Microparticles (MPs) are a heterogeneous subpopulation of extracellular vesicles that originate from the plasma membranes of cells. There is increasing evidence that tumor-derived MPs (T-MPs) play a significant role in tumor progression and immune response in cancer. In our study, we found an increased secretion of MPs in osteosarcoma tissues obtained from metastatic patients. These T-MPs promoted polarization of M2-like macrophages and stimulated the migration and chemoresistance of osteosarcoma cells. Mechanistically, T-MPs promoted macrophage polarization to an M2-like phenotype through TBK1-STAT6 signaling. Consequently, these M2-like macrophages mediated osteosarcoma cell migration via CCL18/STAT3 signaling. Blockade of STAT3 signaling pathway improved the outcome of chemotherapy in LM8-bearing osteosarcoma mice model. Thus, our study reveals how tumor cells regulate macrophage polarization by releasing MPs and provides new insights into clinical osteosarcoma therapy.

Abstract Purpose This study aimed to evaluate the clinical and radiological outcomes of modified suture-bridge technique fixation for anterior cruciate ligament (ACL) tibial avulsion fracture. Method Minors who underwent arthroscopic reduction and modified suture bridge fixation of ACL tibial avulsion fracture between January 2018 and January 2022 were retrospectively analyzed. Postoperative MRI and X-ray examinations were performed to evaluate the presence of epiphyseal plate injury and fracture healing. Moreover, KT-1000 side-to-side difference, Lachman test, range of motion (ROM), the subjective Knee score of the International Knee Documentation Committee (IKDC), Lysholm Knee score, and Tegner activity grade score were evaluated preoperatively and at the minimum 1-year follow-up visit. Results A total of 16 participants met the inclusion criteria. They had a mean age of 12.6 years (range, 9–16 years); mean time to surgery, 6.9 days (range, 2–13 days) and had a minimum of 12 months clinical follow-up (mean, 25.4 months; range, 12–36 months) after surgery. Postoperative radiographs and MRI showed no injury to the epiphyseal plate, optimal reduction immediately after the operation, and bone union within three months in all patients. All of the following showed significant improvements (pre- vs. postoperatively): mean KT-1000 side-to-side difference (8.6 vs. 1.5; p < 0.05), Lachman tests (2 grade 9 and 3 grade 7 vs. 0 grade 12 and 1 grade 4; p < 0.05), IKDC subjective score (48.3 vs. 95.0; p < 0.05), mean Lysholm score (53.9 vs. 92.2; p < 0.05), mean Tegner activity score (3.2 vs. 8.3; p < 0.05) and mean ROM (42.9°vs 133.1°; p < 0.05). Conclusion Arthroscopic reduction and modified suture bridge fixation for ACL tibial avulsion fracture is a dependable and recommended treatment that can effectively restore the stability and function of the knee and is worthy of clinical promotion.

INTRODUCTION:The Ilizarov bone transport technique is widely recognised as an effective method for treating large segment bone defects in clinical practice. However, axial deviation is a common complication in the treatment of tibial large segment bone defects, which can have a serious impact on the clinical efficacy of bone transport. Our study aims to construct and validate a nomogram for predicting axial deviation of tibial bone transport.METHOD:This study retrospectively collected data from 363 patients who underwent the tibial Ilizarov technique for bone transport. Univariate and multivariate logistic regression analyses were performed to determine the independent risk factors for axial deviation, which were later used to construct a nomogram. The nomogram was evaluated using the decision curve analysis (DCA), the calibration curve, and the area under the receiver operating characteristic curve (AUC).RESULTS:Of the 363 patients who underwent Ilizarov tibial bone transport, 31.7% (115/363) experienced axial deviation. Multivariate logistic regression analysis showed that gender, height, defect site, and external fixation index were important risk factors for axial deviation. The AUC value of the nomogram model was 0.705. The calibration curve and the decision curve analysis showed a good consistency between the actual axial deviation and the predicted probability.CONCLUSION:The model assigns a quantitative risk score to each variable, which can be used to predict the risk of axial deviation during tibial bone transport.

Bone defects and nonunion following initial treatment remain significant clinical challenges. The Ilizarov method constitutes a fundamental approach for addressing bone defects, and its integration with adjunctive techniques, such as the accordion maneuver, antibiotic spacers, or internal fixation, has become increasingly widespread. Despite this, limited research exists on the clinical outcomes specifically related to the use of the Ilizarov method combined with the accordion technique for treating long bone defects in the lower limbs. This study seeks to systematically review the application of the Ilizarov method in combination with the accordion technique for addressing long bone deficiencies in the lower limbs. Systematic review; Level of evidence, 4. A systematic review was performed in alignment with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), involving searches of Medline, Embase, Web of Science, and the Cochrane Library, with the search process concluding on August 20, 2024. The study population consisted of patients with bone defects who underwent treatment using the Ilizarov method in conjunction with the accordion technique. The methodological quality of the included studies was evaluated using the MINORS (Methodological Index for Non-Randomized Studies) scoring system. This study recorded and analyzed the participant count for each study that met the inclusion criteria, along with the number of patients who achieved bone healing, the bone and functional outcomes, and complications such as pin infections, pain, and refracture. Drawing from eight studies involving 80 patients with bone defects treated through the Ilizarov method combined with the accordion technique, this systematic review evaluated the method’s impact on bone regeneration. Of these patients, 24

Objective Osteoporosis is the imbalance in bone homeostasis between osteoblasts and osteoclasts. In this study, we investigated the effects of the circ_0029463/miR-134-5p/Rab27a axis on RANKL-induced osteoclast differentiation. Methods RT-qPCR and western blotting were used to detect the expression of circ_0029463, miR-134-5p, and Rab27a in tissues from patients with osteoporosis and in RANKL-induced osteoclasts. Osteoclast differentiation was verified by TRAP staining. Osteoclast biomarkers, including NFATc1, TRAP, and CTSK, were measured. The target and regulatory relationships between circ_0029463, miR-134-5p, and the Rab27a axis were verified using RIP, dual-luciferase reporter gene, and RNA pull-down assays. Results Elevated expression of circ_0029463 and Rab27a and decreased miR-134-5p expression were observed in the tissues of patients with osteoporosis, and a similar expression pattern was observed in RANKL-induced osteoclasts. Suppression of circ_0029463 expression or miR-134-5p overexpression curbed RANKL-induced osteoclast differentiation, whereas such an effect was abolished by Rab27 overexpression. circ_0029463 sponges miR-134-5p to induce Rab27a expression. Conclusion circ_0029463 sponges miR-134-5p to abolish its suppressive effect of miR-134-5p on Rab27a expression, thereby promoting osteoclast differentiation.

The rise in drug resistance in pathogenic bacteria greatly endangers public health in the post-antibiotic era, and drug-resistant bacteria currently pose a great challenge not only to the community but also to clinical procedures, including surgery, stent implantation, organ transplantation, and other medical procedures involving any open wound and compromised human immunity. Biofilm-associated drug failure, as well as rapid resistance to last-resort antibiotics, necessitates the search for novel treatments against bacterial infection. In recent years, the flourishing development of nanotechnology has provided new insights for exploiting promising alternative therapeutics for drug-resistant bacteria. Metallic agents have been applied in antibacterial usage for several centuries, and the functional modification of metal-based biomaterials using nanotechnology has now attracted great interest in the antibacterial field, not only for their intrinsic antibacterial nature but also for their ready on-demand functionalization and enhanced interaction with bacteria, rendering them with good potential in further translation. However, the possible toxicity of MNPs to the host cells and tissue still hinders its application, and current knowledge on their interaction with cellular pathways is not enough. This review will focus on recent advances in developing metallic nanoparticles (MNPs), including silver, gold, copper, and other metallic nanoparticles, for antibacterial applications, and their potential mechanisms of interaction with pathogenic bacteria as well as hosts.

BACKGROUND:Medial patellar ligament reconstruction (MPFL-R) in combination with derotational distal femoral osteotomy (DDFO) for treating recurrent patellar dislocation (RPD) in the presence of increased femoral anteversion is one of the most commonly used surgical techniques in the current clinical practice. However, there are limited studies on the clinical outcomes of MPFL-R in combination with DDFO to treat RPD in the presence of increased femoral anteversion.PURPOSE:To study the role of MPFL-R in combination with DDFO in the treatment of RPD in the presence of increased femoral anteversion.METHODS:A systematic review was performed according to the PRISMA guidelines by searching the Medline, Embase, Web of Science, and Cochrane Library databases through June 1, 2023. Studies of patients who received MPFL-R in combination with DDFO after presenting with RPD and increased femoral anteversion were included. Methodological quality was assessed using the MINORS (Methodological Index for Nonrandomized Studies) score. Each study's basic characteristics, including characteristic information, radiological parameters, surgical techniques, patient-reported outcomes, and complications, were recorded and analyzed.RESULTS:A total of 6 studies with 231 patients (236 knees) were included. Sample sizes ranged from 12 to 162 patients, and the majority of the patients were female (range, 67-100%). The mean age and follow-up ranges were 18 to 24 years and 16 to 49 months, respectively. The mean femoral anteversion decreased significantly from 34° preoperatively to 12° postoperatively. In studies reporting preoperative and postoperative outcomes, significant improvements were found in the Lysholm score, Kujala score, International Knee Documentation Committee score, and visual analog scale for pain. Postoperative complications were reported in all studies, with an overall reported complication rate of 4.7%, but no redislocations occurred during the follow-up period.CONCLUSION:For RPD with increased femoral anteversion, MPFL-R in combination with DDFO leads to a good clinical outcome and a low redislocation rate. However, there was no consensus among researchers on the indications for MPFL-R combined with DDFO in the treatment of RPD.

The posterior cruciate ligament (PCL) rupture rarely occurs, especially in skeletally immature adolescents, and poses a dilemma in appropriately managing the open physis with its vast growth potential. However, although many epiphyseal-protecting techniques for anterior cruciate ligament (ACL) reconstruction have been reported, a similar problem in PCL reconstruction has received scant attention and needs more relevant research. So, this study aims to evaluate the short-term clinical and imaging results of the arthroscopic physeal-sparing reconstruction program. All the 13 patients we reviewed in this study have accepted the arthroscopic physeal-sparing PCL reconstruction from January 2019 to December 2022 in our Department of Orthopedics. Primary demographic data collected include gender (8 males and 5 females), age (11–15 years, average 13.3 years), follow-up period (15–35 months, average 25.2 months), injury mechanism (nine non-contact injuries and four contact injuries), and days following injury (1–10 days, average 5.3 days). The assessment of clinical outcomes included pre- and postoperative physical examination, knee functional scores, and imaging data. All patients in this study were followed up with an average 25.2-month (range 15–35 months) follow-up period. All the cases preoperatively had a positive posterior drawer test and turned negative at the final follow-up. The average ROM improved from 103.6° ± 11.4° to 132.6° ± 3.6° at the last follow-up (p < 0.05). The VAS score decreased from 5.8 ± 1.6 to 0.9 ± 0.5 (p < 0.05); the average KT-1000 healthy-side to affected-side difference decreased from 11.3 ± 1.6 to1.8 ± 0.5 mm. The comparison of all the knee functional scores (IKDC, Tegner scores, and Lysholm) at preoperative and last follow-up showed a significant difference (p < 0.05). None of the cases had operation-related complications, and all recovered to sports well. The arthroscopic physeal-sparing posterior cruciate ligament reconstruction is a dependable and recommended treatment for posterior cruciate ligament rupture in adolescents with open physis, showing a striking improvement in knee function without growth arrest and angular deformity of the affected limb in the short-term follow-up.

Background: It is rare to see knee lumen infection with calf effusion abscess. Traditional open surgery is traumatic, slow and difficult to recover. And there are few reports of using arthroscopy to diagnose and treat knee lumen infection with calf effusion abscess. This case series aims to introduce the clinical outcomes of arthroscopic treatment of knee lumen infection with calf effusion abscess. Methods： fifteen patients with knee joint cavity infections and calf abscesses from from January 2015 to December 2019, were included(11 males and 4 females; age range from 33 to 61, the average age is 46.6years). All patients were treated with arthroscopic multi-channel combined approach. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were recorded before and at the last follow-up. The knee function was evaluated according to the visual analogue scoring method (visual analogue scale, VAS) pain score and Lysholm score. Results： fifteen patients were followed up from 12 months to 2 years, and the average follow-up time was 18.4 months. The operation was smooth in all patients, the incisions were healed at grade I, no postoperative recurrence, no nerve damage, and no complications such as knee stiffness. At the last follow-up, ESR decreased from preoperative (44.6±10.1) to (11.4±3.1) (P <0.001), and CRP decreased from preoperative (30.2±8.0) to (3.9±1.0) ( P <0.001). Lysholm score was reduced by Before (46.9±7.7) improved to (93.0±8.1) ( P <0.001), the VAS score decreased from (7.0±0.9) before operation to (2.1±1.2) ( P <0.001), and the differences were statistically significant. Conclusion： Arthroscopic multi-channel combined approach is a safe, effective and minimally invasive treatment method for knee joint cavity infection with calf abscess.

Abstract Background: Both the non-anatomical double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) and lateral extra-articular tenodesis (LET) show superior performance in controlling the rotational stability of the knee. However there are few studies published to investigate the curative effect of non-anatomical DB ACLR combined with LET in high-grade pivot shift anterior cruciate ligament ruptures. This study aims to evaluate the short-term clinical and imaging results of the treatment program and summarize the advantages of the surgical technique. Method: All the 33 patients we reviewed in this study have accepted the non-anatomical DB ACLR with LET surgery from January 2018 to January 2022 in our Department of Orthopedics. Primary demographic data collected include gender (23 males and 10 females), age (16-37 years, average 23.5 years), BMI (21.8-31.2 kg/m2, average 25.7 kg/m2), follow-up period (12-18 months, average 15.2 months) and injury mechanism (25 sports Injuries and 8 traffic accidents). The assessment of clinical outcomes included pre- and post-operative physical examination, knee functional scores and imaging data. Result: All patients in this study were followed up with an average 16.8-month (range 12-26 months) follow-up period. 23 patients had a grade 3 pivot shift and 10 had a grade 2 pivot shift. Immediate postoperative pivot shift tests were all negative, and only one case had a grade 1 pivot shift at the final follow-up. All the cases preoperatively had a positive Lachman test and turned negative at the final follow-up. The average ROM improved from 63.2°± 17.9° to 132.8°±3.6 °at the last follow-up (p<0.001); The VAS score decreased from 5.6±1.8 to 0.9±0.7 (p<0.001); the average KT-1000 healthy-side to affected-side difference decreased from 9.3±1.6 mm to 2.2 ± 0.5 mm. The comparison of all the knee functional scores ( IKDC, Tegner scores and Lysholom ) at pre-operative and last follow-up showed a significant difference (p<0.001). None of the cases had operation-related complications except one with slight prepatellar pain. Conclusion: Non-anatomical double-bundle anterior cruciate ligament reconstruction combined with modified lateral extra-articular tenodesis is a reliable and recommended treatment for anterior cruciate ligament rupture with high-grade pivot shift, showing a striking improvement in knee rotational Stability and function in the short-term follow-up.

Background The two geriatric diseases, sarcopenia and cardiovascular disease (CVD), often coexist, yet the causal relationship is unclear. However, few studies focus on the effect of muscle mass on CVD. This comprehensive study is dedicated to unearthing the potential connection between sarcopenia-related traits and CVD at the genetic level. Method A two-sample bi-directional Mendelian randomization (MR) study was conducted. In the first stage, we performed MR analysis regarding coronary heart disease (CHD), stroke, and myocardial infarction (MI) as exposure factors to reveal their effect on appendicular lean mass (ALM) and hand grip strength. In the second stage, we reverse the position of exposures and outcomes. The inverse variance weighted (IVW) method was used as the primary approach to reveal the potential causation between the exposure and outcome. Results The results of the IVW method revealed a negative causal effect of ALM on CHD (OR = 0.848, 95% CI = 0.804 to 0.894, p = 8.200E-10), stroke (OR = 0.931, 95% CI = 0.890 to 0.975, p = 2.220E-03), and MI (OR = 0.810, 95% CI = 0.694 to 0.901, p = 1.266E-13). Additionally, the left-hand grip strength is a significant protective factor for CHD (OR = 0.737, 95% CI = 0.601 to 0.904, p = 3.353E-03) and MI (OR = 0.631, 95% CI = 0.515 to 0.765, p = 2.575E-06), but is not causally linked to the stroke (OR = 0.971, 95% CI =0.829 to 1.139, p = 0.720). Meanwhile, the same conclusion about the effect of right-hand grip strength on CHD (OR = 0.681, 95% CI = 0.558 to 0.832, p = 1.702E-05), MI (OR = 0.634, 95% CI = 0.518 to 0.776, p = 9.069E-06), and stroke (OR = 1.041, 95% CI = 0.896 to 1.209, p = 0.604) was obtained. However, no significant causal effect of CVD (CHD, stroke, MI) on sarcopenia-related traits (ALM, handgrip strength) was found. Conclusion There is a unidirectional causal relationship between sarcopenia and CVD. The loss of muscle mass and strength has a significant causal role in promoting the occurrence and development of CVD, providing a reference for the prevention and treatment of comorbidities in older people.

Abstract Background Anteromedial tibial plateau fracture with posterolateral corner (PLC) injury is a relatively rare combined injury in the clinic. In addition, there is no unified treatment scheme for this combined injury. The purpose of this study was to evaluate the clinical and imaging results of single-stage arthroscopic-assisted surgery for anteromedial tibial plateau fracture with PLC injury, and to explore the advantages of this surgical technique. Method In this retrospective study, a total of 9 patients (7 males and 2 females) were included, aged 24–64 years (average 40.7 years), treated in our Department of Orthopedics from January 2016 to January 2021. In the preoperative evaluations, there were 9 cases of anteromedial tibial plateau fractures with PLC injuries, 6 cases of concomitant PCL injuries, 6 cases of concomitant medial or lateral meniscus injuries, and 2 cases of concomitant fibular head avulsion fractures. All patients underwent single-stage arthroscopic-assisted surgery. Results All patients were followed up, and the average follow-up period was 15.2 months (range 12–18 months). The average operation time was 135.6 min (range 100–160 min), and the average surgical blood loss was 87.2 ml (range 60–110 ml). The anatomical reduction was achieved in 9 cases, and the anatomical reduction rate was 100%. The average fracture healing time was 13.1 weeks (range 12–16 weeks). At the last follow-up, the average VAS score was 1 (range 0–2); the average Lysholm function score was 90.7 (range 86–95), and the average IKDC score was 91.4 (range 88–95); the average knee extension angle of all patients was 0° and the average knee flexion angle was 128.3° (average 120–135°); The posterior drawer test, the Lachman test and the dial test were negative for all cases. None of the patients had operation-related complications. Conclusion Single-stage arthroscopy-assisted surgery in the treatment of anteromedial tibial plateau fracture with PLC injury can achieve good clinical outcomes, restore the stability of the knee joint, and reduce the risk of severe lower extremity dysfunction.

Background: Metallic foreign body migration into the pulmonary artery after limb trauma is extremely rare. If not treated in time, the patient may die. The metallic foreign body was implanted from the thigh into the pulmonary artery and remained for 5 years. It has never been reported in limb trauma. Case Presentation: The patient was a 51-year-old male who had a small metal foreign body embedded in the middle and lower left thigh due to trauma. The foreign body was not found during emergency debridement operation. During the operation, a full-body X-ray was used to reveal a high-density shadow in the left upper lung. The 3D-CT of the chest immediately confirmed that the high-density shadow was a small iron foreign body, and the iron fragment foreign body was present in the pulmonary artery branch, but no abnormal symptoms were observed. He was hospitalized for observation for 3 days without obvious discomfort and refused to open his chest. The patient then decided to leave the hospital voluntarily. Conclusion: Surgical removal of all foreign bodies traveling to the pulmonary artery is not necessary, and the most appropriate treatment plan should be made considering the location of the foreign body, the patient's wishes and the general condition.

Background Symptomatic pulmonary embolism (PE) after knee arthroscopy is extremely rare. If the embolism is not treated promptly, the patient may die. Bilateral pulmonary embolism with associated pulmonary infarct without concomitant deep vein thrombosis has never been reported following routine knee arthroscopy. Case presentation A 50-year-old female patient with no other risk factors other than hypertension, obesity, varicose veins in the ipsilateral lower extremities and elevated triglyceride (TG) presented to our ward. She had experienced sudden chest tightness, polypnea and fainting after going to the bathroom the morning of the second postoperative day and received emergency medical attention. Colour ultrasonography of the extremities showed no deep vein thrombosis. Lung computed tomography angiography (CTA) showed multiple embolisms scattered in both pulmonary artery branches. Thus, emergency interventional thrombolysis therapy was performed, followed by postoperative symptomatic treatment with drugs with thrombolytic, anticoagulant and protective activities. One week later, lung CTA showed a significant improvement in the PEs compared with those in the previous examination. Since the aetiology of PE and no obvious symptoms were discerned, the patient was discharged. Conclusion Although knee arthroscopy is a minimally invasive and quick procedure, the risk factors for PE in the perioperative period should be considered and fully evaluated to enhance PE detection. Moreover, a timely diagnosis and effective treatment are important measures to prevent and cure PE after knee arthroscopy. Finally, clear guidelines regarding VTE thromboprophylaxis following knee arthroscopy in patients with a low risk of VTE development are needed.

Rationale: Three-dimensional (3D) printing has attracted wide attention for its potential and abilities in the assistance of surgical planning and the development of personalized prostheses. We herewith report a unique case of chronic clavicle osteomyelitis treated with a two-stage subtotal clavicle reconstruction using a 3D printed polyether-ether-ketone (PEEK) prosthesis. Patient concerns: A 23-year-old Chinese female presented to our clinic complaining about a progressive pain of her right clavicle for about 1 year. Diagnoses: Chronic clavicle osteomyelitis confirmed by percutaneous biopsy and lesion biopsy. Interventions: This patient accepted a long-term conservative treatment, which did not gain satisfactory outcomes. Thus, a subtotal removal and two-stage reconstruction of the right clavicle with a 3D-printed polyether-ether-ketone prosthesis stabilized by screw fixation system was performed. Outcomes: At 2-year follow-up, complete pain relief and satisfactory functional recovery of her right shoulder were observed. Lessons: Personalized 3D printed prosthesis is an effective and feasible method for reconstruction of complex bone defects.

Background：Despite the widespread adoption of chemotherapy, drug resistance has been the major obstacle in tumor elimination of cancer patients. Our aim was to explore the role of TGF-β in osteosarcoma chemo-resistance. Methods：We performed cytotoxicity analysis of methotrexate (MTX) and cisplatin (CIS) in TGF-β treated osteosarcoma cells. Then a metabolite profile of the core energetic routes was analyzed by 1H-NMR in Saos-2 and MG-63 cell extracts. We detected the expression of succinate dehydrogenase (SDH), STAT1, and Hypoxia-inducible factor 1α (HIF1α) in TGF-β treated osteosarcoma cells, and further tested the effects of these molecules on the cytotoxicity of chemotherapeutic agents. In vivo, we examined the tumor growth and survival time of Saos-2 bearing mice given the combination therapy of chemotherapeutic agents and a HIF1α inhibitor. Results：Metabolic analysis revealed an enhanced succinate production of osteosarcoma cells after TGF-β treatment. We further found the decrease in SDH expression and the increase in HIF1α expression of TGF-β treated osteosarcoma cells. Consistently, blockade of SDH aggravated the resistance of Saos-2/MG-63 cells to MTX and CIS. Also, a HIF1α inhibitor significantly strengthened the anti-cancer efficacy of chemotherapeutic drugs in mice with osteosarcoma cancer.Conclusion：Our study demonstrated that TGF-β attenuated the expression of SDH through reducing the transcription factor STAT1. The reduction of SDH then caused the up-regulation of HIF1α, thereby rerouting the glucose metabolism and aggravating chemo-resistance in osteosarcoma cells. Linking tumor cell metabolism to the formation of chemotherapy resistance, our study may guide the development of more effective treatments of osteosarcoma.

Abstract Background The purpose of this study was to evaluate the clinical and radiographic outcomes after medial patellofemoral ligament (MPFL) reconstruction combined with supracondylar biplanar femoral derotation osteotomy (FDO) in recurrent patellar dislocation (RPD) with increased femoral anteversion angle (FAA) and genu valgum. Methods Between January 2017 to December 2020, a total of 13 consecutive patients (13 knees, 4 males and 9 females, mean age 18.7 (range, 15–29 years) with RPD with increased FAA (FAA > 25°) and genu valgum (mechanical axis deformity of ≥5°) who underwent supracondylar biplanar FDO using a Tomofix-locking plate combined with MPFL reconstruction in our institution were included. Preoperative full-leg standing radiographs, lateral views, and hip-knee-ankle computed tomography (CT) scans were used to evaluate the mechanical lateral distal femoral angle (mLDFA), anatomical femorotibial angle (aFTA), mechanical axis, patellar height, tibial tubercle-trochlear groove (TT-TG) distance, and torsional angle of the tibial and femoral in the axial plane. Patient reported outcomes were evaluated using the International Knee Documentation Committee (IKDC) score, Kujala score, Lysholm score, visual analog scale (VAS), and Tegner score preoperatively and postoperatively. Postoperative CT scans were used to evaluate the changes of FAA and TT-TG, and full-leg standing radiographs was used to evaluate the changes of mLDFA, aFTA, and mechanical axis. Results A total of 13 patients (13 knees) were included with an average follow-up period of 26.7 months (range 24–33). No cases developed wound infection, soft tissue irritation, and recurrent patellar dislocation during the follow-up period after surgery. Bone healing at the osteotomy site was achieved in all cases, and all patients regained full extension and flexion. Clinical outcomes (VAS, Kujala, IKDC, Lysholom, and Tegner scores) improved significantly at the final follow-up after surgery (p < 0.05). The mean mLDFA, aFTA, mechanical axis, and TT-TG distance showed statistically significant improvement following the combined surgery (p < 0.05), while the CDI did not change significantly after surgery (p>0.05). Conclusion MPFL reconstruction combined with supracondylar biplanar FDO showed satisfactory clinical outcomes and radiographic results in the short-term follow-up period.

Background: It is rare to see knee lumen infection with calf effusion abscess. Traditional open surgery is traumatic, slow and difficult to recover. And there are few reports of using arthroscopy to diagnose and treat knee lumen infection with calf effusion abscess. This case series aims to introduce the clinical outcomes of arthroscopic treatment of knee lumen infection with calf effusion abscess. Methods： fifteen patients with knee joint cavity infections and calf abscesses from from January 2015 to December 2019, were included(11 males and 4 females; age range from 33 to 61, the average age is 46.6years). All patients were treated with arthroscopic multi-channel combined approach. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were recorded before and at the last follow-up. The knee function was evaluated according to the visual analogue scoring method (visual analogue scale, VAS) pain score and Lysholm score. Results： fifteen patients were followed up from 12 months to 2 years, and the average follow-up time was 18.4 months. The operation was smooth in all patients, the incisions were healed at grade I, no postoperative recurrence, no nerve damage, and no complications such as knee stiffness. At the last follow-up, ESR decreased from preoperative (44.6±10.1) to (11.4±3.1) (P <0.001), and CRP decreased from preoperative (30.2±8.0) to (3.9±1.0) ( P <0.001). Lysholm score was reduced by Before (46.9±7.7) improved to (93.0±8.1) ( P <0.001), the VAS score decreased from (7.0±0.9) before operation to (2.1±1.2) ( P <0.001), and the differences were statistically significant. Conclusion： Arthroscopic multi-channel combined approach is a safe, effective and minimally invasive treatment method for knee joint cavity infection with calf abscess.

ObjectiveTo investigate the short-term effectiveness of derotational distal femoral osteotomy (DDFO) combined with medial patellofemoral ligament (MPFL) reconstruction in treatment of recurrent patellar dislocation with excessive femoral anteversion angle (FAA≥30°).MethodsBetween June 2017 and August 2019, 17 patients with recurrent patellar dislocation with FAA≥30° were treated with DDFO and MPFL reconstruction. There were 5 males and 12 females, aged 14-22 years, with an average of 17.7 years. The patella dislocated for 2 to 8 times (mean, 3.6 times). The disease duration was 2-7 years (mean, 4.6 years). The patellar apprehension tests were positive. Preoperative pain visual analogue scale (VAS) score, Lysholm score, Tegner score, and Kujala score were 4.2±1.1, 47.8±8.1, 3.6±1.1, and 56.8±5.7, respectively. FAA, mechanical lateral distal femoral angle (mLDFA), lateral patella displacement (LPD), tibial tuberosity-trochlear groove distance (TT-TG) were (34.9±3.4)°, (85.8±3.0)°, (13.7±3.8) mm, and (23.1±2.1) mm, respectively.ResultsAll incisions healed by first intention, and there was no complications such as knee stiffness, infection, and re-dislocation of the patella. All patients were followed up 13-25 months, with an average of 17.7 months. The imaging review showed that 1 case of osteotomy did not union, and achieved satisfactory results after the secondary revision and strengthening fixation; the osteotomies of other patients healed completely after 3 to 4 months of operation. The patellar apprehension tests were negative. At last follow-up, the FAA, mLDFA, LPD, and TT-TG were (15.6±2.7)°, (83.0±2.1)°, (5.0±2.6) mm, and (20.5±2.5) mm, respectively; the VAS score, Lysholm score, Tegner score, and Kujala score were 2.4±1.4, 93.4±7.8, 6.8±1.5, and 89.0±8.0, respectively. There were significant differences in the above indicators between pre- and post-operation ( P<0.05).ConclusionDDFO combined with MPFL reconstruction for the recurrent patellar dislocation with excessive FAA (≥30°) can achieve good short-term effectiveness, significantly reduce knee pain, and improve function.

Supplemental Digital Content is available in the text Abstract Background: Biceps tenotomy and biceps tenodesis are 2 most common surgical procedures for long head of the biceps tendon (LHBT) pathology, but debate still exists regarding the choice of treatment. This meta-analysis was conducted to compare clinical results between tenotomy and tenodesis for the treatment of lesions of LHBT. It was hypothesized that there is no difference in outcomes of tenotomy and tenodesis for lesions of LHBT. Methods: A comprehensive search of literature published between 1980 and April 2020 was performed using MEDLINE, EMBASE, Web of Science, and the Cochrane Library databases. Randomized controlled trials (RCTs) comparing tenotomy and tenodesis for LHBT lesions were included. The primary outcomes were Constant score and Popeye deformity. The secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) for pain, muscle strength, cramping pain, and operative time. For primary outcomes, trial sequential analysis (TSA) was conducted to reduce the risk of random errors and the GRADE (grading of recommendations, assessment, development, and evaluations) approach was used to assess the quality of the body of evidence. Results: A total of 9 RCTs were included. In pooled analysis, statistical significance was observed in the Constant score (mean difference [MD], 1.59; 95% confidence interval [CI] 0.04–3.14; P = .04), Popeye deformity (risk ratio [RR], 0.33; 95% CI, 0.22–0.49; P < .00001) and operative time (MD, 9.94; 95% CI 8.39–11.50; P < .00001). However, there were no significant differences between the tenodesis and tenotomy in ASES score (P = .71), VAS for pain (P = .79), cumulative elbow flexion strength (P = .85), cumulative elbow supination strength (P = .23), and cramping pain (P = .61) TSA revealed that the results for Constant score was inconclusive. Conclusion: For the treatment of LHBT lesions, with the exception of constant score, there was no significant benefit of tenodesis over tenotomy. Although tenotomy is affected by a higher risk of Popeye sign, it is more timesaving.