Osteochondritis dissecans (OCD) of the medial femoral condyle (MFC) is a common disorder in juvenile knees, although its biomechanical etiology remains unclear. Medial meniscus extrusion (MME) has been implicated in joint overload and degenerative changes; however, its relationship with lesion-specific OCD pathogenesis, particularly in inferior-central MFC lesions, has not been elucidated. This cross-sectional study included 56 knees from 47 patients (18y or younger) who underwent surgical treatment for OCD. Lesions were categorized into MFC-classical/extended classic (MFC-C/EC, n=22), MFC-inferior-central (MFC-IC, n=12), and lateral femoral condyle (LFC, n=22). MME was quantified using the relative percentage of extrusion (RPE) on coronal magnetic resonance imaging (MRI). Radiographic parameters included lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA). Nonparametric statistical analyses were performed, and a post hoc power analysis confirmed adequate sensitivity (power=84.3%). RPE was significantly greater in MFC-IC (33.6%) compared with both MFC-C/EC (17.6%) and LFC lesions (18.1%). LDFA was significantly lower in LFC than in MFC-C/EC (80.4˚ vs. 82.4˚). A moderate negative correlation was found between RPE and MPTA ( r =-0.41), while LDFA showed no significant association with RPE. Linear regression identified MPTA as a significant predictor of RPE (slope=-1.30%/degree). MME is significantly associated with inferior-central OCD lesions in juvenile knees, suggesting that altered mechanical loading may contribute to their development. Evaluation of meniscal extrusion and tibial alignment may aid in identifying at-risk patients and developing lesion-specific preventive strategies. Level III-cross-sectional comparative study.

The anteroposterior radiograph of the pelvis is essential for diagnosing hip pathologies. Radiograph-like projections reconstructed as cone-beam images from CT data correlate strongly with conventional radiographs. However, CT inherently uses parallel x-rays rather than a cone-beam geometry. This study aims to determine whether parallel-beam radiograph-like projections from CT provide comparable reference values to cone-beam reconstructions. 63 patients (126 hips) undergoing CT for symptomatic hip pathologies without prior hip surgery were included. From the same CT data, cone-beam and parallel-beam radiograph-like images were reconstructed using a standardized algorithm. Reference values, including lateral center-edge angle (LCEA), medial center-edge angle (MCEA), acetabular index (AI), acetabular arc (AA), extrusion index (EI), crossover sign, and posterior wall sign, were measured on both projection types, eliminating technical bias. Two observers performed all measurements twice to assess inter- and intra-observer reliability, and intraclass correlation coefficients (ICCs) were calculated. 126 hips were analyzed: 52 with LCEA <22° ("acetabular undercoverage"), 49 with LCEA 22°-33° ("normal coverage"), and 25 with LCEA >33° ("acetabular overcoverage"). ICCs between observers and between projection types demonstrated good to excellent reliability for all reference values (0.89-0.99). Parallel-beam radiograph-like projections demonstrate good to excellent reliability (ICCs: 0.89-0.99) for key reference values of hip pathologies compared to cone-beam radiograph-like projections from the same CT data. These findings suggest parallel beam projections can be reliably used with established reference values for conventional radiographs.

Differences in outcomes between primary and revision hip arthroscopy are well documented; however, specific comparisons between revision and primary labral reconstruction are limited, especially regarding midterm outcomes. To evaluate whether revision arthroscopic labral reconstruction achieves minimum 5-year patient-reported outcomes (PROs) and survivorship comparable to primary labral reconstruction. Cohort study; Level of evidence, 3. A retrospective review was conducted of patients undergoing labral reconstruction between June 2008 and December 2019. Inclusion required a minimum 5-year follow-up for PROs, including the Nonarthritic Hip Score, International Hip Outcome Tool-12, and Hip Outcome Score-Sports Specific Subscale. Exclusion criteria included Tönnis grade >1, preexisting hip conditions, lateral center-edge angle <20°, active workers' compensation claims, and intraoperative gluteus medius repair. Revision cases (n = 36) were matched 1:1 with primary reconstruction cases (n = 36) based on age, sex, body mass index, lateral center-edge angle, and capsular treatment strategy. Preoperatively, the primary reconstruction cohort had greater cartilage damage but higher baseline scores for the Nonarthritic Hip Score, International Hip Outcome Tool-12, and Hip Outcome Score-Sports Specific Subscale (P < .01). At 5-year follow-up, both cohorts showed significant improvements in all PROs (P < .01) with comparable postoperative outcomes and achievement of clinically meaningful thresholds. Labral reconstruction during primary and revision hip arthroscopy showed significant, durable clinical improvements over a minimum 5-year follow-up. Midterm outcomes were comparable, highlighting the efficacy of revision reconstruction in appropriately selected patients.

Data on midterm outcomes in patients with borderline hip dysplasia (BHD) based on sex differences after hip arthroscopy are scarce. To report sex-based differences in patient-reported outcome measures (PROMs), clinical benefit, and survivorship in patients with BHD who underwent hip arthroscopy at a minimum 5-year follow-up. Cohort study; Level of evidence, 3. Data were retrospectively reviewed for all patients with BHD who underwent primary hip arthroscopy with a lateral center-edge angle (LCEA) between 18° and 25° from 2008 to 2018. The exclusion criteria were as follows: LCEA <18º or >25º, previous ipsilateral hip surgery or conditions, and Tönnis grade >1. The modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), and visual analog scale (VAS) for pain and patient satisfaction were reported. Clinical benefit was assessed via minimal clinically important difference (MCID), the patient acceptable symptomatic state (PASS), and the maximum outcome improvement (MOI). Survivorship was defined as nonconversion to total hip arthroplasty. A sex-based propensity-matched comparison was made in a 1-to-1 ratio based on age, body mass index (BMI), and Tönnis grade. Propensity-score matching created a cohort of 152 hips, 76 per group. Significant and comparable improvements in all PROMs were observed at a minimum 5-year follow-up, with high achievement rates for the MCID, PASS, and MOI in both groups. However, improvements were significantly higher for women for MCID for the mHHS (86.8% vs 69.7%; P = .0105), MCID for the NAHS (88.2% vs 61.8%; P = .0002), MCID for the VAS for pain (84.2% vs 64.5%; P = .005), PASS for the mHHS (90.8% vs 78.9%; P = .041), and MOI for the NAHS (77.6% vs 55.3%; P = .0057). Survivorship was similar for men (94.74%) and women (89.47%) (P = .229). At a minimum 5-year follow-up, a propensity-matched comparison of female and male patients with BHD who underwent primary hip arthroscopy demonstrated significant improvement and comparable PROMs and survivorship. Clinical benefit was significantly higher in women, as evidenced by higher achievement rates on the MCID, PASS, and MOI.

Orthopaedic surgical decision making is a combination of clinical intuition, radiological measurements, and referenced standards. As clinicians and researchers, we consider hip pathology as a mechanical problem described in geometric and statistical language. For a clinical measurement to be useful, it must be easy to perform, reproducible, and demonstrably associated with the risk of the condition it seeks to diagnose or prevent. Using acetabular dysplasia as an analytic lens, this review discusses what our radiographs actually tell us about hip morphology risk, by separating population reference ("normative") intervals from outcome-anchored decision limits and by tracing the evidentiary lineage of the field's workhorse measurements. We revisit the origins, current use, and statistical power of the lateral center-edge angle, acetabular index/Tönnis angle, femoral head extrusion index, and Graf ultrasonography classification and synthesize what is known about their reproducibility and what clinical decisions can appropriately be made. We examine how nomenclature drift fuels routine miscommunication and show that superficially similar measurements are often tied to reference datasets they were neither derived from nor validated against. The current, normal or not, phenotypic model of risk allocation is considered, and the alternative of a continuous, dose-response relationship is proposed. The aim of this narrative review is to prompt clinicians and researchers to consider has our use of legacy morphological risk models actually curtailed osteoarthritis progression in conditions such as hip dysplasia and can we continue to depend on them? Or do models grounded more in lineage than validation now warrant a fundamental reconstruction.

Instrumented scoliosis correction to T12/L1 can be a full correction (FC) of a single thoracic curve or a selective thoracic fusion (STF) where there is a significant lumbar curve. This study aims to evaluate the utility and feasibility of 3-dimensional (3D) EOS modelling to quantify pre- and post-operative axial plane changes in the uninstrumented lumbar spine. This study included patients undergoing primary surgery (2018-2021) for AIS Lenke 1 or 3, with the lowest instrumented level at T12-L1 and reconstructable EOS bi-planar images available pre-op, post-op, and at 1-year follow-up. EOS 3D modelling gives the apical rotation and mean rotation form T1-L5 from a neutral pelvis. Twenty patients (age 14.3; 7 Lenke 1A (FC), 13 Lenke 1B-3C (STF)) were included. Lumbar Cobb correction averaged 54% (1A), 41% (1B), and 21% (1C/3C). Neither the STF nor FC achieved notable correction of apical lumbar rotation (1A: -5%, p > 0.05, 1B; +0°, p > 0.05, 1C/3C; +2.5°, p > 0.05). Uninstrumented average L1-L5 rotation showed no significant change at 1 year for any curves. A significant correlation was observed between lateral bending Cobb angles and L1-L5 average rotation at one year (p < 0.05). Notably, EOS imaging measured greater axial rotation than PA x-rays, with differences normalising after accounting for pelvic parameters. EOS 3D modelling is valuable for visualising the mobile lumbar spine. Our models showed no significant correction of lumbar rotation, and a large impact from pelvic rotation on radiographic measurements. Increased curve flexibility may improve axial correction. The apparent reduction in lumbar rotation on plain radiographs is more likely attributable to pelvic rotation.

The Aluminum 1100 series is widely used because of its high corrosion resistance and ductility. Joining aluminum by conventional welding is challenging due to its poor weldability. Friction Stir Welding (FSW) is a solid-state joining process in which heat is generated by the tool's rotation pin and shoulder rubbing against the material to be welded, stirring it. The FSW process can reduce welding issues when joining aluminum materials. The quality of the joint formed by friction stir welding depends on the welding parameters, as evidenced by numerous prior investigations. However, previous research has been limited to mechanical strength of welded joints, using destructive testing methods. This allows researchers to examine the quality of welded joints using nondestructive testing. Researchers focus on investigating the quality of friction stir welding joints on an AA 1100 thin plate. The tool used has three flat sides, with a tool pin and shoulder diameter ratio of 1:3. The parameters used were variations in the tool's lateral tilt angle, with values of 0º, 0.5º, and 1º. The travel speed was 45 mm/minute with a tool rotation of 1860 rpm. The clamp/fixture was made of S45C, a heat-treated material; the backing plate was mild steel. The AA 1100 material, thicker than 2 mm, undergoes welding. The quality of FSW joints was inspected using nondestructive testing methods, including visual, radiographic, and eddy-current testing. In contrast, mechanical strength was assessed by tensile testing to validate the nondestructive test. The results indicated that tilt angle 0º had no defects, tilt angle 0.5º had tunneling or voids, and tilt angle 1º had defects in the form of a lack of material. When the tilt angle was changed to 0º, the tensile strength was 85.53 MPa, and the joint efficiency was 78%. When the tilt angle was set to 0.5º and 1º, the tensile strength dropped to 61.84 MPa and 71.91 MPa, respectively.

To evaluate the feasibility, radiological accuracy, and early clinical outcomes of robotic-assisted conversion of partial knee arthroplasty (PKA) to total knee arthroplasty (TKA) using the ROSA system. Feasibility was defined as successful robotic registration and completion of the procedure using standard primary components without femoral components or augments. A retrospective cohort of 23 consecutive conversions (medial or lateral unicompartmental and patellofemoral arthroplasties) was analyzed. The minimum follow-up was 12 months. Clinical outcomes were assessed with the Oxford Knee Score (OKS), visual analogue scale (VAS) for pain, and patient satisfaction. Radiological accuracy was evaluated by comparing planned with achieved component alignment (medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), and hip-knee-ankle (HKA)) using paired t-tests, two one-sided tests for equivalence (SD 1.5°), and Bland-Altman analysis. All cases were successfully registered with the robot and completed without femoral components or augments; 22 of 23 used standard primary components. The mean OKS improved from 17.2 (SD 5.5) to 40.0 (SD 5.0) and VAS pain decreased from 6.7 (SD 1.5) to 1.6 (SD 1.6) (p < 0.001). The mean absolute error between planned and achieved alignment was 0.8° for MPTA and 0.3° for LDFA, confirming accurate restoration, while HKA showed greater variability (mean bias 1.37°; limits -4.1° to 6.9°). One secondary patellar resurfacing was required; no other complications occurred. Robotic-assisted conversion of PKA to TKA was feasible, bone-preserving, and resulted in significant clinical improvement at 12 months, with precise component alignment but slightly more variation in overall mechanical axis restoration.

Primary cam and pincer type morphology of the hip can lead to femoroacetabular impingement and osteoarthritis. This study aimed to assess and compare magnetic resonance imaging (MRI)-based radiological parameters of hip morphology between young male semi-professional soccer players and non-athlete controls. This observational cross-sectional study included a retrospective review of MRI scans of young male soccer players and an age- and sex-matched control group obtained from a hospital radiology database. Lateral center edge angle, acetabular version, alpha angle, collodiaphyseal angle, and femoral head coverage ratio were recorded and compared between groups. Bilateral hip MRI scans of 30 young male soccer players and 30 non-athletes were analyzed. The mean age of participants was 24.88±5.10 years (range, 15-34 years). In the non-athlete control group, anteversion was higher in both hips (P=0.02 for right hip and P=0.05 for left hip) and reached statistical significance for the right hip. The collodiaphyseal angle was higher in the soccer-player group (P=0.01 for the right hip and P=0.03 for the left hip). The femoral head coverage ratio was significantly higher in the control group (P=0.02 for the right hip and P=0.01 for the left hip). No significant difference was observed in lateral center edge angle or alpha angle between groups. Differences in collodiaphyseal angle, acetabular anteversion, and femoral head coverage ratio indicate partial variation in femoroacetabular morphology between groups; however, no evidence showed a higher incidence of cam or pincer morphology in soccer players.

Aims and Background:Dislocation remains one of the most common complications following total hip arthroplasty (THA). Although the classical “Lewinnek’s safe zone” for acetabular cup positioning has long guided surgeons, a considerable number of dislocations still occur even within this zone. Recent evidence emphasizes the importance of the dynamic spinopelvic relationship, specifically variations in pelvic tilt and functional anteversion, which directly influence acetabular orientation and joint stability. This study aims to analyze the spinopelvic relationship and its effect on acetabular cup anteversion and femoral head coverage in THA.Materials and Methods:A total of 30 patients aged between 20 and 70 years undergoing primary THA were included in the study. Pre-operative assessment involved X-rays of the lumbar spine and pelvis in both supine and standing positions to determine changes in pelvic tilt. Acetabular anteversion was modified accordingly. Postoperatively, acetabular cup positioning and femoral head coverage were evaluated radiographically using the Woo and Morrey method for anteversion and the lateral center edge angle (LCEA) of Wiberg. Statistical analysis was performed using the Statistical Package for the Social Sciences version 23.Results:The mean pelvic tilt in supine and standing positions was −3.30° and −5.77°, respectively, with a mean change of −2.44°. The mean target anteversion was 13.32°, and the mean achieved anteversion was 14.65°. The mean LCEA was 50.51°. A weak negative correlation was found between anteversion achieved and LCEA (ρ = −0.27, P = 0.141). The LCEA was highest when acetabular anteversion was within 5°–25°, suggesting optimal femoral head coverage within this range.Conclusion:The study highlights that a fixed “safe zone” for acetabular cup placement is insufficient. Individualized cup orientation based on spinopelvic parameters enhances joint stability and femoral head coverage. Functional assessment of pelvic tilt and anteversion should be integrated into pre-operative planning to reduce the risk of impingement and dislocation in THA.

Does presence of hip dysplasia affect the prevalence and location of cam morphologies in pediatric hip pain patients?

Background:Frequent pivoting, rotation, and deep hip flexion place football players at high risk for femoroacetabular impingement (FAI), a leading cause of hip pain in this population. Previous studies have primarily focused on professional National Football League athletes undergoing mixed surgical techniques, including labral debridement. Limited data exist on outcomes in younger, amateur players treated with labral repair.Purpose:To report return to sport (RTS) rates and functional outcomes at a minimum 5-year follow-up in primarily active high school and college football players undergoing primary hip arthroscopy with labral repair for FAI.Study Design:Case series, Level of evidence, 4.Methods:All football players who underwent primary hip arthroscopy with labral repair for FAI between 2010 and 2019 were identified from an institutional database. Collected data included descriptive data, radiographic parameters, surgical details, and reoperations. At a minimum 5-year follow-up, RTS outcomes and patient-reported outcome measures (PROMs), such as the Modified Harris Hip Score (mHHS) and Hip Outcome Score (HOS), were evaluated.Results:A total of 36 hips in 27 male athletes (mean age, 18 years; body mass index, 28.1 kg/m2) were included. The majority of athletes competed at the high school (70%) or collegiate level (26%). Mean preoperative radiographic measurements were as follows: lateral center-edge angle, 31.6°; Tönnis angle, 4.1°; and alpha angle, 61.4°. Femoroplasty and acetabuloplasty were performed in 100% and 86% of cases, respectively. Also, 84% of players returned to football, all at the same or higher level than before surgery. At a mean follow-up of 9.8 years, all PROMs improved significantly from baseline (P < .002). Outcome scores at follow-up were as follows: mHHS 90.5; HOS-Activities of Daily Living, 94.5; HOS-Sports-Specific Subscale, 91.1; and visual analog scale (VAS) pain with use, 2.3/10; VAS pain at rest, 1.3/10; and surgical satisfaction, 8.5/10. No patients required revision surgery. However, 2 patients (7%) underwent reoperations—including 1 for heterotopic ossification excision and 1 for periacetabular osteotomy.Conclusion:American football players who underwent primary hip arthroscopy with labral repair for FAI achieved excellent long-term outcomes, with high RTS rates at the same or higher levels, and improvements in PROMs and patient satisfaction. Despite favorable outcomes, nonmedical factors, such as graduation, may influence RTS in competitive athletes, particularly at the high school and collegiate levels.

Understanding load distribution in high tibial osteotomies: An inverse Discrete Element Analysis approach.

To evaluate the quadriceps muscle length-to-femoral length ratio (QML:FL) as a predictor of segmental femoral osteotomy (SFO) necessity in small-breed dogs with medial patellar luxation. This retrospective study included 53 small-breed dogs (78 limbs) with medial patellar luxation. Medical records from 2008 to 2021 of dogs undergoing patellofemoral joint reconstruction were reviewed. Signalment, surgical records, and CT data were retrospectively analyzed. Patients were classified into 2 groups based on SFO performance: the group requiring SFO (SFO group) and the group where SFO was unnecessary (NSFO group). Regression analysis compared signalment and CT parameters between groups; statistically significant variables were incorporated into a multiple logistic regression analysis to assess factors correlated with SFO. Receiver operating characteristic curves were generated to determine QML:FL cutoff values for predicting SFO. The SFO group included 26 limbs, while the NSFO group included 52 limbs. Compared to the NSFO group, the SFO group had significantly younger age, lower body weight, higher anatomical distal lateral femoral angle, and lower QML:FL. The QML:FL ratio was the only variable significantly associated with SFO (OR, 0.595; 95% CI, 0.445 to 0.797). The receiver operating characteristic curve identified 0.84 as the optimal cutoff value (sensitivity, 0.83; specificity, 0.96), with an area under the curve of 0.9571. QML:FL was a reliable preoperative indicator for SFO necessity in medial patellar luxation-affected small-breed dogs. This noninvasive measure enhanced surgical planning. QML:FL allowed objective assessment of SFO necessity, improving individualized treatment strategies for femoral patellar joint reconstruction.

Introduction:Coronal tibiofemoral subluxation (CTFS) is a frequently observed radiological feature in varus osteoarthritis (OA) of the knee and may reflect underlying biomechanical misalignment and osseous changes. Understanding its correlation with bone morphometry can help in surgical planning and risk stratification.Aims:To analyze the coronal tibiofemoral (CTF) in varus OA knee and its correlation with bone morphometry in patients undergoing total knee arthroplasty.Materials and Methods:This retrospective and prospective study was conducted between January 2024 and January 2025. A total of 98 patients with varus OA knees planned for total knee arthroplasty were included. Radiographic parameters, including arithmetic hip–knee–ankle (HKA) angle, joint line obliquity, CTF, lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), coronal plane alignment of the knee (CPAK), and posterior condylar offset ratio (PCOR), were evaluated using standardized full-length scanograms.Results:Among 98 patients, 60.2% were over 60 years old, and 61.2% were female. Body mass index classification showed that 42.9% were overweight and 25.5% were obese. Right knee involvement was observed in 53.1% of cases. CTF was present in 64 patients (65.3%) with a mean subluxation distance of 6.2 ± 1.5 mm. Most cases (75%) had subluxation distances between 0 and 6 mm. CPAK Type I was predominant (93.9%), whereas Type IV was seen in 6.1%. CTF prevalence was similar between CPAK Type I (65.2%) and Type IV (66.7%) (P = 0.887). Patients with CTF had higher LDFA (89.8° ± 2.1 vs. 87.9° ± 1.8), lower MPTA (84.5° ± 2.2 vs. 87.2° ± 1.9), higher PCOR (0.52 ± 0.06 vs. 0.48 ± 0.05), and more negative HKA angle (−7.2° ± 2.4 vs. −4.9° ± 2) than those without CTF (all P < 0.005). Correlation analysis showed a significant positive correlation of CTF with LDFA (r = 0.36, P = 0.004), PCOR (r = 0.3, P = 0.015), and HKA (r = 0.44, P = 0.003), and a negative correlation with MPTA (r = −0.42, P = 0.002).Conclusion:CTF is highly prevalent in varus OA knees and is significantly associated with specific morphometric alterations, including increased LDFA and PCOR, decreased MPTA, and a more negative HKA angle. While CPAK Type I predominates in this population, the CPAK classification did not significantly correlate with subluxation presence. These findings underscore the importance of assessing CTFS and bone morphology preoperatively for individualized surgical planning and improved outcomes.

Analysis of mechanical factors related to scapular notching and medial scapular bone spurs with reverse total shoulder arthroplasty and the reduction of their appearance with inferior glenosphere offset

Negative Influence of Joint Line Change on 10.8-Year Outcomes and Survival of Medial Unicompartmental Knee Arthroplasty.

Background: Tibial shaft fractures distal to total knee arthroplasty (TKA) are commonly treated with plate fixation, which requires prolonged weight-bearing restriction. Although intramedullary nailing (IMN) has been attempted in selected cases, its feasibility remains controversial. This study aimed to assess the radiographic feasibility of IMN using anatomical parameters on lateral knee radiographs. Methods: A total of 271 lateral knee radiographs after TKA (January 2022 to October 2023) were retrospectively reviewed. Nail corridor and superior and inferior tibial tuberosity angles were measured on true lateral views. Tibial component size, keel length, BMI, age, and sex were analyzed for their association with nail corridor dimensions. Calibration was performed using known implant sizes. Results: Of the 271 lateral knee radiographs reviewed, 248 patients were included in the final analysis. The mean nail corridor was 9.27 ± 2.41 mm. The average superior and inferior tibial tuberosity angles were 105.88° and 155.79°, respectively. The tibial component size and keel length were not correlated with the nail corridor. In contrast, both superior (β = 0.252, p < 0.001) and inferior (β = 0.148, p = 0.003) tibial tuberosity angles were significantly associated with the nail corridor. No differences were observed in sex or BMI. Conclusions: IMN may be radiographically feasible in selected patients with tibial shaft fractures distal to TKA. The superior and inferior tibial tuberosity angles are anatomical parameters associated with the nail corridor and may serve as reference measures during preoperative radiographic assessment.

Total knee arthroplasty (TKA) is a widely used surgical intervention for advanced osteoarthritis, with evolving surgical techniques aiming to reduce blood loss and hospital stay. The minimally invasive midvastus (MMV) approach is hypothesized to minimize soft tissue damage and promote faster recovery compared to the classic medial parapatellar (MPP) approach. This study aimed to compare clinical and radiological outcomes, including perioperative blood loss and hospital discharge timing, between the MMV and MPP approaches.A total of 99 patients with advanced osteoarthritis who underwent primary TKA between 2013 and 2019 were prospectively analyzed. Patients were divided into MMV (n = 50) and MPP (n = 49) groups. All surgeries were performed by the same experienced surgeon using the same prosthetic system and perioperative protocols. Clinical outcomes included hemoglobin (Hb), hematocrit (Hct), discharge timing, range of motion (ROM), Visual Analog Scale (VAS), and Oxford Knee Score (OKS). Radiological outcomes included alignment and component positioning. Statistical analysis was conducted with significance set at p < 0.05.There were no significant differences between groups in demographic characteristics, surgical duration, alignment parameters (mechanical medial proximal tibial angle, mechanical lateral distal femoral angle, component tibial angle, component femoral angle), VAS, OKS, or final ROM. Postoperative (day 0 and day 3) Hb and Hct values did not differ significantly, and no blood transfusions were required in either group. However, same-day discharge was significantly more common in the MMV group (p = 0.02). One wound complication occurred in the MPP group; one patient from each group required postoperative manipulation under anesthesia.While both surgical approaches provided comparable clinical and radiological outcomes with no differences in blood loss, the MMV approach was associated with a higher rate of same-day discharge, suggesting an advantage in early recovery and reduced hospital stay.

Abstract This study examines the Armenian word bēč/bēǰ , denoting the ‘shoulder blade (scapula)’ and, more broadly, ‘shoulder with back/armpit’. Beyond its anatomical sense, the term is significant in both weaving and occult practice. The meaning ‘handle of a weaver’s comb’, attested in the Canon Law and elsewhere, is preserved at the two geographic extremes of the Armenian world: in Artsakh (Nagorno-Karabakh) in the far east, and in Hamšen and Trabizond (Trabzon) in the northwest. The word also occurs in the context of scapulimancy (omoplatoscopy), i.e., divination using shoulder blades, attested both in classical sources and in modern dialect areas—eastern (Loṙi, Nor Bayazet) and western (Sasun, Bulanǝx, Xlat‘, etc.). The paper surveys the attestations, morphological profile, semantic developments, etymology, and cultural implications of bēč/bēǰ ‘shoulder blade’.