation of operation time due to registration and pin insertion has been reported with robotic‐assisted total knee arthroplasty (RATKA), and there has been concern about an increase in the postoperative incidence of deep vein thrombosis (DVT). In this study, we compared the incidence of DVT after RATKA with that after conventional manual TKA (mTKA). Methods This consecutive retrospective series included 141 knees that underwent primary TKA using the Journey II system. The CORI robot was used. There were 60 RATKAs and 81 mTKAs. Doppler ultrasound was performed in all patients on postoperative day 7 to determine whether DVT was present. Results The operation time was longer in the RATKA cohort (99.5 min vs 78.0 min, p

Abstract Background Although favorable long-term survival of Oxford unicompartmental knee arthroplasty (UKA) has been reported regardless of postoperative varus alignment, the effect of degree of varus alignment on patient-reported outcome measures (PROMs) remains unclear. Furthermore, the Forgotten Joint Score-12 (FJS-12), which has a low ceiling effect, may be useful for such assessment. The objective of this study was to evaluate short-term clinical outcomes after Oxford UKA in knees with a greater degree of preoperative varus alignment focusing on use of the FJS-12. Methods This retrospective study involved 66 knees that had undergone primary Oxford UKA. Based on the hip-knee-ankle angle, the knees were divided into two alignment groups: severe varus group (≥ 185° varus alignment) and a mild varus group (

Abstract Purpose Favorable clinical results have been reported following high tibial osteotomy (HTO) for medial meniscus posterior root tear (MMPRT) in knees with varus alignment. However, the effect on the preoperative neutral alignment of the knee is not known. This study sought to evaluate the clinical outcomes of medial open‐wedge HTO for MMPRT with neutral alignment. Methods We retrospectively reviewed 119 medial open‐wedge HTOs and analyzed 22 knees with MMPRT. The knees were divided according to the preoperative hip‐knee‐ankle angle into a moderate varus alignment group (≤4° of varus alignment) and a varus alignment group (> 4° of varus alignment). The Knee Injury and Osteoarthritis Outcome Score (KOOS) and Forgotten Joint Score‐12 (FJS‐12) values were evaluated preoperatively and at the latest follow‐up. The healing status of MMPRT at the time of second‐look arthroscopy, performed at a mean of 15.4 ± 4.2 months, was compared with that after the primary HTO. Results There were 11 knees in the moderate varus alignment group and 11 in the varus alignment group. In terms of perioperative patient‐reported outcome measures, there was no significant difference in the preoperative or postoperative KOOS subscale score or FJS‐12 score between the moderate varus and varus alignment groups. The healing rate was significantly higher in the moderate varus alignment group. Conclusion Favorable clinical results were obtained by medial open‐wedge HTO in knees with MMPRT and moderate varus alignment in the short term. Surgeons should consider the indications for medial open‐wedge HTO, even with moderate varus alignment, when planning treatment for MMPRT with persistent knee pain. Level of evidence IV

Abstract Purpose To describe the indications for, and surgical technique of, tibial condylar valgus osteotomy (TCVO). Indications TCVO is commonly performed in patients with middle-to-end-stage medial unicompartmental osteoarthritis. Among the most important TCVO indication criteria are the types of tibial plateau shape. The convex-type (also called “pagoda-type”), with over a 5° joint line convergence angle on the standing X-ray, meets the indication criteria for TCVO. Surgical technique An L-shaped osteotomy is performed from the medial side of the proximal tibia to the lateral beak of the intercondylar eminence. The apex of the L-shaped osteotomy line is on the medial border of the patellar tendon insertion. Surgeons should note the direction of the chisel (during the osteotomy) to the intercondylar eminence following fluoroscopic guidance. The posterior cortical bone is cut under a lateral view observation, and the crossed-leg position is adopted to prevent injury to the popliteal blood vessels. The spreader should be positioned at the posterior cortical bone to avoid increasing the tibial slope. The locking plate reliably stabilizes the osteotomy and helps shorten the period of postoperative rehabilitation. Conclusions TCVO adjusts varus deformity alongside joint congruity. Accurate identification of indications and a detailed surgical plan would ensure effective correction and proper alignment. Additional osteotomies are recommended in case of under-correction of the varus limb deformity. TCVO is an effective intervention in patients with advanced knee osteoarthritis and lateral joint laxity with the pagoda-type tibial plateau shape.

Dislocation of the hip joint in adults is usually caused by high-energy trauma such as road traffic accidents or falls from heights. Posterior dislocation is observed in most cases. However, atraumatic anterior dislocation of the hip joint is extremely rare. We present a case of atraumatic anterior dislocation of the hip joint that was induced by an activity of daily living. The possible causes of this dislocation were anterior capsule insufficiency due to developmental dysplasia of the hip, posterior pelvic tilt following thoracolumbar kyphosis due to vertebral fracture, and acetabular anterior coverage changes by postural factor. Acetabular anterior coverage changes in the sagittal plane were measured using a tomosynthesis imaging system. This system was useful for elucidation of the dislocation mechanism in the present case.