Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Calf muscle strain injuries (CMSI), also known as “tennis leg,” are frequently observed in middle-aged and physically active people, including non-professional athletes. While magnetic resonance imaging (MRI) is frequently used to assess the extent of these injuries, the relationship between MRI findings and long-term functional outcomes in non-athletic populations remains underexplored. This study aimed to investigate the correlation between MRI-detected injury severity and functional outcomes using the Achilles Tendon Rupture Score (ATRS) and the Tegner Activity Scale (TAS). A retrospective review was conducted on 78 non-athletic patients diagnosed with CMSI and were followed for an average of 25.6 ± 16.1 months. Injury severity was classified into three grades: Grade 1 (edema without architectural disruption), Grade 2 (partial muscle disruption with hematoma), and Grade 3 (complete muscle disruption or tendon detachment) based on MRI examination. The functional outcomes were assessed using the ATRS and TAS. A simple linear regression analysis was conducted to assess the impact of demographic variables and MRI findings on ATRS. The mean ATRS at the final follow-up was 92.9 ± 10.6, with 75.6% of patients achieving an excellent outcome. Despite the excellent ATRS scores, a notable reduction in TAS was evident from the pre-injury assessment (4.4 ± 1.2) to the final follow-up (3.8 ± 1.3; p < 0.001). Moreover, 44.9% of patients did not resume their pre-injury activity levels. The regression analysis demonstrated no statistically significant correlation between MRI-detected injury severity, demographic factors (age, gender, BMI), and ATRS outcomes (R² = 0.094, adjusted R² = -0.011). MRI-detected injury severity does not significantly predict long-term functional outcomes in patients with CMSI, even though most patients achieved excellent ATRS scores. However, nearly half of the patients did not return to their pre-injury activity levels. These findings suggest that additional factors might influence recovery, and further research is needed to elucidate these factors in non-athletic patients. Level IV, Retrospective case series.

Background/Objectives: The purpose of this study was to evaluate the reliability and diagnostic accuracy of smartphone-based photogrammetry for the assessment of pes planus and to determine its agreement with standard radiographic measurements. Methods: This prospective diagnostic study included 100 skeletally mature patients (50 males, 50 females; mean age 43.4 years) who underwent standardized lateral weight-bearing foot radiographs and smartphone-based foot photography. The calcaneal pitch angle (CPA) was measured on radiographs, and a corresponding photographic arch pitch angle (P-APA) was measured from standardized smartphone photographs using digital software (Angle Meter iOS v1.9.8). Three independent observers performed each measurement twice. Inter- and intra-observer reliability was assessed using intraclass correlation coefficients (ICC). Agreement between methods was evaluated with Pearson correlation, Lin’s concordance correlation coefficient (CCC), Bland–Altman analysis, and Deming regression. Receiver operating characteristic (ROC) analysis was performed to determine the diagnostic accuracy of calibrated P-APA, with the radiographic threshold of 18° serving as the reference standard for pes planus classification. Results: All measurements demonstrated excellent intra- and inter-observer reliability (ICC ≥ 0.900). P-APA values were systematically higher than radiographic values (31.8° ± 4.3 vs. 21.8° ± 5.5; p < 0.001). A strong correlation was observed between the two methods (r = 0.799, p < 0.001), but concordance was poor (CCC = 0.222). Bland–Altman analysis revealed a mean bias of +10.1° with wide limits of agreement (3.8° to 16.4°). Deming regression yielded the calibration equation Radiographic CPA = (P-APA × 1.371) − 21.883. ROC analysis of calibrated values yielded an AUC of 0.885 (95% CI, 0.820–0.951), with an optimal cutoff of 22.8° (sensitivity, 100%; specificity, 61.1%), corresponding to 32.6° on the uncalibrated photographic scale. Conclusions: Conventional weight-bearing radiography remains the reference standard for diagnosis and clinical decision-making in pes planus. The smartphone-derived photographic arch pitch angle is a non-equivalent surrogate measure that shows substantial systematic bias and limited agreement with radiographic calcaneal pitch, and therefore cannot replace weight-bearing radiographs. Smartphone photogrammetry may be used only as a complementary tool for preliminary screening or telemedicine support; any positive or equivocal findings require radiographic confirmation.

Background/Objectives: The modified Budin radiographic technique is a practical alternative to CT for measuring femoral neck anteversion (FNA); however, the impact of hip abduction angle on its accuracy remains unclear. This experimental study examined how varying abduction angles affect agreement between modified Budin measurements and CT. Methods: Twenty-seven dry adult femora underwent CT scanning, and FNA was measured using a validated three-slice superimposition method as the reference standard. Modified Budin radiographs were obtained at 20°, 30°, and 40° of femoral abduction. Two orthopedic surgeons independently measured FNA on all images twice, with at least 15 days between measurements. Intra- and interobserver reliability were assessed using the intraclass correlation coefficient (ICC). Mean values per femur were analyzed. Agreement with CT was evaluated using Pearson correlation, Bland–Altman analysis, and absolute error comparisons across abduction angles. Results: Reliability was excellent across all modalities (ICC, 0.982–0.998). Mean CT-derived FNA was 10.0° ± 8.5°, compared with 9.1° ± 8.0° at 20°, 8.3° ± 7.8° at 30°, and 7.8° ± 7.5° at 40° of abduction (p < 0.001). Correlation with CT was strong at all positions, but systematic underestimation increased with abduction angle. Among the tested positions, 20° abduction showed the smallest bias, the narrowest limits of agreement, and the lowest absolute error. Conclusions: Hip abduction angle significantly influences the accuracy of the modified Budin view. Under controlled experimental conditions, 20° abduction provided the closest agreement with CT among the tested positions. These findings suggest that lower abduction angles may improve geometric accuracy, although clinical feasibility and performance must be confirmed in vivo before routine clinical application can be recommended.

Background: This study aimed to evaluate the predictive value of anthropometric measurements for two-stranded peroneus longus tendon (PLT) graft thickness using ultrasonography Materials and methods: A prospective study was conducted on 204 healthy volunteers (102 males and 102 females) aged 18–40 years. Anthropometric measurements were recorded, including height, weight, body mass index (BMI), fibular length, calf circumference, and ankle circumference. The Tegner Activity Scale (TAS) was used to assess activity levels. PLT cross-sectional area (CSA) was measured using ultrasonography. Two-stranded PLT graft thickness was calculated using the previously reported formula by Luo et al. A thickness of less than 8 mm of PLT graft was accepted as an insufficient autograft for anterior cruciate ligament reconstruction (ACLR). Correlation and regression analyses were performed to identify predictors of two-stranded PLT graft thickness. Receiver operating characteristic (ROC) analysis was performed to establish the best threshold values. Results: Males had a significantly greater PLT CSA (0.17 ± 0.03 cm²) and predicted two-stranded PLT graft thickness (8.1 ± 0.6 mm) compared with females (0.15 ± 0.03 cm² and 7.5 ± 0.6 mm, respectively; p < 0.001 for both). Correlation analysis revealed that two-stranded PLT graft thickness positively correlated with height, weight, BMI, fibular length, calf circumference, ankle circumference, and Tegner Activity Scale in both genders, with stronger correlations observed in females. The logistic regression model identified height and calf circumference as significant predictors of sufficient two-stranded PLT graft thickness (≥ 8 mm) in males, while calf circumference and the TAS were significant predictors in females. ROC analysis demonstrated that calf circumference and the TAS had acceptable discriminatory abilities in females, with 36.25 cm and ≥ 4 cutoff points, respectively. However, no anthropometric variables in males exhibited strong discriminatory abilities for predicting two-stranded PLT graft thickness Conclusions: Calf circumference and the TAS are significant predictors for two-stranded PLT autograft thickness in females. However, no anthropometric variables in males could be used strongly for prediction. These anthropometric measurements can assist in preoperative planning and decision-making, potentially improving ACLR outcomes by ensuring adequate graft thickness in females. Level of evidence: Level II prospective study