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 PdfReconsidering Early Anatomy Exposure: Performance, Identity, and Belonging in Specialty Choice
Rebecca L. Pratt
Professor of Anatomy, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
Undergraduate anatomy coursework is often discussed as a possible prerequisite for medical school acceptance or as a course elective for improving medical student performance in clinical anatomy material. Current evidence, including the 2024 publication Effect of anatomical studies prior to medical school on medical school anatomy study success and residency choice, suggests that early anatomy exposure does not reveal a measurable advantage in medical school anatomy performance or standardized examination outcomes1. The authors also proposed that early introduction to anatomy could possibly influence specialty choice, particularly in anatomy-driven fields such as surgery, orthopedics, and radiology. Anonymous survey results, instead, highlighted that students who applied to surgical specialties demonstrated higher performance in anatomical courses and higher USMLE Step 1 scores compared to those who did not apply to surgical specialties1.
Rather than viewing these conclusions as dismissive of pre-matriculation anatomy coursework, this commentary offers a broader interpretation. Drawing on medical education literature and long-standing observations from decades of anatomy teaching, early anatomy exposure may function less as a performance accelerator and more as a formative experience that shapes professional identity. Students often make career decisions not on objective metrics alone, but on how confident and capable they feel within a discipline. This is an internal narrative shaped through exposure, mentorship, and informal laboratory conversations with faculty2-4. By reframing the value of pre-medical anatomy coursework away from score optimization and toward identity formation we refresh the conversation about how anatomy education supports specialty exploration.
DOI: 10.29245/2767-5130/2026/1.1245 View / Download PdfA Six-Month Study on the Efficacy and Safety of a Single Intra-Articular Injection of Sodium Hyaluronate in Knee Osteoarthritis
Serhat Gafur Karaca1*, Burak Kaval2
1Orthopaedic Surgeon, Private Practice, Atasehir-Istanbul, Turkey
2Orthopaedic Surgeon, Isparta City Hospital, Isparta, Turkey
Objective: This single-center, open-label, phase IV study aimed to evaluate the six-month efficacy and safety of a single intra-articular injection of 2% sodium hyaluronate (Hyarelief®) in patients with grade III knee osteoarthritis (OA).
Material and Methods: Ninety patients aged ≥40 years with ACR-defined grade III knee OA received a single injection. Primary outcomes were pain intensity (10-cm Visual Analogue Scale, VAS) and joint function (WOMAC index), assessed at baseline and on days 15, 30, 60, 90, 120, 150, and 180. A linear mixed model with Bonferroni correction analyzed changes over time. Subgroup analyses (Mann-Whitney U test) examined differences by gender, adverse events, and rescue medication use.
Results: A significant effect of time was found for both VAS (F=263.319, p<0.001) and WOMAC scores (F=1054.539, p<0.001). Mean VAS decreased from 6.33±1.01 cm at baseline to 1.06±0.90 cm at day 90 (p<0.001). Mean WOMAC improved from 0.733±0.099 to 0.309±0.066 at day 120 (p<0.001). All follow-up scores were significantly better than baseline (all p<0.001). Subgroup analysis revealed significantly higher average pain in males versus females (p=0.001) and in patients requiring rescue medication (p<0.001). Adverse events were rare (5.6%) and mild.
Conclusion: A single injection of 2% sodium hyaluronate provides statistically and clinically significant improvement in pain and function for up to six months in patients with grade III knee OA, with a favorable safety profile. The treatment effect appears robust, though pain reporting may vary by gender.
DOI: 10.29245/2767-5130/2026/1.1244 View / Download Pdf