{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:02:54Z","timestamp":1780963374604,"version":"3.54.1"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T00:00:00Z","timestamp":1777075200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":45,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Orthop Traumatol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>While recent investigations have focused on injury mechanism classifications of tibial plateau fractures (TPFs), the association between valgus TPFs and concomitant soft-tissue damage involving menisci and ligaments remains insufficiently elucidated. This study aimed to characterize intra-articular soft-tissue injuries associated with various valgus TPFs and assess the predictive value of lateral plateau depression (LPD) and widening (LPW). Additionally, the analysis extended to other injury mechanisms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This study included adult patients with acute tibial plateau fractures who had complete imaging data, excluding patients with open fractures and multiple fractures throughout the body. Imaging examinations were used to assess the fracture mechanism and intra-articular soft-tissue damage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study retrospectively analyzed the clinical data of 138 patients with valgus injury TPFs in our hospital. The study compared the incidence of TPFs with intra-articular soft-tissue damage under different injury mechanisms. The result demonstrated that the incidence of valgus hyperextension TPFs combined with medial collateral ligament injuries was relatively high (61.5%) compared with TPFs with other injury mechanism. Multivariable logistic regression and smooth curve fitting revealed significant dose\u2013response relationships of LPD (odds ratio [OR]\u2009=\u20091.408; 95% confidence interval [CI] 1.217, 1.627) and LPW (OR\u2009=\u20091.782; 95% CI 1.387, 2.290) with the risk of lateral meniscus (LM) tears in valgus TPFs. Receiver operating characteristic curves showed the area under the curve (AUC) values and the optimal thresholds of LPD and LPW. For all valgus TPFs, the AUCs of LPD and LPW associated with LM tear were 0.804 (95% CI 0.728, 0.880) and 0.741 (95% CI 0.657, 0.825), respectively. And the optimal threshold for LPD to predict LM tears was 7.11\u00a0mm (sensitivity 0.80, specificity 0.74). Subgroup analysis by injury mechanism further demonstrated that, under the valgus extension injury mechanism, the optimal threshold was 8.45\u00a0mm (sensitivity 0.68, specificity 0.91). Under the valgus flexion injury mechanism, the optimal threshold was 7.18\u00a0mm (sensitivity 0.69, specificity 0.87). Further analyses revealed that varus flexion TPFs demonstrated elevated risks of anterior cruciate ligament injuries (82.5%), lateral collateral ligament injuries (65.0%), and meniscal tears (70.0%), whereas varus hyperextension TPFs showed higher posterior cruciate ligament injury prevalence (56.3%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>LPD serves as a reliable predictor of fractures combined with LM tears. Specifically, under the overall valgus injury mechanism, the possibility of LM tears (particularly the posterior horn tears) should be guarded against when LPD exceeds 7.11\u00a0mm. For the valgus extension subtype, the possibility of LM tears (especially the anterior horn tears) should be highly suspected when LPD exceeds 8.45\u00a0mm. And for the valgus flexion subtype, an LPD exceeding 7.18\u00a0mm should prompt evaluation for LM tears, particularly those affecting the posterior horn.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>Level 3.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s10195-026-00927-5","type":"journal-article","created":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T03:45:18Z","timestamp":1777088718000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A study on the association between tibial plateau fractures and intra-articular soft-tissue injuries under valgus injury mechanisms"],"prefix":"10.1186","volume":"27","author":[{"given":"Shuo","family":"Duan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuaishuai","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tongtong","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinghan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6227-4240","authenticated-orcid":false,"given":"Minglei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,25]]},"reference":[{"issue":"3","key":"927_CR1","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1097\/bot.0000000000001042","volume":"32","author":"SJ Warner","year":"2018","unstructured":"Warner SJ, Garner MR, Schottel PC et\u00a0al. (2018) The effect of soft tissue injuries on clinical outcomes after tibial plateau fracture fixation. J Orthop Trauma 32(3):141\u2013147. https:\/\/doi.org\/10.1097\/bot.0000000000001042","journal-title":"J Orthop Trauma"},{"issue":"5","key":"927_CR2","doi-asserted-by":"publisher","first-page":"410","DOI":"10.2106\/jbjs.19.00485","volume":"102","author":"X Xie","year":"2020","unstructured":"Xie X, Zhan Y, Wang Y et\u00a0al. (2020) Comparative analysis of mechanism-associated 3-dimensional tibial plateau fracture patterns. J Bone Jt Surg Am 102(5):410\u2013418. https:\/\/doi.org\/10.2106\/jbjs.19.00485","journal-title":"J Bone Jt Surg Am"},{"issue":"1","key":"927_CR3","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-018-31705-x","volume":"8","author":"H Chang","year":"2018","unstructured":"Chang H, Zheng Z, Shao D et\u00a0al. (2018) Incidence and radiological predictors of concomitant meniscal and cruciate ligament injuries in operative tibial plateau fractures: a prospective diagnostic study. Sci Rep 8(1):13317. https:\/\/doi.org\/10.1038\/s41598-018-31705-x","journal-title":"Sci Rep"},{"key":"927_CR4","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2023.1095961","volume":"10","author":"H Lv","year":"2023","unstructured":"Lv H, Li W, Wang Y et\u00a0al. (2023) Prediction model for tibial plateau fracture combined with meniscus injury. Front Surg 10:1095961. https:\/\/doi.org\/10.3389\/fsurg.2023.1095961","journal-title":"Front Surg"},{"issue":"2","key":"927_CR5","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1007\/s00068-022-02127-2","volume":"49","author":"G Th\u00fcrig","year":"2023","unstructured":"Th\u00fcrig G, Korthaus A, Frosch KH et\u00a0al. (2023) The value of magnetic resonance imaging in the preoperative diagnosis of tibial plateau fractures: a systematic literature review. Eur J Trauma Emerg Surg 49(2):661\u2013679. https:\/\/doi.org\/10.1007\/s00068-022-02127-2","journal-title":"Eur J Trauma Emerg Surg"},{"key":"927_CR6","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/5353820","volume":"2018","author":"JP Kolb","year":"2018","unstructured":"Kolb JP, Regier M, Vettorazzi E et\u00a0al. (2018) Prediction of meniscal and ligamentous injuries in lateral tibial plateau fractures based on measurements of lateral plateau widening on multidetector computed tomography scans. BioMed Res Int 2018:5353820. https:\/\/doi.org\/10.1155\/2018\/5353820","journal-title":"BioMed Res Int"},{"issue":"3","key":"927_CR7","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1007\/s00167-012-2201-5","volume":"21","author":"AS Spiro","year":"2013","unstructured":"Spiro AS, Regier M, Novo de Oliveira A et\u00a0al. (2013) The degree of articular depression as a predictor of soft-tissue injuries in tibial plateau fracture. Knee Surg Sports Traumatol Arthrosc 21(3):564\u2013570. https:\/\/doi.org\/10.1007\/s00167-012-2201-5","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"2","key":"927_CR8","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1097\/01.ta.0000203548.50829.92","volume":"60","author":"MJ Gardner","year":"2006","unstructured":"Gardner MJ, Yacoubian S, Geller D et\u00a0al. (2006) Prediction of soft-tissue injuries in Schatzker II tibial plateau fractures based on measurements of plain radiographs. J Trauma 60(2):319\u2013323. https:\/\/doi.org\/10.1097\/01.ta.0000203548.50829.92. (discussion 324)","journal-title":"J Trauma"},{"issue":"5","key":"927_CR9","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1007\/s00590-015-1614-5","volume":"25","author":"J Wang","year":"2015","unstructured":"Wang J, Wei J, Wang M (2015) The distinct prediction standards for radiological assessments associated with soft tissue injuries in the acute tibial plateau fracture. Eur J Orthop Surg Traumatol 25(5):913\u2013920. https:\/\/doi.org\/10.1007\/s00590-015-1614-5","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"1","key":"927_CR10","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-021-04967-2","volume":"23","author":"Y Pu","year":"2022","unstructured":"Pu Y, Lei Z, Wenge D et\u00a0al. (2022) Correlation between CT images of lateral plateau and lateral meniscus injuries in patients with Schatzker II tibial plateau fractures:a retrospective study. BMC Musculoskelet Disord 23(1):9. https:\/\/doi.org\/10.1186\/s12891-021-04967-2","journal-title":"BMC Musculoskelet Disord"},{"issue":"3","key":"927_CR11","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1016\/j.injury.2017.01.043","volume":"48","author":"HC Tang","year":"2017","unstructured":"Tang HC, Chen IJ, Yeh YC et\u00a0al. (2017) Correlation of parameters on preoperative CT images with intra-articular soft-tissue injuries in acute tibial plateau fractures: a review of 132 patients receiving ARIF. Injury 48(3):745\u2013750. https:\/\/doi.org\/10.1016\/j.injury.2017.01.043","journal-title":"Injury"},{"issue":"9","key":"927_CR12","doi-asserted-by":"publisher","first-page":"2141","DOI":"10.1007\/s00167-012-2195-z","volume":"21","author":"MO Durakbasa","year":"2013","unstructured":"Durakbasa MO, Kose O, Ermis MN et\u00a0al. (2013) Measurement of lateral plateau depression and lateral plateau widening in a Schatzker type II fracture can predict a lateral meniscal injury. Knee Surg Sports Traumatol Arthrosc 21(9):2141\u20132146. https:\/\/doi.org\/10.1007\/s00167-012-2195-z","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"927_CR13","first-page":"94","volume":"138","author":"J Schatzker","year":"1979","unstructured":"Schatzker J, McBroom R, Bruce D (1979) The tibial plateau fracture. The Toronto experience 1968\u20131975. Clin Orthop Relat Res 138:94\u2013104","journal-title":"Clin Orthop Relat Res"},{"issue":"10 Suppl","key":"927_CR14","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1097\/00005131-200711101-00001","volume":"21","author":"JL Marsh","year":"2007","unstructured":"Marsh JL, Slongo TF, Agel J et\u00a0al. (2007) Fracture and dislocation classification compendium\u20142007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 21(10 Suppl):S1-133. https:\/\/doi.org\/10.1097\/00005131-200711101-00001","journal-title":"J Orthop Trauma"},{"issue":"7","key":"927_CR15","doi-asserted-by":"publisher","first-page":"929","DOI":"10.1007\/s00402-013-1735-4","volume":"133","author":"G Yang","year":"2013","unstructured":"Yang G, Zhai Q, Zhu Y et\u00a0al. (2013) The incidence of posterior tibial plateau fracture: an investigation of 525 fractures by using a CT-based classification system. Arch Orthop Trauma Surg 133(7):929\u2013934. https:\/\/doi.org\/10.1007\/s00402-013-1735-4","journal-title":"Arch Orthop Trauma Surg"},{"issue":"12","key":"927_CR16","doi-asserted-by":"publisher","first-page":"2252","DOI":"10.1016\/j.injury.2018.11.010","volume":"49","author":"M Kfuri","year":"2018","unstructured":"Kfuri M, Schatzker J (2018) Revisiting the Schatzker classification of tibial plateau fractures. Injury 49(12):2252\u20132263. https:\/\/doi.org\/10.1016\/j.injury.2018.11.010","journal-title":"Injury"},{"issue":"1","key":"927_CR17","first-page":"472","volume":"8","author":"HW Chen","year":"2015","unstructured":"Chen HW, Chen CQ, Yi XH (2015) Posterior tibial plateau fracture: a new treatment-oriented classification and surgical management. Int J Clin Exp Med 8(1):472\u2013479","journal-title":"Int J Clin Exp Med"},{"issue":"7","key":"927_CR18","doi-asserted-by":"publisher","first-page":"1488","DOI":"10.1016\/j.injury.2016.04.026","volume":"47","author":"Y Wang","year":"2016","unstructured":"Wang Y, Luo C, Zhu Y et\u00a0al. (2016) Updated three-column concept in surgical treatment for tibial plateau fractures\u2014a prospective cohort study of 287 patients. Injury 47(7):1488\u20131496. https:\/\/doi.org\/10.1016\/j.injury.2016.04.026","journal-title":"Injury"},{"issue":"5","key":"927_CR19","doi-asserted-by":"publisher","first-page":"e152","DOI":"10.1097\/bot.0000000000000510","volume":"30","author":"R Firoozabadi","year":"2016","unstructured":"Firoozabadi R, Schneidkraut J, Beingessner D et\u00a0al. (2016) Hyperextension varus bicondylar tibial plateau fracture pattern: diagnosis and treatment strategies. J Orthop Trauma 30(5):e152-157. https:\/\/doi.org\/10.1097\/bot.0000000000000510","journal-title":"J Orthop Trauma"},{"issue":"21","key":"927_CR20","doi-asserted-by":"publisher","first-page":"2001","DOI":"10.2106\/jbjs.23.01274","volume":"106","author":"B Wang","year":"2024","unstructured":"Wang B, Ye T, Zhang B et\u00a0al. (2024) Relationship of fracture morphological characteristics with posterolateral corner injuries in hyperextension varus tibial plateau fractures. J Bone Jt Surg Am 106(21):2001\u20132008. https:\/\/doi.org\/10.2106\/jbjs.23.01274","journal-title":"J Bone Jt Surg Am"},{"issue":"10","key":"927_CR21","doi-asserted-by":"publisher","first-page":"1517","DOI":"10.1007\/s40279-016-0540-y","volume":"46","author":"CT Beals","year":"2016","unstructured":"Beals CT, Magnussen RA, Graham WC et\u00a0al. (2016) The prevalence of meniscal pathology in asymptomatic athletes. Sports Med 46(10):1517\u20131524. https:\/\/doi.org\/10.1007\/s40279-016-0540-y","journal-title":"Sports Med"},{"issue":"2","key":"927_CR22","doi-asserted-by":"publisher","first-page":"80","DOI":"10.3928\/01477447-20100104-05","volume":"33","author":"VM Ringus","year":"2010","unstructured":"Ringus VM, Lemley FR, Hubbard DF et\u00a0al. (2010) Lateral tibial plateau fracture depression as a predictor of lateral meniscus pathology. Orthopedics 33(2):80\u201384. https:\/\/doi.org\/10.3928\/01477447-20100104-05","journal-title":"Orthopedics"},{"issue":"1","key":"927_CR23","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-023-06924-7","volume":"24","author":"Y Liu","year":"2023","unstructured":"Liu Y, Fang R, Tu B et\u00a0al. (2023) Correlation of preoperative CT imaging shift parameters of the lateral plateau with lateral meniscal injury in Schatzker IV-C tibial plateau fractures. BMC Musculoskelet Disord 24(1):793. https:\/\/doi.org\/10.1186\/s12891-023-06924-7","journal-title":"BMC Musculoskelet Disord"},{"issue":"8","key":"927_CR24","doi-asserted-by":"publisher","first-page":"1269","DOI":"10.1007\/s00402-020-03533-0","volume":"141","author":"B Yan","year":"2021","unstructured":"Yan B, Sun J, Yin W (2021) The prevalence of soft tissue injuries in operative Schatzker type IV tibial plateau fractures. Arch Orthop Trauma Surg 141(8):1269\u20131275. https:\/\/doi.org\/10.1007\/s00402-020-03533-0","journal-title":"Arch Orthop Trauma Surg"},{"issue":"12","key":"927_CR25","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2024.111921","volume":"55","author":"J Peng","year":"2024","unstructured":"Peng J, Ren W, Feng B et\u00a0al. (2024) Schatzker IV tibial plateau fractures involving the posterolateral column: higher incidence of lateral meniscus and anterior cruciate ligament injuries with suboptimal postoperative outcomes. Injury 55(12):111921. https:\/\/doi.org\/10.1016\/j.injury.2024.111921","journal-title":"Injury"},{"issue":"3","key":"927_CR26","doi-asserted-by":"publisher","first-page":"e85","DOI":"10.1097\/bot.0000000000002743","volume":"38","author":"DC O\u2019Neill","year":"2024","unstructured":"O\u2019Neill DC, Sato EH, Steffenson LN et\u00a0al. (2024) Worse quality of life associated with hyperextension varus tibial plateau fracture pattern. J Orthop Trauma 38(3):e85\u2013e91. https:\/\/doi.org\/10.1097\/bot.0000000000002743","journal-title":"J Orthop Trauma"},{"issue":"11","key":"927_CR27","doi-asserted-by":"publisher","first-page":"e369","DOI":"10.1097\/bot.0000000000000930","volume":"31","author":"LJ Gonzalez","year":"2017","unstructured":"Gonzalez LJ, Lott A, Konda S et\u00a0al. (2017) The hyperextension tibial plateau fracture pattern: a predictor of poor outcome. J Orthop Trauma 31(11):e369\u2013e374. https:\/\/doi.org\/10.1097\/bot.0000000000000930","journal-title":"J Orthop Trauma"},{"issue":"2","key":"927_CR28","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1007\/s10140-003-0298-z","volume":"10","author":"DL Bennett","year":"2003","unstructured":"Bennett DL, George MJ, El-Khoury GY et\u00a0al. (2003) Anterior rim tibial plateau fractures and posterolateral corner knee injury. Emerg Radiol 10(2):76\u201383. https:\/\/doi.org\/10.1007\/s10140-003-0298-z","journal-title":"Emerg Radiol"},{"issue":"1","key":"927_CR29","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/j.knee.2008.08.002","volume":"16","author":"JH Yoo","year":"2009","unstructured":"Yoo JH, Kim EH, Yim SJ et\u00a0al. (2009) A case of compression fracture of medial tibial plateau and medial femoral condyle combined with posterior cruciate ligament and posterolateral corner injury. Knee 16(1):83\u201386. https:\/\/doi.org\/10.1016\/j.knee.2008.08.002","journal-title":"Knee"},{"issue":"1","key":"927_CR30","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-020-01806-3","volume":"15","author":"J Liangjun","year":"2020","unstructured":"Liangjun J, Qiang Z, Zhijun P et\u00a0al. (2020) Clinical features and treatment of \u201cnon-dislocated hyperextension tibial plateau fracture.\u201d J Orthop Surg Res 15(1):289. https:\/\/doi.org\/10.1186\/s13018-020-01806-3","journal-title":"J Orthop Surg Res"},{"issue":"6","key":"927_CR31","doi-asserted-by":"publisher","first-page":"642","DOI":"10.1053\/jars.2001.22362","volume":"17","author":"T Chiba","year":"2001","unstructured":"Chiba T, Sugita T, Onuma M et\u00a0al. (2001) Injuries to the posterolateral aspect of the knee accompanied by compression fracture of the anterior part of the medial tibial plateau. Arthroscopy 17(6):642\u2013647. https:\/\/doi.org\/10.1053\/jars.2001.22362","journal-title":"Arthroscopy"},{"issue":"Suppl 1","key":"927_CR32","doi-asserted-by":"publisher","first-page":"S34","DOI":"10.1055\/s-0031-1280969","volume":"26","author":"X Conesa","year":"2013","unstructured":"Conesa X, Minguell J, Cortina J et\u00a0al. (2013) Fracture of the anteromedial tibial plateau associated with posterolateral complex injury: case study and literature review. J Knee Surg 26(Suppl 1):S34-39. https:\/\/doi.org\/10.1055\/s-0031-1280969","journal-title":"J Knee Surg"},{"issue":"7","key":"927_CR33","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1007\/s00402-020-03422-6","volume":"140","author":"F V\u00f6llner","year":"2020","unstructured":"V\u00f6llner F, Herl F, Greimel F et\u00a0al. (2020) The effects of soft tissue lateral release on the stability of the ligament complex of the knee. Arch Orthop Trauma Surg 140(7):933\u2013940. https:\/\/doi.org\/10.1007\/s00402-020-03422-6","journal-title":"Arch Orthop Trauma Surg"},{"issue":"3","key":"927_CR34","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/s0268-0033(97)00043-0","volume":"13","author":"DT Harfe","year":"1998","unstructured":"Harfe DT, Chuinard CR, Espinoza LM et\u00a0al. (1998) Elongation patterns of the collateral ligaments of the human knee. Clin Biomech (Bristol) 13(3):163\u2013175. https:\/\/doi.org\/10.1016\/s0268-0033(97)00043-0","journal-title":"Clin Biomech (Bristol)"},{"key":"927_CR35","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1016\/j.knee.2020.12.002","volume":"28","author":"A Shetty","year":"2021","unstructured":"Shetty A, Prabhath S, Alappatt K et\u00a0al. (2021) Lateral collateral ligament and anterolateral ligament of the knee\u2014a morphological analysis with orthopedic significance. Knee 28:202\u2013206. https:\/\/doi.org\/10.1016\/j.knee.2020.12.002","journal-title":"Knee"}],"container-title":["Journal of Orthopaedics and Traumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s10195-026-00927-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s10195-026-00927-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s10195-026-00927-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T23:46:31Z","timestamp":1780962391000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s10195-026-00927-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,25]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["927"],"URL":"https:\/\/doi.org\/10.1186\/s10195-026-00927-5","relation":{},"ISSN":["1590-9999"],"issn-type":[{"value":"1590-9999","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,25]]},"assertion":[{"value":"25 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study adhered to the principles outlined in the Declaration of Helsinki. The local ethics committees reviewed the study protocol and determined that no ethical approval was required, given the purely retrospective and observational nature of the design.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"29"}}