Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 2 2026 05 18 64 7 Ebrahim Piri PhD in Sports Biomechanics, Department of Sports Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran Amir Jafarnezhadgro Associate Professor, Department of Sports Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran 2025 08 22 2026 05 17 Securing a durable and effective reintegration into athletic activities after anterior cruciate ligament reconstruction (ACLR) viasurgery, constitutes an intricate and multifactorial endeavor. While most patients express strong optimism for unrestricted sports resumption, empirical outcomes reveal a notable disparity: only approximately 50% of individuals regain their prior competitive level, and among this group, one in five encounters a subsequent anterior cruciate ligament (ACL) rupture. In recent years, numerous assessment frameworks have been introduced to gauge postoperative readiness and mitigate the likelihood of recurrent injury. Nevertheless, contemporary studies indicate that a significant number of sports practitioners do not fulfill conventional clearance benchmarks, and notably, achieving these benchmarks does not invariably safeguard against a second injury, thereby calling into question their prognostic utility. This observed limitation implies that prevailing evaluation methods may possess inadequate discriminative capacity. The results derived from such assessments arguably mirror the caliber and comprehensiveness of the preceding rehabilitative intervention, thus inviting a rigorous reappraisal of standard therapeutic regimens. A pivotal inquiry emerges regarding the adequacy of contemporary preparation strategies in equipping athletes for the rigorous, dynamic, and stochastic challenges inherent in field and court sports. This integrative narrative analysis consolidates seminal findings from the last fifteen years, concentrating on three pivotal domains: 1) contemporary methodologies for evaluating return-to-sport readiness, 2) the architecture and efficacy of postoperative rehabilitation protocols, and 3) the conceptualization of the return-to sport process as a sequential continuum. These dimensions are examined through a unified and overarching analytical framework. https://jost.tums.ac.ir/index.php/jost/article/view/702 https://jost.tums.ac.ir/index.php/jost/article/download/702/464

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 2 2026 05 18 68 71 Iman Kiani Center for Orthopedic Trans-Disciplinary Applied Research, Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran Abolfazl Safari Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran Parham Talebian Orthopedic Surgeon and Spine Fellowship, Orthopedic Surgery Research Center (OSRC), Tehran University of Medical Sciences, Tehran, Iran 2025 07 27 2026 04 11 Background: Sagittal spinopelvic alignment, encompassing parameters such as lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and sagittal vertical axis (PL-SVA), is a critical determinant of outcomes following lumbar decompression surgery. While decompression is effective in alleviating neurogenic claudication in degenerative lumbar spinal stenosis (DLSS), its impact on sagittal alignment remains uncertain. This study evaluates the radiographic and clinical outcomes associated with decompression surgery. Methods: In this prospective cohort study, 24 patients underwent decompression via laminectomy or laminotomy between July 2017 and July 2018. Sagittal alignment parameters were assessed preoperatively and at follow-up using EOS imaging. Pain and functional outcomes were evaluated using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Statistical comparisons were performed using paired t-tests. Results: Postoperative evaluation showed significant improvement in LL (29.50 ± 15.02 to 51.58 ± 5.99, p < 0.001), SS (31.15 ± 2.05 to 26.99 ± 5, p < 0.001), and a significant decrease in PT (11.68 ± 2.91 to 6.06 ± 4.62, p < 0.001). No statistically significant changes were noted in PI (p = 0.264) or PL-SVA (p = 0.540). Improvements in LL and SS were negatively correlated with reductions in VAS scores (p = 0.034 and p = 0.028). Conclusion: Lumbar decompression can significantly influence spinopelvic alignment and reduce pain in patients with DLSS. These findings suggest that realignment of sagittal parameters following decompression alone may contribute to improved clinical outcomes. https://jost.tums.ac.ir/index.php/jost/article/view/699 https://jost.tums.ac.ir/index.php/jost/article/download/699/465

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 2 2026 05 18 107 11 EN Sadegh Saberi Associate Professor, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Aysan Valinejad-Qanati Medical Student, Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran Seyyed Saeed Khabiri Assistant Professor, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran 2025 08 23 2026 05 18 This case-based expert review from ORTHOBIT 2025 Congress (Tehran, Iran) highlights the practical challenge of distinguishing between enchondroma/atypical cartilaginous tumor (ACT) (low-grade) and higher-grade chondrosarcoma (CS). A 57-year-old woman presented with 4 months of shoulder pain. Magnetic resonance imaging (MRI) revealed a proximal humeral metaphyseal intramedullary cartilaginous lesion with a focal cortical breach and a small extraosseous component. The core needle biopsy (CNB) suggested enchondroma, and the patient underwent extended curettage, cementation, and plate fixation. Final pathology upgraded the lesion to central CS, grade 2, prompting resection and reconstruction using a proximal humeral megaprosthesis. At 3 years, she was pain-free, recurrence-free, The Musculoskeletal Tumor Society Score (MSTS) 26/30, with moderate range of motion (ROM) limitation, and radiographic superior prosthetic migration without major complications. This case emphasizes the importance of radiology-pathology correlation and planning for possible diagnostic upgrading in borderline cartilaginous tumors. https://jost.tums.ac.ir/index.php/jost/article/view/704 https://jost.tums.ac.ir/index.php/jost/article/download/704/472

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 2 2026 05 18 72 6 Madhuchandra Puttamaregowda Professor, Department of Orthopedics, BGS Global Institute of Medical Sciences, Bengaluru, India Pawankumar Keelara Mahadevappa Professor, Department of Orthopedics, Dr. Chandramma Dayananda Sagar Institute of Medical Education and Research, Dayananda Sagar University, Bengaluru, India Nandeesh Shashidhar Associate Professor, Department of Orthopedics, BGS Global Institute of Medical Sciences, Bengaluru, India Raju Koluru Puttaswamygowda Professor, Department of Orthopedics, BGS Global Institute of Medical Sciences, Bengaluru, India 2025 09 25 2026 05 17 Background: The management of femoral neck fracture in elderly patients above 60 years of age remains controversial. Although internal fixation is one of the surgical options, it is associated with high failure rates due to complications such as non-union andvarus collapse. Hemiarthroplasty also has inherent complications, including acetabular erosion, secondary arthritis, and protrusio acetabuli. Primary total hip arthroplasty (THA) offers a stable hip joint with excellent functional outcomes. Methods: This study was conducted at a tertiary care institute between January 2020 and June 2024. A total of 48 THAs were performed in 47 patients as a primary procedure for femoral neck fracture. All procedures were cemented total hip replacements and were performed by a single surgeon. Preoperative evaluation was carried out using the Harris Hip Score (HHS). Radiological assessment was performed using standard radiological parameters. Results: At the end of the follow-up period, the mean HHS was 86.3 (range: 77-97). Of the 48 hips, 16 demonstrated excellent outcomes (HHS > 90), 27 showed good outcomes (HHS: 80-89), and 5 had fair outcomes (HHS: 70-79). Complications included three cases of superficial infection and four cases of deep vein thrombosis (DVT). Conclusion: Primary THA is an excellent alternative to internal fixation and hemiarthroplasty in the management of femoral neck fracture in elderly patients. The study also suggests that the modified lateral approach is a safer surgical approach in reducing the risk of dislocation.  https://jost.tums.ac.ir/index.php/jost/article/view/718 https://jost.tums.ac.ir/index.php/jost/article/download/718/466

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 2 2026 05 18 77 85 Seyed Mohammad Mohammadi Assistant Professor, Department of Orthopedics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Mohammad Lotfi Medical Student, Student Research Committee, Abadan University of Medical Sciences, Abadan, Iran Naser Kamyari Assistant Professor, Department of Public Health, School of Health, Abadan University of Medical Sciences, Abadan, Iran Fatemeh Shojaei Moghaddam Medical Student, Student Research Committee, Abadan University of Medical Sciences, Abadan, Iran Gholamreza Goudarzi Professor, Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Heidar Maleki PhD Candidate, Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Jasem Salehi Clinical Research Development Unit, Taleghani Educational Hospital, Abadan University of Medical Sciences, Abadan, Iran Seyed Amin Hossaini Motlagh Associate Professor, Department of Environmental Health Engineering, School of Health, Yasuj University of Medical Sciences, Yasuj, Iran Khadijeh Kanani Clinical Research Development Unit, Taleghani Educational Hospital, Abadan University of Medical Sciences, Abadan, Iran Sheyda Ghasemi Medical Student, Student Research Committee, Abadan University of Medical Sciences, Abadan, Iran Esmat Radmanesh Associate Professor, Research Center for Environmental Contaminants (RCEC), Abadan University of Medical Sciences, Abadan, Iran 2025 09 16 2026 04 04 Background: This study examined the correlation between bone mineral density (BMD) and particulate matter (PM) in patients with osteoporosis. Methods:  People with osteopenia, osteoporosis, and normal BMD were included in the study. BMD, bone mineral content (BMC), T-scores, and Z-scores of the lumbar vertebrae (L1-L4) and femur were obtained by dual-energy X-ray absorptiometry (DEXA). Daily PM2.5 and PM10 concentrations during the study period (January 21, 2022, to May 21, 2023) were obtained from local monitoring stations, with missing data estimated using satellite-derived aerosol optical depth (AOD).  Results: In patients with osteoporosis, an inverse correlation exists between PM2.5 and PM10 with BMD, BMC, T-score, and Z-score in different parts of the femur except the neck T-score and lumbar spine. Still, none of the correlations was statistically significant.  Conclusion: There was no significant correlation between the mean concentration of PM2.5 and PM10 and the parameters of BMD, BMC, T-score, and Z-score in the bones of the femur and lumbar spine of patients with osteoporosis. https://jost.tums.ac.ir/index.php/jost/article/view/714 https://jost.tums.ac.ir/index.php/jost/article/download/714/467

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 2 2026 05 18 86 90 EN Mahesh Shinde Assistant Professor, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Mihir Patel Additional Professor, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Bibhas DasGupta Professor and Head, Department of Orthopaedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Juhu Mumbai, Maharashtra Atharva Sharma Senior Resident, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Kshitij Sarwey Senior Resident, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Sanket Jethliya Senior Resident, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Shreyas Revankar Senior Resident, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Deepanshu Garg Senior Resident, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Rohan Bahl Senior Resident, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Samreen Chunawala Medical Student, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Sidharth Mitra Medical Student, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Juily Satam Senior Resident, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Yash Nav Singh Medical Student, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Kiara Thakur Medical Student, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India 2025 09 11 2026 05 17 https://jost.tums.ac.ir/index.php/jost/article/view/690 https://jost.tums.ac.ir/index.php/jost/article/download/690/460

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 1 2026 03 06 37 42 Seyyed Hadi Kalantar Assistant Professor, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Omid Salkhori Assistant Professor, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Nima Bagheri Associate Professor, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Seyyed Saeed Khabiri Assistant Professor, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Aidin Arabzadeh Assistant Professor, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Alireza Talebi Orthopedic Surgeon, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Hadi Jahanbin Orthopedic Surgeon, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Seyed Mohammadjavad Mortazavi Professor, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Hamed Naghizadeh Orthopedic Surgeon, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran 2025 09 13 2026 01 26 Background: Segmental bone defects of the lower extremity, particularly involving the femur and tibia, remain a major reconstructive challenge. Traditional techniques such as the Ilizarov method, Masquelet’s induced membrane, and vascularized fibular grafts are effective but often associated with prolonged treatment duration and significant morbidity. Recent advances in additive manufacturing have introduced patient-specific three-dimensional (3D)-printed implants as a promising alternative. Methods: This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was conducted to collect current knowledge on 3D-printed implants of the tibia and femur. Databases including PubMed, Scopus, Embase, and Web of Science were searched from January 2000 to April 2025 for studies reporting outcomes of treatment of tibial or femoral segmental bone defects. Primary outcomes included bone union rate and complications. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) tool, and pooled data were analyzed using a random-effects model. Results: Seventeen studies involving 174 patients were included. The mean bone defect length was 12.3 cm, and the mean follow-up was 27.2 months. The pooled union rate was 92.4% [95% confidence interval (CI): 89.0%-94.8%], with no statistically significant heterogeneity (I2 = 0%). The mean time to radiological union was 7.66 months. The pooled complication rate was 23.5% (95% CI: 15.6%- 33.8%), with reoperation, deep infection, and device-related events being the most common. Assessment of publication bias revealed no statistically significant effect. Conclusion: Custom-made 3D-printed implants represent a highly effective and safe option for the reconstruction of segmental bone defects in the lower extremity. The high union rate and acceptable complication profile support their utility in managing complex cases. Further prospective studies are needed to confirm these findings and define optimal indications.   https://jost.tums.ac.ir/index.php/jost/article/view/712 https://jost.tums.ac.ir/index.php/jost/article/download/712/461

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 1 2026 03 06 43 9 Mohammadreza Golbakhsh Associate Professor, Department of Orthopedic Surgery, Orthopedic Subspecialty Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Seyed Aref Daneshi Orthopedic Surgeon, Orthopedic Subspecialty Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Tina Azimzadeh Bachelor of Nursing, Orthopedic Subspecialty Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Amirmohammad Sharafi Medical Student, Orthopedic Subspecialty Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Mehrdad Sheikhvatan Assistant Professor, Department of Medical Genetics, Orthopedic Subspecialty Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Seyed Hossein Shafiei Assistant Professor, Department of Orthopedic Surgery, Orthopedic Subspecialty Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran 2025 02 27 2026 01 26 Background: Caring for trauma patients is a paramount international concern. Delays in diagnosing patients in need of intensive care have unredeemable consequences. Identifying predicting factors of ICU admission in trauma patients is not without merit regarding this matter. This study aimed to investigate the underlying factors associated with ICU admission in trauma patients. Methods: A retrospective study was designed based on data from the National Trauma Registry of Iran from 2016 to 2021. ICU admission was considered the primary endpoint. Relationships between demographic variables, injury site, injury mechanism, vital signs, and trauma scores with the outcome were evaluated by univariate analyzes. ICU risk factors and their specific odds ratio were determined by multivariate analysis. Results: Following univariate and multivariate analysis, age> 55 years, widowhood, injuries due to road accidents, falling from a height, penetrating objects, and gunshot, underlying cardiovascular disease, injury to head, thorax, abdomen, spine, and lower extremities, hypotension, hypertension, tachycardia, bradycardia, hyperpnea, low oxygen saturation, high body temperature, GCS≤8, and ISS>15 were introduced as independent risk factors of ICU admission. Nonetheless, transport to the hospital (personal car) and upper extremity injury reduced the outcome incidence. Conclusions: Numerous contextual variables were significantly associated with ICU admission, each with its own matter. When entering the emergency room, paying attention to these factors can help diagnose people in need of ICU care sooner. https://jost.tums.ac.ir/index.php/jost/article/view/661 https://jost.tums.ac.ir/index.php/jost/article/download/661/462

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 1 2026 03 06 50 4 Fenil Shah Junior Resident, Department of Orthopedics, GMERS Medical College, Gotri, Vadodara, Gujarat, India Chirag Thakkar Professor, Department of Orthopedics, GMERS Medical College, Gotri, Vadodara, Gujarat, India Dhaval Pandya Assistant Professor, Department of Orthopedics, GMERS Medical College, Gotri, Vadodara, Gujarat, India Rajvee Shah Junior Resident, Department of Pharmacology, GMERS Medical College, Gotri, Vadodara, Gujarat, India Jeevan Kishor A Junior Resident, Department of Orthopedics, GMERS Medical College, Gotri, Vadodara, Gujarat, India Tarun Desai Associate Professor, Department of Orthopedics, GMERS Medical College, Gotri, Vadodara, Gujarat, India 2025 05 19 2026 01 26 Background: Total knee arthroplasty (TKA) is the gold standard surgical intervention for treating end-stage knee osteoarthritis (OA). Measured resection (MR) and gap balancing (GB) are the primary surgical techniques that are employed to achieve these outcomes. Each of these procedures has its own distinct principles and advantages; MR is completely based on predetermined bone cuts and femoral rotation whereas GB is truly based on native knee anatomy. Their comparative impact on short-term recovery, implant alignment, and long-term outcomes remains debated, highlighting the need for evidence-based guidance. This study was conducted to compare the functional outcomes, complications, and patient-related outcomes of these two different techniques in the hands of a single surgeon. Methods: A prospective randomized study was carried out with 60 patients undergoing TKA. They were categorized as the MR group (Group MR) or the GB group (Group GB). Functional recovery was the primary outcome and was assessed using the Knee Society Score (KSS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score. Secondary outcomes included tourniquet times, postoperative visual analogue scale (VAS) score, and postoperative knee flexion at various intervals. Results: The GB subset demonstrated statistically significant improvement one month following surgery in both KSS Part 1 (P < 0.001) and KSS Part 2 (P = 0.004) and larger reduction in WOMAC score (P < 0.001), suggesting rapid and comprehensive functional recovery and early improvement in pain and joint stiffness. However, the difference between the two groups was not statistically significant at 12 and 24 months post-operatively. Conclusion: GB offers superior short-term outcomes, but the choice of surgical technique should take into account individual patient profile or patient-specific factors, the surgeon’s op