Commentary: Ultra-Congruent Versus Cruciate-Retaining Inserts in Bilateral Simultaneous Total Knee Arthroplasty - A Randomized Controlled Trial
Kushagra Pathak1, Sahil Batra1*, Rajesh Malhotra2,3
1Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
2Clinical Lead and Senior Consultant Orthopaedics, Indraprastha Apollo Hospitals, New Delhi, India
3Former Head of the Department of Orthopaedics, AIIMS, New Delhi, India
Insert selection in total knee arthroplasty (TKA) increasingly targets high-end satisfaction rather than basic function alone. Ultra-congruent (UC) bearings increase conformity to enhance anteroposterior stability and may substitute for variable posterior cruciate ligament behavior without a post-cam mechanism. In a recent Level I prospective bilateral contralateral randomized trial, Pathak et al. compared UC and cruciate-retaining (CR) inserts within the same patient undergoing bilateral simultaneous TKA using the Forgotten Joint Score-12 (FJS-12) as the primary endpoint. UC knees achieved statistically higher FJS-12, whereas legacy patient-reported outcome measures (Oxford Knee Score and Knee Society Score), radiographic measures, gait-laboratory outcomes, and clinical stability surrogates were similar. This pattern should be interpreted cautiously. First, FJS-12 is less prone to ceiling effects and may detect subtle patient-perceived differences that other measures miss. Second, commonly invoked mechanistic explanations - improved anteroposterior stability, greater mid-flexion confidence, and better performance in transitional tasks - remain hypotheses rather than proven causal pathways in the index trial. Third, although the trial is methodologically elegant, it remains limited by sample size, two-year follow-up, single-surgeon/single-center execution, and the external-validity constraints and perception biases inherent to bilateral simultaneous TKA. The broader literature still supports short- to mid-term equivalence of UC and CR/posterior-stabilized designs in most clinical and objective outcomes, with implant-specific survivorship data generally reassuring for UC. Current findings therefore argue more strongly for better outcome measurement than for routine superiority claims. Future work should link joint-awareness PROMs with task-specific biomechanics, prespecified subgroup analyses, and longer-term implant-family surveillance.
DOI: 10.29245/2767-5130/2026/2.1246 View / Download PdfOsteoid Osteoma of the Temporomandibular Joint: A Systematic Review
Huaitian Xue1, Jiafen Zhang1, Luoyu Yang1, Wenchao Zhong1, Qingbin Zhang2, Jiansuo Hao1*
1Department of Orthognathic, TMJ, Facial Trauma Surgery, School and Hospital of Stomatology, Guangdong Engineering Research Center of Oral Restoration and Reconstruction& Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou Medical University, Guangzhou, China
2Department of Temporomandibular Joint, School and Hospital of Stomatology, Guangdong Engineering Research Center of Oral Restoration and Reconstruction& Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou Medical University, Guangzhou, China
Purpose: Osteoid osteoma (OO) rarely involves the temporomandibular joint (TMJ) and is frequently misdiagnosed as temporomandibular disorders (TMD), leading to delayed diagnosis. This study aimed to systematically summarize the clinical features, imaging findings, treatment strategies, and outcomes of TMJ OO.
Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and ScienceDirect were searched from inception to February 2026. Case reports and small case series reporting TMJ-related OO were included. Data on demographics, clinical presentation, imaging characteristics, treatment, and outcomes were extracted.
Results: Nine studies comprising ten patients were included. Nocturnal preauricular pain was the most common symptom, often partially relieved by nonsteroidal anti-inflammatory drugs (NSAIDs). Computed tomography (CT) or cone beam computed tomography (CBCT) consistently identified the characteristic nidus, whereas magnetic resonance imaging (MRI) mainly demonstrated secondary inflammatory changes. All patients underwent surgical excision, resulting in complete symptom resolution without reported recurrence during follow-up.
Conclusions: TMJ OO should be considered in patients with nocturnal preauricular pain unresponsive to conventional TMD treatment. Early CT-based imaging is essential for accurate diagnosis, and surgical excision provides excellent clinical outcomes.
DOI: 10.29245/2767-5130/2026/2.1250 View / Download Pdf