Background:Knee osteoarthritis (OA) is a widespread joint disease with no disease-modifying treatments. Chondrocyte damage is a key process in knee OA and ferroptosis is lipid peroxidation-induced iron-dependent cell death that exacerbates the process of knee OA and aggravates an imbalance in the synthesis as well as degradation of matrix metallopeptidase 13 (MMP13) and type II collagen. The clinical diagnosis of knee OA mainly depends on imaging. Whether ferroptosis-related genes could be used as new biomarkers for the diagnosis of OA remains to be explored. Methods:A dataset was used to build a diagnostic model used to diagnose and differentiate patients with end-stage knee OA. Normalization and quality control of the three profiles was carried out using R 4.1.0. Results:Analysis of a dataset (GSE114007) of differentially expressed genes (DEGs) found that the expression of 15 ferroptosis-related genes, including activating transcription factor 3 (ATF3), cyclin-dependent kinase inhibitor 1A (CDKN1A), and cytochrome b-245 beta chain (CYBB), showed significant changes in osteoarthritic chondrocytes relative to normal subjects. Based on 15 ferroptosis-related genes, we developed and compared diagnostic models using different supervised learning algorithms. Conclusions:The diagnostic model based on the support vector machine gave a convincing diagnostic performance for both verifications (Area Under Curve [AUC] = 0.9601) and testing (AUC = 0.8725). The results collectively indicate that ferroptosis-related genes may play an indispensable role in knee OA and could be specific diagnostic biomarkers for knee OA.

Objective:To investigate the effectiveness and technical points of posterior open approach combined with suture bridge technique for the treatment of tibial insertion avulsion fractures of posterior cruciate ligament (PCL). Methods:A retrospective analysis was conducted on 21 patients with PCL tibial insertion avulsion fractures who underwent posterior open approach combined with suture bridge technique between July 2023 and July 2025. There were 14 males and 7 females, aged 11-68 years (mean, 48.3 years). Fracture displacement ranged from 3.9 to 13.7 mm, with an average of 7.9 mm. Preoperative Lysholm score was 46.1±3.9, International Knee Documentation Committee (IKDC) subjective score was 44.8±4.1, and posterior knee laxity was (4.1±0.5) mm. The time from injury to surgery ranged from 1 to 30 days, with an average of 9.4 days. The operation time and intraoperative blood loss were recorded. Knee function was assessed using Lysholm score and IKDC subjective score. Posterior knee laxity was measured bilaterally using a KT-2000 arthrometer, and the results were expressed as the side-to-side difference. Results:All surgeries were successfully completed. The operation time ranged from 40 to 130 minutes (mean, 80.2 minutes), and intraoperative blood loss ranged from 7 to 20 mL (mean, 10.4 mL). All incisions healed by first intention without early complication such as surgery-related infection or neurovascular injury. All 21 patients were followed up 12-20 months, with a mean of 18.3 months. Radiographic examination showed anatomical reduction and bony union in all fractures, with healing time ranging from 8 to 14 weeks (mean, 11.5 weeks). During follow-up, no reduction loss, implant loosening or breakage was observed. At last follow-up, the Lysholm score was 90.3±3.1, IKDC subjective score was 91.0±3.1, and posterior knee laxity was (1.6±0.4) mm, all showing significant differences compared with preoperative values ( P<0.05). Conclusion:The posterior open approach combined with suture bridge technique for PCL tibial insertion avulsion fractures offers the dual advantages of reliable reduction under direct vision and robust fixation with suture bridge, demonstrating safety and efficacy. It is particularly suitable for complex cases such as comminuted fractures, old fractures, or those complicated by posterior neurovascular injury.

Purpose We introduced a cost-effective semi-automatic total knee arthroplasty (TKA) robotic system-LANCET RobPath and validate its accuracy and effectiveness through a prospective and multicenter trial. Methods A multicenter prospective controlled single-blind clinical trial was conducted by five joint centers. Patients who underwent TKA were admitted and divided into two groups: robot-assisted group (RA group) and conventional manual group (CM group). Patients’ baseline characteristics, clinical subjective assessment indices, radiographic findings, hemoglobin (Hb) level changes, and operative duration were recorded and analyzed. Results No adverse events related to machine malfunctions occurred. The mean HKA angles of the two groups were (178.5° ± 2.9°) and (177.3° ± 3.7°), respectively (P=0.014). The HKA offset in the RA group was (2.5° ± 2.1°), while (3.6° ± 2.8°) in the CM group (P=0.006). The compliance rates of the planned prostheses were 86.96% and 73.02%, respectively. Compared with the CM group, the RA group extended the surgical time (149.8 ± 46.0 min vs 97.5 ± 32.3 min, P=0.020). At the end of 3-month follow-up period, there was no significant difference between RA and CM groups when assessed by range of motion, Knee Society Score, Visual Analog Scale. Conclusion The LANCET robot-assisted knee replacement surgery system has good safety, precise surgical planning and osteotomy, and can obtain better lower limb alignment. This robotic system has the potential to be widely applied in clinical practice.

BackgroundScreening for adolescent idiopathic scoliosis (AIS) has progressed considerably in recent years. However, specific physical indicators for accurately determining spinal curve types are lacking. This study aimed to explore the association between incorrect posture and curve types in AIS.MethodsWe analyzed data from 10,453 students who underwent full-spine evaluation in the outpatient department between 2022 and 2023. Assessments included postural observations, Adam’s Forward Bending Test, angle of trunk rotation (ATR), and full-spine radiographic imaging. Correlation and logistic regression (LR) models were used to analyze the associations among incorrect posture, curve magnitude, and curve type.ResultsIncorrect postures, particularly the presence of a rib hump, were significantly correlated with the curve magnitude in AIS. Univariate LR analysis showed that female, age, Risser sign, and incorrect postures were identified as associated factors for the curve type. Multivariate LR analysis revealed that right scapular tilt [odds ratio (OR): 1.553, 95% confidence interval (CI): 1.192–2.025, p = 0.001], right rib hump (OR: 1.715, 95% CI: 1.451–2.028, p < 0.001), and right thoracic ATR ≥ 5° (OR: 1.769, 95% CI: 1.484–2.109, p < 0.001) were associated with the thoracic curve; right pelvic tilt (OR: 1.411, 95% CI: 1.253–1.588, p < 0.001) and right rib hump (OR: 1.452, 95% CI: 1.215–1.736, p < 0.001) were associated with the thoracolumbar curve; and left pelvic tilt (OR: 1.266, 95% CI: 1.085–1.477, p = 0.003), right pelvic tilt (OR: 1.321, 95% CI: 1.175–1.485, p = 0.003), and left lumbar eminence (OR: 1.229, 95% CI: 1.033–1.462, p = 0.020) were associated with the lumbar curve.ConclusionIncorrect posture and ATR, especially right rib hump, were significantly associated with curve magnitude and curve type in AIS. These indicators can provide an objective reference for triaging children referred from school-based screening for AIS, facilitating a more targeted and efficient identification of at-risk individuals.

Objective:To investigate the incidence and risk factors of preoperative deep vein thrombosis (DVT) in patients with periprosthetic hip fractures. Methods:This retrospective clinical cohort study enrolled 95 patients with periprosthetic hip fractures who met predefined inclusion and exclusion criteria between January 2016 and December 2025. The cohort included 28 males and 67 females, with a mean age of 72.9 years (range, 39-96 years). According to Vancouver classification, there were 1 case of type A, 32 cases of type B1, 59 cases of type B2, 1 case of type B3, and 2 cases of type C. The interval from injury to hospital admission ranged from 1 to 150 days (mean, 10.9 days). All patients received bilateral lower-extremity venous ultrasonography for preoperative DVT screening. Patients were divided into DVT-positive and DVT-negative groups according to ultrasound findings. Univariate analyses were conducted to compare demographic data (age, gender), underlying comorbidities (hypertension, diabetes mellitus, coronary atherosclerotic heart disease, cerebral infarction, etc.), Vancouver fracture type, injury-to-admission interval, and laboratory indicators (prothrombin time, activated partial thromboplastin time, thrombin time, international normalized ratio, D-dimer, fibrinogen, hemoglobin, red blood cell count, hematocrit, platelet count, serum albumin, triglycerides, total cholesterol, apolipoprotein, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol) between the two groups. The risk factors of preoperative DVT in periprosthetic hip fractures were further screened by logistic regression analysis. Results:The overall preoperative prevalence of DVT was 28.42% (27/95) among patients with periprosthetic hip fractures. Subgroup analysis stratified by thrombus location showed 1 case (1.05%) of proximal DVT, 2 cases (2.11%) of distal axial DVT, and 24 cases (25.26%) of calf muscular vein thrombosis. Univariate analysis revealed significant intergroup differences in the prevalence of history of coronary atherosclerotic heart disease and preoperative D-dimer levels between DVT-positive and DVT-negative groups ( P<0.05). Receiver operating characteristic curve analysis was performed to assess the predictive efficacy of preoperative D-dimer for preoperative DVT. The area under the curve was 0.667 (95% CI: 0.545, 0.772) ( P=0.016). The optimal D-dimer cutoff value was 5.26 mg/L, with a sensitivity of 0.667 and specificity of 0.618. Stratified analysis based on this cutoff demonstrated that patients with D-dimer≥5.26 mg/L had a markedly higher incidence of DVT than those with D-dimer<5.26 mg/L [40.91% (18/44) vs. 17.65% (9/51); χ 2=6.283, P=0.012]. logistic regression analysis further verified that history of coronary atherosclerotic heart disease and preoperative D-dimer≥5.26 mg/L were independent risk factors for preoperative DVT ( P<0.05). Conclusion:The incidence of preoperative DVT is considerably high in patients with periprosthetic hip fractures. History of coronary atherosclerotic heart disease and elevated preoperative D-dimer (≥5.26 mg/L) are independent risk factors for preoperative DVT in patients with periprosthetic hip fractures, which should be paid great attention to clinically.

Removing a well-fixed acetabular cup is technically challenging with the risk of complications during revision hip arthroplasty. Established tools like the Explant Acetabular Cup Removal System (ES) are effective but can be time-consuming to set up and use, and their application is limited by design constraints and availability. A novel, simple strategy was developed to detach the cup by impacting its ring with a designed instrument to generate a vertical shear force (VSF). This study aimed to evaluate the safety and efficiency of using the VSF technique as a rapid, bone-preserving initial step in the removal sequence, with the ES serving as a subsequent rescue option if needed. This retrospective study included 70 patients who underwent revision total hip arthroplasty in our center between 2019 and 2022. Patients with acetabular removed by the new technique (n = 32) or the Explant System (ES) were recruited (n = 38), followed up for a minimum of 2 years. The new strategy aimed to break the connection between bone and cup by impacting on the ring of cup with a designed instrument to create a vertical shear force (VSF) along the hemispherical shape of the acetabular surface. The diameter of the removed and re-implanted cup, severity of acetabular bone defect, hip joint function score, and complications were retrieved and compared between the two groups. The Wilcoxon-Mann–Whitney test (two-tailed) was used to assess intergroup differences in the acetabular cup size, bone defect severity, preoperative and final follow-up Harris Hip Scores (HHS). Intergroup differences in bone grafting and metal augment utilization were analyzed using chi-square tests. The average and median diameter of the revised cup was 1.7 mm and 2 mm larger than that of the removed cup in the VSF group, while 3.2 mm and 3.0 mm in the ES group. Metal augments were more frequently used in the ES group than in the VSF group. The patients were followed up for an average of 34 months in the VSF group and 50 months in the ES group, and none of them required re-revision due to acetabular component loosening. The mean HHS improved in both groups. The VSF strategy is a simple, rapid, cost-effective and bone stock preserve technique for removing a well-fixed acetabular cup. It can be used as a primary choice during revision surgery, with the Explant System readily available as a subsequent rescue option if needed.

Objective:To explore the clinical feasibility and effect of minimally invasive treatment of accidentally sutured surgical drains after arthroplasty with orthopedic broken screw hollow saw, in order to provide a safe and convenient solution for clinical practice. Methods:Between January 2016 and October 2023, the clinical data of 5 patients with accidentally sutured surgical drains after orthopedic joint replacement were retrospectively analyzed. There were 4 males and 1 female with an average age of 69.6 years ranging from 65 to 75 years. The hollow saw for broken screws in the orthopedic tool kit for broken screws was used to closely follow the drainage tube wall to the suture site for precise cutting operation without additional self-made tools or enlarged incision. By measuring the length of the extracted drainage tube and cross-checking it with the original record, while simultaneously examining the tube's integrity to confirm the absence of any residue. Results:The drainage tubes were successfully removed in 5 patients, and the removal process took 3-8 minutes, with an average of 5.4 minutes (excluding the time of instrument preparation and disinfection). After removal, all the drainage tubes were complete in shape, the measured length was completely consistent with the intraoperative depth record, and no fracture or residue was confirmed; no high-density foreign body shadow was found in the postoperative X-ray examination. There was no exudation or incision dehiscence after operation. All patients were followed up 24 months, and there was no sign of joint dysfunction, chronic pain or infection, and no complications related to delayed foreign body residues. Conclusion:The application of orthopedic broken screw hollow saw in the treatment of accidentally sutured surgical drains after orthopedic joint replacement has the advantages of simple operation, minimally invasive, short time-consuming, high success rate and no need for self-made tools.

With the aging of the population, the incidence of hip and knee diseases is increasing year by year, resulting in an increasing number of patients requiring joint replacement surgery. However, the recovery process after surgery is complex and long, and patients often experience pain and dysfunction. The main purpose of this study was to evaluate the intervention effect of Shiquan Dabu Decoction on the postoperative recovery of hip and knee replacement patients, and to explore the application value of medical infrared thermal imaging technology in this process. Before and after treatment, medical infrared thermal imaging equipment was used to scan the patient's hip and knee area and record the temperature distribution data. Clinical data, including pain score, joint range of motion and functional recovery, were collected to comprehensively evaluate the intervention effect of Shiquan Dbu Decoction. By comparing the thermal infrared images of the intervention group and the control group, we found that the temperature distribution in the joint area was more uniform in the intervention group, indicating improved blood circulation. The mean temperature difference of the intervention group was significantly lower than that of the control group, which was related to the promotion of local blood circulation and the alleviation of inflammatory response by Shiquan Dbu Decoction. Clinical data also showed that patients in the intervention group improved their pain scores and joint motion better than those in the control group, indicating that Shiquan Dbu Decoction had a positive effect in promoting postoperative recovery. The effect of Shiquan Dabu Decoction on improving local blood circulation and alleviating inflammation can be directly observed through the temperature distribution of thermal infrared images.

RNA interference (RNAi) and oxidative stress inhibition therapeutic strategies have been extensively utilized in the treatment of osteoarthritis (OA), the most prevalent degenerative joint disease. However, the synergistic effects of these approaches on attenuating OA progression remain largely unexplored. In this study, matrix metalloproteinase-13 siRNA (siMMP-13) was incorporated onto polyethylenimine (PEI)-polyethylene glycol (PEG) modified Fe3O4 nanoparticles, forming a nucleic acid nanocarrier termed si-Fe NPs. Subsequently, a poly(vinyl alcohol) (PVA) crosslinked phenylboronic acid (PBA)-modified hyaluronic acid (HA) hydrogel (HPP) was used to encapsulate the si-Fe NPs, resulting in a bifunctional hydrogel (si-Fe-HPP) with reactive oxygen species (ROS)-responsive and RNAi therapeutic properties. Studies in vitro demonstrated that si-Fe-HPP exhibited excellent biocompatibility, anti-inflammatory effects and prolonged stable retention time in knee joint. Intra-articular injection of si-Fe-HPP significantly attenuated cartilage degradation in mice with destabilization of the medial meniscus (DMM)-induced OA. The si-Fe-HPP treatment not only notably alleviated synovitis, osteophyte formation and subchondral bone sclerosis, but also markedly improved physical activity and reduced pain in DMM-induced OA mice. This study reveals that si-Fe-HPP, with its ROS-responsive and RNAi abilities, can significantly protect chondrocytes and attenuate OA progression, providing novel insights and directions for the development of therapeutic materials for OA treatment.

Information on pathogens and sensitive antibiotics is crucial for treating periprosthetic joint infection (PJI), one of the most severe complications of joint arthroplasty. Lacking this information is not uncommon, and empirical antibiotic treatment should be adopted as a compromise. This study aimed to develop regional-specific antimicrobial regimens and provide a reference for empirical antibiotic treatment for PJI by retrospectively analyzing the pathogen profiles of PJI patients treated in our center and their antibiotic sensitivities. PJI patients treated at our center from January 2018 to December 2024 were retrospectively recruited. Joint aspiration was performed preoperatively to collect synovial fluid for culture and differential cell counting, and synovial tissue samples were obtained intraoperatively from at least three different sites for culture. Patients were diagnosed according to the guidelines of the 2018 International Consensus Meeting and the European Bone and Joint Infection Society. The culture-positive rate, distribution of gram-positive pathogens, methicillin resistance, mixed infections, and multidrug resistance were analyzed. The effective coverage rates of antibiotics were determined, and appropriate empirical antibiotic regimens were proposed. A total of 255 PJI patients, comprising 104 males and 151 females, were included; 141 patients had hip PJI, and 114 had knee PJI. Among them, 224 patients (87.8

Osteoarthritis (OA) is a prevalent joint disease primarily induced by overstrain, leading to disability and significantly impacting patients' quality of life. However, current OA studies lack an ideal in vitro model, which can recapitulate the high peripheral strain of the joint and precisely model the disease onset process. In this paper, we propose a novel cartilage-on-a-chip platform that incorporates a biohybrid hydrogel comprising Neodymium (NdFeB)/Poly-GelMA-HAMA remote magneto-control hydrogel film. This platform facilitates chondrocyte culture and stress loading, enabling the investigation of chondrocytes under various stress stimuli. The Neodymium (NdFeB)/Poly-GelMA-HAMA hydrogel film exhibits magneto-responsive shape-transition behavior, further dragging the chondrocytes cultured in hydrogels under magnetic stimulation. It was investigated that inflammation-related genes and proteins in chondrocytes are changed with mechanical stress stimulation in the cartilage-on-a-chip. Especially, MMP-13 and the proportion of collagen secretion are upregulated, showing a phenotype similar to that of real human osteoarthritis. Therefore, we believed that this cartilage-on-a-chip platform provides a desired in vitro model for osteoarthritis, which is of great significance in disease research and drug development.

ObjectiveTo evaluate the accuracy and safety of the LANCET robotic system, a robot arm assisted operation system for total hip arthroplasty via a multicenter clinical randomized controlled trial.MethodsA total of 116 patients were randomized into two groups: LANCET robotic arm assisted THA group (N = 58) and the conventional THA group (N = 58). General information about the patients was collected preoperatively. Operational time and bleeding were recorded during the surgery. The position of the acetabular prosthesis was evaluated by radiographs one week after surgery and compared with preoperative planning. Harris score, hip mobility, prosthesis position and angle and complications were compared between the two groups at three months postoperatively.ResultsNone of the 111 patients who ultimately completed the 3-month follow-up experienced adverse events such as hip dislocation and infection during follow-up. In the RAA group, 52 (92.9 %) patients were located in the Lewinnek safe zone and 49 (87.5 %) patients were located in the Callanan safe zone. In the control group were 47 (85.5 %) and 44 (80.0 %) patients, respectively. In the RAA group, 53 (94.6 %) patients had a postoperative acetabular inclination angle and 51 (91.1 %) patients had an acetabular version angle within a deviation of 5° from the preoperative plan. These numbers were significantly higher than those of the control group, which consisted of 42 (76.4 %) and 34 (61.8 %) patients respectively. There were no significant differences between the two groups of subjects in terms of general condition, intraoperative bleeding, hip mobility, and adverse complications.ConclusionThe results of this prospective randomized, multicenter, parallel-controlled clinical study demonstrated that the LANCET robotic system leads conventional THA surgery in accuracy of acetabular cup placement and does not differ from conventional THA surgery in terms of postoperative hip functional recovery and complications.The translational potential of this articleIn the past, the success rate of total hip arthroplasty (THA) relied heavily on the surgeon's experience. As a result, junior doctors needed extensive training to become proficient in this technique. However, the introduction of surgical robots has significantly improved this situation. By utilizing robotic assistance, both junior and senior doctors can perform THA quickly and efficiently. This advancement is crucial for the widespread adoption of THA, as patients can now receive surgical treatment in local facilities instead of overwhelming larger hospitals and straining medical resources. Moreover, the development of surgical robots with fully independent intellectual property rights holds immense value in overcoming the limitations of high-end medical equipment. This aligns with the objectives outlined in the 14th Five Year Plan for National Science and Technology Strategy.

BACKGROUND:Good wound healing is critical to infection prophylaxis and satisfactory rehabilitation in Total Knee Arthroplasty (TKA). Currently, two techniques, i.e., barbed continuous subcuticular suture without skin adhesive or combined use skin adhesive (n-butyl-2) are being used for superficial wound closure of TKA. While a new skin adhesive (2-octyl) with self-adhesive mesh has been employed as an alternative to conventional surgical skin closure in TKA, its superiority, especially in reducing wound complications and improving wound cosmetic outcomes has not been investigated. This study aimed to compare 2-octyl, n-butyl-2, and no skin adhesive in terms of safety and efficacy in TKA superficial wound closure. METHODS:We conducted a multicenter, prospective, randomized controlled study in 105 patients undergoing primary TKA between May 2022 and October 2023. Each patient's knee was randomized to receive 2-octyl, n-butyl-2, or no skin adhesive skin closure with all using barbed continuous sutures in deep tissue. Wounds were followed 1, 3, 5 days, 2, 6 weeks, and 3 months after surgery. Wound discharge, complications, cosmetic outcomes, patient satisfaction, and wound-related costs were compared among these three methods. RESULTS:Wound discharge was less in 2-octyl group and n-butyl-2 group than in non-adhesive group at 1 day, with the discharge only being less in 2-octyl group than in the non-adhesive group at day 3 and day 5 days (P < 0.05). There was no statistical difference in the incidence of other wound complications among the groups (P > 0.05). The 2-octyl group achieved better cosmetic effects than the other two groups in 6 weeks and 3 months (P < 0.05). Compared to the non-adhesive group, 2-octyl group scored higher in overall patient satisfaction score in 2 weeks and incurred lower costs (P < 0.05). CONCLUSIONS:Skin closure in TKA using 2-octyl adhesive material showed superiority when compared to no skin adhesive or n-butyl-2, in reducing wound discharge, improving the cosmetic outcomes, without increasing wound complications. In addition, the use of 2-octyl yielded better patient satisfaction and also was less costly compared to no skin adhesive. Our study exhibited that 2-octyl was a safe and effective wound closure technique for patients undergoing TKA. TRIAL REGISTRATION:This study has been registered at Clinical Trials. Gov (No. ChiCTR210046442).

Objective To observe the mid-term outcome of treatment procedures for preventing periprosthetic joint infection（PJI） in conversion total hip arthroplasty（cTHA）. Methods Clinical data of 54 patients underwent cTHA managed with treatment procedures for preventing PJI and followed-up for at least 2 years in Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital between January 2018 and June 2020 were retrospectively analyzed. There were 29 males and 25 females with an age of（68.3±12.1）（43-82）years. Reason for cTHA included femoral head avascular necrosis after internal fixation with cannulated screws for femoral neck fracture in 31 cases and after intramedullary nail fixation of intertrochanteric fractures in 8 cases, non-union of femoral neck fracture in 4 cases and secondary osteoarthritis after internal fixation for acetabular fracture in 11 cases. The type of previous operation and preoperative erythrocyte sedimentation rate（ESR） and C-reactive protein（CRP） were compared between patients with and without positive finding in intraoperative tissue culture. Results The follow-up time was（35.0±8.7）（24-54）months. Bacteria was identified by culture of joint fliud in 2 patients before cTHA, while in 9 patients by intra-operative tissue biopsy. The ESR and CRP of the 11 patients were higher than that of patients with negative intra-operative tissue culture, although the difference was not statistically significant. PJI occurred in 3 patients（5.6%） after cTHA within 6 months, and treated with primary revision. The pre-operative CRP was elevated and more than 12 mg/L in all the 3 patients. Patients showed significantly higher Harris score at last follow-up（87.4±9.3） when compared to the pre-operative one（47.3±16.4）（P＜0.001）. Conclusion Patients underwent cTHA would confront higher risk of PJI. Our algorithm by optimizing the diagnosis of infection before and during operation, the usage of antibiotics and the nutrition support therapy could reduce the development of PJI.

OBJECTIVE:To explore correlation between femoral mechanical axis and Blumensaat line (FMBL) angle of knee joint (angle between Blumensaat line and femoral mechanical axis), α angle (angle between Blumensaat line and axis of distal femur in sagittal plane) on EOS biplane imaging and non-contact anterior cruciate ligament(ACL) injury, and evaluate angle for its accuracy in predicting the populations prone to non-contact ACL injury. METHODS:From February 2018 to October 2020, EOS imaging and clinical data from 88 patients (176 knees) with unilateral non-contact ACL injury were retrospectively analyzed, including 53 males and 35 females, aged from 18 to 45 years old with an average of (30.3±6.2) years old, 48 patients on the left side and 40 patients on the right side. The patients were divided into ACL-affected group and ACL-health group according to side of ACL injuries, and 51 patients (51 knees) with non-ACL identified from EOS database were included in normal control group, including 28 males and 23 females, aged from 20 to 44 years old with an average of (31.6±5.5) years old, 26 patients on the left side and 25 patients on the right side. Full-length EOS imaging of skeleton extremitatis inferioris among three groups were reconstructed to 3D images of skeletal system with EOS software, and then FMBL angle and α angle were measured on the images. Univariate binary Logistic regression analysis was performed to determine the influence of the univariate(FMBL angle or α angle) on ACL status(normal or torn). And the angle cutoff value for univariate was selected based on receiver operating characteristics curve (ROC) to got the best accuracy. RESULTS:There was no statistically significant difference in age, gender and side distribution between ACL-injured group and normal control group(P>0.05). Statistical analyses (one-way ANOVA) indicated no significant difference in FMBL angle between ACL-injured knee group (32.8±2.3)° and ACL-injured contralateral knee group(32.5±2.3)°(P>0.05), but the values between two groups were significantly lower than that in normal control group (37.0±2.0)°(P<0.001). There was no statistically significant difference in α angle among three groups (P>0.05). Univariate binary Logistic regression analysis demonstrated that FMBL angle was risk factor for non-contact ACL injury[OR=0.433, 95%CI(0.330, 0.569), P<0.001]. The area under ROC curve for FMBL angle was 0.909[95%CI(0.861, 0.958), P<0.001], and the sensitivity and specificity were 70.5% and 98.0% respectively, cut-off value was 33.7°. CONCLUSION:FMBL angle formed by Blumensaat line and femoral mechanical axis is one of the risk factors for non-contact ACL injury and has good predictive accuracy. The general population with FMBL angle below 33.7° may be increased risk for ACL injury.

Background Surgical techniques related to soft tissue management play critical roles in optimizing surgical outcomes and patient satisfaction in total knee arthroplasty (TKA). Despite the importance of wound closure and bleeding management approaches, no published guidelines/consensus are available. Methods Twelve orthopedic surgeons participated in a modified Delphi panel consisting of 2 parts (each part comprising two rounds) from September–October 2018. Questionnaires were developed based on published evidence and guidelines on surgical techniques/materials. Questionnaires were administered via email (Round 1) or at a face-to-face meeting (subsequent rounds). Panelists ranked their agreement with each statement on a five-point Likert scale. Consensus was achieved if ≥70% of panelists selected 4/5, or 1/2. Statements not reaching consensus in Round 1 were discussed and repeated or modified in Round 2. Statements not reaching consensus in Round 2 were excluded from the final consensus framework. Results Consensus was reached on 13 goals of wound management. Panelists agreed on 38 challenges and 71 strategies addressing surgical techniques or wound closure materials for each tissue layer, and management strategies for blood loss reduction or deep vein thrombosis prophylaxis in TKA. Statements on closure of capsular and skin layers, wound irrigation, dressings and drains required repeat voting or modification to reach consensus. Conclusion Consensus from Asia-Pacific TKA experts highlights the importance of wound management in optimizing TKA outcomes. The consensus framework provides a basis for future research, guidance to reduce variability in patient outcomes, and can help inform recommendations for wound management in TKA.

Background: The measurements of lower extremity rotational deformities in patients with recurrent patellar dislocation (RPD) in the standing position are available with the application of the EOS imaging system. The aim of our case-control study was to identify the differences on the femur rotation between the supine and standing positions, and to investigate the differences of anatomical and functional femur rotation between RPD patients and controls. Methods: Thirty-five lower extremities affected by RPD from 30 patients and 27 intact lower extremities from 27 controls with acute meniscus tear or anterior cruciate ligament injury were recruited. Anatomical femoral anteversion (AFA), functional femoral anteversion (FFA), femorotibial rotation (FTR) and distal femoral torsion (DFT) of all subjects were measured with the EOS imaging system. Computed tomography scans were carried out to analyze the AFA and FFA in the supine position in PRD patients. The differences in FFA between supine and standing position and in AFA, FTR and DFT between RPD and controls were analyzed. The predictor importance of each variable on RPD was observed after cluster analysis. Results: The EOS images were available in all subjects. The FFA was significantly smaller in the standing position than in the supine position (P < 0.05) in RPD patients. When comparing with the controls, RPD patients showed higher AFA, FTR and DFT (P < 0.05) but comparable FFA (P < 0.05). The cluster model prompted that FTR and DFT had higher predictor importance than AFA. Conclusion: Larger AFA but comparable FFA in patients with RPD than the controls in an upright standing position suggested more internally rotated distal femur in the RPD patients. AFA may be inadequate and FFA should also be considered while planning the treatment for RPD. DFT and FTR should be taken into consideration when evaluating the abnormalities in femur rotation in RPD patients. (c) 2021 Elsevier B.V. All rights reserved.

BACKGROUND:Secreted frizzled-related protein 5 (SFRP5) is an endogenous inhibitor of Wnt5a (wingless-type family member 5a), which has been implicated in anti-inflammatory response. In this study, we aimed to investigate whether SFRP5 could protect chondrocytes against LPS-induced inflammation and apoptosis.METHODS:ATDC5 cells that overexpressed with SFRP5 or not were challenged with LPS to observe the effects of SFRP5 overexpression on LPS-triggered inflammation and apoptosis as well as Wnt5a/JNK activation. Wnt5a was elevated in ATDC5 cells in the presence of SFRP5 overexpression, to determine whether Wnt5a/JNK signaling was involved in the actions of SFRP5.RESULTS:The mRNA and protein levels of SFRP5 was significantly reduced by LPS in a concentration-dependent manner. Overexpression of SFRP5 in ATDC5 cells inhibited LPS-induced inflammation and apoptosis, as evidenced by decreased production of TNF-α, IL-1β, IL-6, and ROS, together with a reduced ratio of TUNEL-positive cells, a lower expression of Bax and cleaved caspase 3, but a higher expression of Bcl-2. Meanwhile, SFRP5 overexpression also repress Wnt5a and phosphorylated JNK expression. However, the overexpression of Wnt5a considerably weakened the inhibitory effect of SFRP5 on LPS-triggered inflammation and apoptosis. Besides, the level of Wnt5a and JNK phosphorylation, which was inhibited by SFRP5 overexpression, was also partially recovered by Wnt5a overexpression.CONCLUSION:SFRP5 could alleviate LPS-induced ATDC5 cell inflammation and apoptosis; these actions may rely on repressing Wnt5a/JNK activation.