Microfracture (MF) is the first-line treatment strategy for Osteochondral lesions of the talus (OLT), while its clinical outcomes have been reported, the early-stage (4–6 months) healing effects of MF for OLT has been poorly characterized. This study investigated the early MF repairing outcomes in patients with concurrent OLT and CLAI treated with staged surgery. We retrospectively evaluated 34 consecutive patients with concomitant OLT and CLAI who underwent staged surgery, consisting of first-stage MF for OLT and second-stage modified Brostrom-Gould repair with second-look arthroscopy. Repair quality was assessed using the Ferkel and Cheng staging system and the International Cartilage Repair Society (ICRS) score. Preoperative and postoperative magnetic resonance imaging (MRI) was evaluated using the Hepple classification. Clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) and visual analog scale (VAS) scores. Spearman correlation analysis was used to examine associations among preoperative variables, postoperative clinical scores, and second-look repair grades. All lesions showed effective filling at second-look arthroscopy; however, four patients with contiguous lesions involving zones 4 and 1 underwent revision MF because of poor integration in anterior zone 1. According to the Ferkel and Cheng system, repair quality was Grade A in 2.9

The LAMBDA sign has been reported to be associated with syndesmotic-region injury on MRI, but its relationship with long-term outcomes after isolated ATFL surgery remains unclear. To evaluate the association between the preoperative MRI LAMBDA sign and long-term patient-reported outcomes in patients undergoing isolated anterior talofibular ligament (ATFL) repair or reconstruction. We retrospectively reviewed patients who underwent ATFL repair or reconstruction at a single institution between 2014 and 2016. A transparent cohort flow was documented, comparing included and excluded patients to assess for selection bias. The primary endpoint was the Foot and Ankle Outcome Score (FAOS) at final follow-up. At surgery, all patients were diagnosed clinically as having isolated ATFL injuries without chondral lesions, and the syndesmosis was not examined. Preoperative MRIs were reanalyzed, and patients were classified according to the presence or absence of the LAMBDA sign. LAMBDA-positive patients were additionally stratified by distal tibiofibular joint effusion height (DTJEH ≥ 8 mm vs. < 8 mm). Baseline characteristics and long-term patient-reported outcomes (FAOS, Karlsson, Tegner, VAS, satisfication) were collected. Adjusted effects, along with 95

Background: Distal tibiofibular syndesmosis instability (DTSI) often coexists with chronic lateral ankle instability and may delay recovery. Suture button fixation is widely used, but its benefit in this setting is uncertain. Purpose: To evaluate midterm outcomes of suture button fixation for DTSI with concomitant lateral ankle instability. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent surgery for lateral ankle instability with arthroscopic syndesmosis assessment between 2017 and 2023 were retrospectively identified. Patients with an intact syndesmosis formed the intact group, whereas those with arthroscopically confirmed dynamic syndesmotic instability (≥2-mm diastasis) underwent additional suture button fixation and formed the instability group. All patients received standardized lateral ligament surgery and rehabilitation. Clinical assessments were performed preoperatively, at 12 months, and at final follow-up using Karlsson-Peterson, Foot and Ankle Ability Measure (FAAM), Tegner, Ankle Ligament Reconstruction–Return to Sport after Injury (ALR-RSI), visual analog scale (VAS) pain scores, and ankle range of motion. Group differences were analyzed with α = .05 and interpreted using minimal clinically important differences (MCIDs). Results: Of 216 eligible patients, 154 completed follow-up at a mean of 67.3 ± 24.8 months (range, 24-113 months). No bilateral cases were included; therefore, the number of ankles was identical to the number of patients: 80 patients (80 ankles) in the intact syndesmosis group and 74 patients (74 ankles) in the syndesmotic instability group. Preoperatively, the instability group had lower Karlsson-Peterson scores than the intact group, with a median between-group difference of −4.00 points (95% CI, −6.00 to −2.00; P < .001). At 12 months, Karlsson-Peterson scores were comparable between groups (median between-group difference, 0.00 points; 95% CI, −1.00 to 1.00; P = .63). At final follow-up, the instability group had a statistically higher Karlsson-Peterson score than the intact group, although the absolute difference was small (median between-group difference, 1.00 point; 95% CI, 0.00 to 2.00; P = .02). The between-group difference in Karlsson-Peterson improvement was 4.88 points (95% CI, 3.13 to 6.63; P < .001), which did not exceed the MCID threshold of 13.50 points. After adjustment for preoperative Karlsson-Peterson score, sex, body mass index, age, anterior talofibular ligament surgical modality, and follow-up duration, syndesmotic instability treated with suture button fixation remained modestly associated with the final Karlsson-Peterson score (β = 1.525; 95% CI, 0.340 to 2.709; P = .01). Final FAAM Activities of Daily Living, FAAM Sports, Tegner, ALR-RSI, and VAS scores showed no clinically meaningful between-group differences. The instability group had greater residual dorsiflexion limitation at final follow-up, with a median between-group difference of 2.00° (95% CI, 2.00° to 3.00°; P < .001), but this limitation was not significantly correlated with final patient-reported outcomes. Conclusion: Our study demonstrated that, for patients with chronic lateral ankle instability and arthroscopically confirmed concomitant DTSI, suture button fixation combined with lateral ligament surgery was associated with substantial midterm functional improvement, with outcomes approaching those of patients with an intact syndesmosis. However, because the comparison involved biologically distinct cohorts, these findings should be interpreted as supportive rather than definitive. Future matched or randomized studies are needed to clarify the independent contribution of suture button fixation.

To address the challenges in anterior cruciate ligament (ACL) reconstruction surgery—such as the high precision required for femoral tunnel positioning, lack of standardized procedures, and the time-consuming nature of preoperative planning—an intelligent femoral tunnel planning method based on CT imaging is proposed. This approach integrates techniques from 3D segmentation and reconstruction of knee joint CT images based on 3D U-Net and prior knowledge, with tunnel planning guided by the quadrant method and ratio analysis, aiming to improve the accuracy and standardization of both intra-articular and extra-articular femoral tunnel orifice localization. The proposed method was assessed through human-machine comparison and physical model validation. Experimental results demonstrate that the automated approach attains positioning accuracy comparable to that of expert manual operation, while offering faster speed and greater consistency.

BACKGROUND:The concept of early intervention at the appropriate time has been recognized for treating posttraumatic osteoarthritis (PTOA). However, the optimal intervention timing to achieve superior therapeutic efficacy remains unclear. In addition, there is a lack of direct evidence regarding therapeutic efficacies achieved at different time points. HYPOTHESIS:The administration schedule of stem/stromal cells can significantly influence their ability to improve function and slow progression of PTOA. There may exist an appropriate time window for achieving superior therapeutic efficacy. STUDY DESIGN:Controlled laboratory study. METHODS:A total of 72 Sprague Dawley rats were included in this study. Anterior cruciate ligament transection (ACLT) was performed to induce PTOA. Animals in the control group underwent ACLT alone, whereas those in the sham group underwent knee articular capsulotomy alone. Bone marrow mesenchymal stem/stromal cells or phosphate-buffered saline (PBS) was intra-articularly administered on days 3, 7, 14, and 28 after ACLT (n = 6). Bioluminescence imaging was used to detect the retention of stem cells administered at different time points (n = 3). At the end of the experiment (8 weeks), gait analysis was conducted using CatWalk to compare the recovery of knee function between the 2 groups. Micro-computed tomography (CT) was performed to assess general appearance and quantify the microstructure of subchondral bone. Histological staining was used to evaluate the whole-joint pathology. Semiquantitative evaluations were conducted using Osteoarthritis Research Society International and Mankin scores. RESULTS:PBS administration at different time points had no therapeutic effects on lower limb function or PTOA progression. Gait analysis suggested that stem cell administration significantly improved the general function of knee joints compared with the control group at all time points. However, the duty cycle was significantly higher on days 7 and 14 after ACLT. Micro-CT and histopathological staining of the knee samples suggested that although stem cell administration significantly ameliorated the progression of PTOA, the therapeutic efficacy was significantly better on days 7 and 14. After stem cell administration, the articular surface was considerably smoother with few scattered osteophytes, the deposition of cartilage extracellular matrix was more abundant, subchondral bone remodeling was significantly alleviated, and the synovium was less hyperplastic with reduced inflammatory cell infiltration. The general retention time of stem cells did not differ significantly at different administration time points. CONCLUSION:This study suggests that the intervention schedule is significantly correlated with the therapeutic efficacy of stem cells for PTOA, with the best effects observed on days 7 and 14 after ACLT. CLINICAL RELEVANCE:Days 7 to 14 after trauma may be the appropriate intervention timing for clinical prevention and treatment of PTOA.

Background : The LAMBDA sign on ankle MRI suggests distal tibiofibular syndesmosis injury. This study evaluated whether the LAMBDA sign predicts long-term outcomes in patients undergoing anterior talofibular ligament (ATFL) surgery. Methods : We retrospectively reviewed patients who underwent ATFL repair or reconstruction at a single institution (2014–2016). A transparent cohort flow was documented, comparing included and excluded patients to assess for selection bias. The primary endpoint was defined as the Foot and Ankle Outcome Score (FAOS) at final follow-up. At surgery, all were diagnosed clinically as isolated ATFL injuries without chondral lesions; the syndesmosis was not explored. Preoperative MRIs were re-read and patients classified by presence/absence of the LAMBDA sign. LAMBDA-positive patients were additionally stratified by distal tibiofibular joint effusion height (DTJEH ≥8 mm vs <8 mm). Baseline characteristics and long-term patient-reported outcomes (FAOS, Karlsson, Tegner) were collected. Adjusted effects with 95% CIs were reported. Rater reliability (ICC/κ) for LAMBDA and DTJEH was assessed with CIs and exact methods. Results : Seventy-nine patients were included (mean follow-up 112.2±8.0 months): 46 LAMBDA-positive and 33 LAMBDA-negative. Compared with the negative group, LAMBDA-positive patients had higher preinjury Tegner scores (6.0 [6.0–7.0] vs 5.0 [4.5–6.5]; p<0.05) but worse final outcomes: FAOS 80.0 [75.0–85.0] vs 86.0 [81.5–88.0] (mean difference -6.1; 95% CI, -9.3 to -3.0; p<0.001), Karlsson 80.0 [75.0–85.0] vs 85.0 [84.0–90.0] (mean difference -6.1; 95% CI, -9.5 to -2.7; p=0.001), and greater Tegner decline 2.0 [1.0–3.0] vs 1.0 [0.5–2.0] (p<0.05). While statistically significant, these differences did not reach established MCID thresholds (FAOS: 11.7, Karlsson: 10.0). Conclusion : The presence of a positive LAMBDA sign on preoperative MRI is associated with poorer long-term clinical outcomes. However, DTJEH is not significantly correlated with overall long-term outcomes. The LAMBDA sign can serve as a valuable preoperative prognostic indicator. Level of Evidence: III (retrospective cohort).

Tendon, a connective tissue structure, serves the crucial role of transmitting force between muscles and bones. However, tendon injury repair continues to pose a significant challenge in clinical settings. In this study, we utilized single-cell RNA sequencing to delve into the cell populations and signaling pathways that are integral to tendon healing. Our findings suggest that hypoxia plays a pivotal role in activating macrophages, stimulating endothelial cell migration, and fostering fibroblast proliferation. Based on these insights, we have developed a PCL scaffold coated with DFOA, which effectively mimics a hypoxic environment to enhance tendon tissue regeneration. Furthermore, the PCL-DFOA scaffolds exhibit exceptional ability in promoting macrophage polarization and angiogenesis. This research offers a therapeutic strategy that harnesses the regenerative power of hypoxia to accelerate and optimize tendon healing processes.

Recent advancements in neuroimaging have illustrated that anterior cruciate ligament (ACL) injuries could impact the central nervous system (CNS), causing neuroplastic changes in the brain beyond the traditionally understood biomechanical consequences. While most of previous functional magnetic resonance imaging (fMRI) studies have focused on localized cortical activity changes post-injury, emerging research has suggested disruptions in functional connectivity across the brain. However, these prior investigations, albeit pioneering, have been constrained by two limitations: a reliance on small-sample participant cohorts, often limited to two to three patients, potentially limiting the generalizability of findings, and an adherence to region of interest based analysis, which may overlook broader network interactions. To address these limitations, our study employed resting-state fMRI to assess whole-brain functional connectivity in 15 ACL-injured patients, comparing them to matched controls using two distinct network analysis methods. Using Network-Based Statistics, we identified widespread reductions in connectivity that spanned across multiple brain regions. Further modular connectivity analysis showed significant decreases in inter-modular connectivity between the sensorimotor and cerebellar modules, and intra-modular connectivity within the default-mode network in ACL-injured patients. Our results thus highlight a shift from localized disruptions to network-wide dysfunctions, suggesting that ACL injuries induce widespread CNS changes. This enhanced understanding has the potential to stimulate the development of strategies aiming to restore functional connectivity and improve recovery outcomes.

Background Non-invasive diagnosis of distal tibiofibular syndesmosis instability (DTSI) was a great challenge to clinicians. We designed a new method, the Standing on single foot-Binding test, and investigated the accuracy of the test in the diagnosis of distal tibiofibular syndesmosis instability in adults with a history of ankle injury. Methods 85 participants with ankle injury were subjected to the Standing on single foot-Binding test, MRI and palpation to detect the distal tibiofibular syndesmosis instability (DTSI) and the findings were compared with ankle arthroscopic results. Both participants and arthroscopist were blind to the predicted results of the clinical tests. Sensitivity, specificity, PPV, NPV, LR+, LR − and their 95% CIs were calculated for each of the clinical tests as well as for the positive clinical diagnosis. Results The Standing on single foot-Binding test (SOSF-B test) outperformed MRI and palpation, in terms of sensitivity (87.5%/84.38%), specificity (86.79%/86.79%), PPV (80%/79.41%), NPV (92%/91.2%), LR+ (6.625/6.39), LR- (0.14/0.18) and diagnostic accuracy (87.06/85.88), among others, in the diagnosis of distal tibiofibular syndesmosis instability (DTSI). The diagnostic performance of 20° SOSF-B test was virtually identical to that of 0° SOSF-B test. According to the prevalence (28.7%) of DTSI and LR of four tests, the post-test probability could be used in clinical practice for the prediction of DTSI. Conclusion This prospective and double-blind diagnostic test showed that the SOSF-B test is clinically feasible for the diagnosis of distal tibiofibular syndesmosis instability (DTSI), and new diagnostic tools for rapid screening of distal tibiofibular syndesmosis instability (DTSI). Level of evidence II.

Inflammation is part of the natural healing response, but persistent inflammatory events tend to contribute to pathology changes of tendon or ligament. Phenotypic switching of macrophages within the inflammatory niche is crucial for tendon healing. One viable strategy to improve the functional and biomechanical properties of ruptured tendons is to modulate the transition from inflammatory to regenerative signals during tendon regeneration at the site of injury. Here, we developed a tendon repair scaffold made of biodegradable polycaprolactone by electrospinning, which was modified to deliver Wnt3a protein and served as an implant to improve tendon healing in a rat model of Achilles tendon defect. During the in vitro study, Wnt3a protein promoted the polarization of M2 macrophages. In the in vivo experiment, Wnt3a scaffold promoted the early recruitment and counting curve of macrophages and increased the proportion of M2 macrophages. Achilles function index and mechanical properties showed that the implantation effect of the Wnt3a group was better than that of the control group. We believe that this type of scaffold can be used to repair tendon defects. This work highlights the beneficial role of local delivery of biological factors in directing inflammatory responses toward regenerative strategies in tendon healing.

Background: Despite increased recognition of coexisting tibial and talar osteochondral lesions (OCLs), the risk factors influencing clinical outcomes remain unclear. Purpose: To report clinical follow-up results after arthroscopic microfracture surgery in patients with OCLs of the distal tibial plafond and talus and assess possible factors affecting these clinical outcomes. Study Design: Case series; Level of evidence, 4. Methods: A total of 40 patients with coexisting talar and tibial OCLs who underwent arthroscopic microfracture surgery were included. For analysis, the study used the American Orthopaedic Foot & Ankle Society (AOFAS) scale, Karlsson-Peterson scale, and visual analog scale (VAS) for pain for clinical evaluations on the day before surgery, 12 months after surgery, and at the last follow-up. A stepwise regression model and Spearman rank correlation were used to assess possible factors affecting these clinical outcomes. Results: The median follow-up time was 34.5 months (interquartile range [IQR], 26.5-54 months). At the final follow-up, the cohort included 40 patients (26 men and 14 women) with a mean age of 38.8 years (range, 19-60 years). The median AOFAS score increased from 57.5 (IQR, 47-65) before surgery to 88 (IQR, 83-92.5) at the final follow-up, the median Karlsson-Peterson score increased from 48 (IQR, 38.5-67) to 82 (IQR, 76-92), and the median VAS score improved from 5 (IQR, 4-6) to 1 (IQR, 0-2). All scale scores showed significant differences between the preoperative and final follow-up evaluations ( P < .001). In the stepwise regression model and Spearman rank correlation analysis, the grade of tibial OCL had a significant independent effect on the final postoperative AOFAS scores of the patients (β = –0.502, P = .001; r = –0.456, P = .003). The size of the tibial lesion also had a significant independent effect on the final postoperative Karlsson-Peterson scores of the patients (β = –0.444, P = .004; r = –0.357, P = .024). Conclusion: Arthroscopic microfracture treatment for coexisting talar and tibial OCLs can achieve good short- to midterm clinical outcomes. The grade and size of tibial OCLs are the main risk factors affecting the prognostic functional scores of such patients.

[目的]探讨对踝关节镜诊断的下胫腓联合不稳采用Tightrope修复的临床意义.[方法]2017年11月—2020年3月,对41例踝关节镜下确诊下胫腓联合不稳患者行经皮Tightrope修复.评价临床与影像资料.[结果]41例患者均顺利完成手术,切口均Ⅰ期愈合.所有患者随访24～52个月,平均随访时间(35.4±7.7)个月,随访过程中,41例患者均未出现切口感染、神经血管损伤、下肢静脉血栓形成等并发症,均未行翻修手术.随时间推移(术前、术后6、12个月和末次随访),VAS评分显著减少[(4.4±2.8),(2.6±1.8),(1.8±1.6),(1.4±1.5),P＜0.001],而 AOFAS 评分[(60.9±28.6),(73.4±13.9),(82.2±14.0),(85.0±10.0),P＜0.001]和 SF-36 评分[(89.5±12.1),(98.8±12.9),(106.8±12.0),(112.2±13.4),P＜0.001]显著增加;但是,踝关节跖屈-背伸和旋前-旋后活动度无显著变化(P＞0.05).至末次随访时,39例恢复伤前运动水平,占95.1％.影像方面,随时间推移,踝内侧间隙(medial clear space,MCS)、胫腓间隙(tibiofibular clear space,TFCS)、胫腓重叠(tibiofibular overlap,TFO)均无显著改变(P＞0.05).[结论]踝关节镜检查是发现远端胫腓联合不稳定的有效工具,采用经皮Tightrope修复下胫腓联合不稳可获得满意疗效.

Purpose To analyze the accuracy of MRI in diagnosis of distal tibiofibular syndesmosis instability (DTSI) and construct new diagnostic parameters. Materials and methods This retrospective study evaluated 212 patients with history of ankle sprains and 3 T MRI and received a final diagnosis of distal tibiofibular syndesmosis instability by ankle arthroscopic surgery from October 2017 and December 2021. We compared the accuracy of syndesmotic injury, qualitative index of distal tibiofibular joint effusion (DTJE), and quantitative index of distal tibiofibular joint effusion (DTJE) in diagnosing distal tibiofibular syndesmosis instability. The criteria for syndesmotic injury were consistent with previous literature, and DTJE was grouped according to the pre-experimental results. Results A total of 212 patients (mean age, 35.64 ± 11.79, 74 female and 138 male) were included. Independent predictive MRI features included syndesmotic injury, qualitative index of distal tibiofibular joint effusion, and quantitative index of DTJE including the height, projected area of equal-point method, and projected area of incremental-value method. The quantitative index of DTJE showed a higher area under the receiver operating characteristic curve (0.805/0.803/0.804/0.811/0.817/0.805 > 0.8, P < 0.05; in comparison with all other method). The height measurement method was simpler and easier to operate, that could be gotten only by measuring the DTJE distance of a MRI independent layer, and the cut-off value of the effusion height was 8.00 mm and the Youden index (0.56) was the best. Conclusions Our research translated a complicated string of MRI multi-dimensional spatial measurements into a simple measuring process, and established the significance of quantifying DTJE in the diagnosis of DTSI. We found that the 8-mm height of DTJE was a more specific indicator for DTSI and could serve as a novel MRI diagnostic cutoff in clinical practice.

BACKGROUND:Melatonin plays a role in repairing damaged cartilage and regulating immune cells. The anti-inflammatory effect of Melatonin involves multiple pathways and molecular activation, which directly or indirectly inhibits inflammatory reaction. M2 macrophages have the ability to anti-inflammatory response and repair damaged tissues, secrete IL10 and IL-4, and participate in tissue repair and remodeling. Erk5 is a recently discovered member of the MAPK family and one of the least studied members. It plays an important role in cell differentiation, proliferation, secretion and other functions. This experiment aims to study how Melatonin affects M2 Macrophage polarization and secretion through ERK5 signaling pathway.METHODS:The RAW 264.7 macrophages were used for cell culture. The cells were cultured according to the pre-experimental results. The effects of Melatonin on M2 macrophages were comprehensively evaluated by CCK8 activity detection, RT-PCR, ELISA, cellular immunofluorescence, and WB.SD mice were selected to evaluate the effect of Melatonin on cartilage damage in rats with knee Osteoarthritis through HE staining, immunohistochemistry and immunofluorescence.RESULTS:Melatonin cultivates RAW 264.7 macrophages. Without affecting the polarization ratio of M2 Macrophage polarization, Melatonin may reduce Erk5 gene expression, reduce Erk5 and p-Erk5 protein synthesis, and cooperate with BIX 02189 to enhance the secretion function of existing M2 macrophages and increase the secretion of cytokines IL10. Immunohistochemistry of rat knee Osteoarthritis model confirmed that the expression of IL10 was up-regulated and the synthesis of type II collagen was enhanced, but immunofluorescence found that the polarization of M2 Macrophage polarization in subchondral bone was not obvious.CONCLUSION:Melatonin enhances the ability of M2 macrophages to secrete IL10 by inhibiting Erk5 signaling pathway, but has no effect on M2 Macrophage polarization.

Graft-host mechanical mismatch has been a longstanding issue in clinical applications of synthetic scaffolds for soft tissue regeneration. Although numerous efforts have been devoted to resolve this grand challenge, the regenerative performance of existing synthetic scaffolds remains limited by slow tissue growth (comparing to autograft) and mechanical failures. We demonstrate a class of rationally designed flexible network scaffolds that can precisely replicate nonlinear mechanical responses of soft tissues and enhance tissue regeneration via reduced graft-host mechanical mismatch. Such flexible network scaffold includes a tubular network frame containing inversely engineered curved microstructures to produce desired mechanical properties, with an electrospun ultrathin film wrapped around the network to offer a proper microenvironment for cell growth. Using rat models with sciatic nerve defects or Achilles tendon injuries, our network scaffolds show regenerative performances evidently superior to that of clinically approved electrospun conduit scaffolds and achieve similar outcomes to autologous nerve transplantation in prevention of target organ atrophy and recovery of static sciatic index.

Osteochondral lesion of talus (OLT) is a foot and ankle disease characterized by ankle pain, which may impact the joint function and life quality. If managed improperly, it may lead to a further ankle arthritis, severely compromising the prognosis. The therapeutic effect of conservative treatment for OLT is still uncertain. Surgery is still the main treatment modality for OLT with various techniques. However, the optimized surgical technique is still inconclusive, furthermore, regeneration and repair of cartilage after debridement is also a great challenge for the treatment of OLT. Platelet-rich plasma (PRP) with good repair effect on cartilage injury is gradually applied in the treatment of OLT. However, there still lacks the unified understanding of the technique and specification of PRP for the treatment of OLT. Therefore, National Orthopedics Center of Shanghai Sixth People′s Hospital allied Foot Ankle Basic Research & Orthopedics Group, Chinese Association of Orthopedic Surgeons; Foot and Ankle Committee of Chinese Association of Sports Medicine Physicians; and Foot and Ankle Group of Orthopedic Specialized Branch of Shanghai Medical Association to organize related experts to formulate the Expert consensus on platelet- rich plasma treatment for osteochondral lesion of talus ( version2023). Fifteen recommendations were put forward upon PRP preparation, indications, contraindications and treatment methods of PRP for OLT, so as to standardize the PRP treatment for OLT.

Background: There is controversy about whether treatment of chronic lateral ankle instability (CLAI) with osteochondral lesions of the talus (OLT) can be performed concurrently. Purpose: To investigate the midterm results of arthroscopic treatment of CLAI combined with OLT in different surgical settings. It was hypothesized that the outcomes of treating both injuries at the same time would not be inferior to those of staged surgery. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Included were 103 patients with both CLAI and OLT who underwent arthroscopic microfracture surgery and an open, modified Broström-Gould procedure for ligament repair from January 2015 to December 2016. The patients were assigned randomly to a staged group (51 patients) and a single-stage group (52 patients). The staged group underwent arthroscopic debridement of the OLT and microfracture, then rehabilitation for 4 to 6 months before undergoing modified Broström-Gould ligament repair. The single-stage group underwent both procedures simultaneously. Clinical evaluations were performed on the day before surgery and at 12-month, 24-month, and final follow-up periods using the Karlsson-Peterson score, American Orthopaedic Foot & Ankle Society (AOFAS) score, and pain visual analog scale. The Karlsson-Peterson score at 24 months postoperatively was considered the primary outcome. The predefined noninferiority margin for the primary outcome was −5 points. Results: At the final follow-up, 50 patients in the single-stage group and 48 patients in the staged group completed the study. The median lesion size was 0.72 cm2 (interquartile range [IQR], 0.5-1.12 cm2) in the single-stage group and 0.84 cm2 (IQR, 0.7-1.05 cm2) in the staged group. At 12-month follow-up, the single-stage group had a significantly higher median Karlsson-Peterson score (79 [IQR, 70-85] vs 75 [IQR 65-80] for staged; P = .024) and median AOFAS score (85 [IQR, 76-89] vs 79.5 [IQR, 70-87] for staged; P = .045). At 24-month follow-up, the median difference in the Karlsson-Peterson score for single-stage versus staged surgery was 2 points (95% CI, −2 to 5 points), and the confidence interval was greater than the predefined value. Conclusion: At midterm follow-up, there was no clinical difference between single-stage versus staged surgery to treat CLAI with OLT. Single-stage surgery achieved better clinical outcomes than staged surgery at short-term follow-up.

Background Osteochondral lesion of the talus (OLT) is one of the most common ankle injuries, which will lead to biomechanical changes in the ankle joint and ultimately affect ankle function. Finite element analysis (FEA) is used to clarify the effect of talus osteochondral defects on the stability of the ankle joint at different depths. However, no research has been conducted on talus osteochondral defect areas that require prompt intervention. In this research, FEA was used to simulate the effect of the area size of talus osteochondral defect on the stress and stability of the ankle joint under a specific depth defect. Methods Different area sizes (normal, 2 mm* 2 mm, 4 mm* 4 mm, 6 mm* 6 mm, 8 mm* 8 mm, 10 mm* 10 mm, and 12 mm* 12 mm) of the three-dimensional finite element model of osteochondral defects were established. The model was used to simulate and calculate joint stress and displacement of the articular surface of the distal tibia and the proximal talus when the ankle joint was in the heel-strike, midstance, and push-off phases. Results When OLT occurred, the contact pressure of the articular surface, the equivalent stress of the proximal talus, the tibial cartilage, and the talus cartilage did not change significantly with an increase in the size of the osteochondral defect area when the heel-strike phase was below 6 mm * 6 mm. Gradual increases started at 6 mm * 6 mm in the midstance and push-off phases. Maximum changes were reached when the defect area size was 12 mm * 12 mm. The same patterns were observed in the talus displacement. Conclusions The effect of the defect area of the ankle talus cartilage on the ankle biomechanics is evident in the midstance and push-off phases. When the size of the defect reaches 6 mm * 6 mm, the most apparent change in the stability of the ankle joint occurs, and the effect does not increase linearly with the increase in the size of the defect.

[目的]评估髋关节镜术治疗股骨髋臼撞击综合征(femoroacetabular impingement syndrome,FAI)合并外侧弹响髋(external snapping hip,ESH)的临床疗效.[方法]回顾性分析2014年1月—2019年6月本院行髋关节镜术患者,25例FAI合并ESH的患者列入观察组,行镜下关节内病变处理和镜下髂胫束松解;另外25例单纯FAI患者列为对照组,仅行镜下FAI病变处理.比较两组围手术期、随访与影像资料.[结果]两组患者均顺利手术,均未发生严重并发症.观察组手术时间显著长于对照组(P＜0.05),但两组术后完全脱拐行走时间、切口愈合等级和住院时间的差异均无统计学意义(P＞0.05).所有患者均随访12个月以上,与术前相比,末次随访时,两组患者疼痛视觉模拟评分(visual analogue scale,VAS)显著降低(P＜0.05),而改良 Harris 髋关节评分(modified Harris Hip Scores,mHHS)和国际髋关节结果工具评分(International Hip Outcome Tool,iHOT-33)显著增加(P＜0.05);观察组伸直位髋内收活动度(range of motion,ROM)显著增加(P＜0.05).术前,观察组VAS评分显著高于对照组(P＜0.05),观察组iHOT-33评分显著低于对照组(P＜0.05),观察组下肢伸直位内收ROM显著小于对照组(P＜0.05);末次随访时,两组上述指标的差异均无统计学意义(P＞0.05).影像方面,与术前相比,末次随访时两组患者α角显著减小(P＜0.05),股骨头颈偏矩(femoral head neck offset,FHNO)显著增加(P＜0.05).相应时间点,两组间α角、FHON、LCE角和T?nnis分级的差异均无统计学意义(P＞0.05).[结论]关节镜同时处理FAI和ESH病变具有创伤小、操作简单的优点,其临效床果与单纯FAI患者相近.

OBJECTIVE:To evaluate clinical efficacy of single-tunnel double-line technique with tendoscopy in treating tibial intercondylar eminence fractures.METHODS:From January 2016 to April 2020, 22 patients with tibial intercondylar eminence fractures were admitted, including 14 males and 8 females with a mean age of (34.8±5.9) years old ranging from 26 to 45 years old. The mean duration from injury to surgery was(11.2±4.1) days(ranged, 5 to15 d). All patients were treated with arthroscopic single-tunnel double-line technique. The fracture healing was evaluated according to X-ray. The Lysholm score, IKDC 2000 score and the anterior drawer test were used to evaluate efficacy before operation and at the latest follow-up.RESULTS:All patients were followed up, and the duration ranged from 12 to 75 months, with an average of(34.6±13.0) months. Lysholm score was (89.60±2.89) points at the latest follow-up, showing significant difference when compared with preoperative score which was (30.80±9.55)points(t=9.67, P<0.01). IKDC 2000 score was(80.00±6.17) points at the latest follow-up, showing significant difference when compared with preoperative score which was(24.60±7.21)points(t=11.41, P<0.01). One patient showed weakly positive of drauer test.CONCLUSION:Single-channel double-line technique could effectively fix bone block of intercondylar eminence with advantage of easy operation and minimally invasive, which could be applied to various types of tibial intercondylar eminence fractures.