Background The lateral femoral notch (LFN) sign, a footprint of tibiofemoral impaction, is recognized indicator of nterior cruciate ligament (ACL) injury. However, its potential for spontaneous osseous remodeling after reconstruction has yet to be established, precluding evidence-based patient counseling regarding its prognosis. Methods This retrospective multi-timepoint cohort study ( from July 2017 to January 2025), patients who underwent ACL reconstruction (ACLR) and received 3.0-T MRI at baseline (≤ 30 days post-injury) and one postoperative time point (1, 2, or 5 years) were included. Patients were allocated to three cohorts based on their single follow-up MRI: 1-year cohort (n = 38), 2-year cohort (n = 27), and 5-year cohort (n = 37). Inclusion criteria were sports-related injury and an MRI obtained within 30 days post-injury. The maximal depth of the LFN was measured on sagittal MRI. Results The depth of the LFN decreased significantly from preoperative values at 1 year (0.70 ± 0.30 mm, P < .001), 2 years (0.55 ± 0.26 mm, P < .001), and 5 years (0.46 ± 0.19 mm, P < .001) postoperatively. The change in LFN depth between 1 and 5 years was significant (P < .001), but the rate of change from 1–2 years did not did not differ significantly from that of the 2–5 years interval. LFN depth was significantly associated with age (r = -0.276, P = .005), Body mass index (BMI) (r = 0.312, P = .001), and injured side (r = 0.222, P = .025). Changes in LFN depth were significantly associated with gender (r = 0.215, P = .030) and injured side (r = -0.207, P = .037). Conclusion The LFN sign exhibits significant spontaneous osseous remodeling over 5 years post-ACLR. These findings provide crucial evidence for clinicians to manage patient expectations, alleviate kinesiophobia by demonstrating the dynamic nature of this lesion, and consider personalized rehabilitation strategies based on individual factors like gender and injured side.

Background:There is a risk of convergence between the anterior cruciate ligament reconstruction (ACLR) femoral tunnel and the lateral extra-articular tenodesis (LET) tunnel, which may cause damage to the graft and fixation device. Purpose:To develop a simple and safe method for drilling the LET tunnel to avoid convergence between the ACL femoral tunnel and the LET tunnel. Study Design:Descriptive laboratory study. Methods:Three-dimensional computed tomography reconstructed images of 60 knees after ACLR and 10 knees after ACLR and LET between August 2023 and July 2024 were analyzed. The possibility and utility of using the anterior cartilage edge (ACE) of the lateral femoral condyle medial wall as an intra-articular landmark of the LET tunnel exit were analyzed in 60 knees grouped by ACL tunnel diameter: the 7-mm group (n = 20); the 8-mm group (n = 20); and the 9-mm group (n = 20). The safe zone is defined as the area of the LET bone tunnel exit at the medial wall of the lateral condyle of the femur where the 2 bone tunnels do not intersect. In addition, the bone bridge thickness was measured in 10 knees after ACLR and LET. Results:The x-coordinate of the highest point in the cartilage edge was significantly smaller than that of the intersection point between the safe line and the cartilage edge in each group (7-mm group: 57.27 ± 7.32 vs 88.27 ± 6.17; P = .000; 8-mm group: 56.37 ± 6.90 vs 81.10 ± 8.23; P = .000; 9-mm group: 56.05 ± 3.98 vs 70.99 ± 14.85; P = .000). The ACE was beyond the safe zone. The safe zone increased as the ACL bone tunnel diameter decreased. There was no tunnel conflict in all 10 patients who underwent ACLR and LET. The bone bridge thickness ranged from 3.15 to 8.92 mm. Conclusion/Clinical Relevance:To avoid tunnel convergence in ACLR combined with LET, the ACE of the lateral femoral condyle medial wall is a useful landmark to drill the LET bone tunnel.

In the original publication [...].

PURPOSE:To perform a systematic review and meta-analysis on the incidence rate and risk factors for high-grade pivot shift in patients with anterior cruciate ligament (ACL) injury. It was hypothesised that the risk factors associated with high-grade pivot shift can be successfully identified. METHODS:Pubmed, Scopus, Embase and Web of Science databases were systematically searched from inception to March 22, 2025, to identify relevant studies. Comparative studies reporting risk factors for high-grade pivot shift were included in this analysis. A random-effects model was utilised to assess the pooled effect and identify risk factors significantly associated with high-grade pivot shift. RESULTS:A total of 16 studies investigating risk factors for high-grade pivot shift (nine defined as grade ≥II and seven defined as grade III) involving 6051 patients were included in this analysis. The overall pooled incidence rate of high-grade pivot shift was 55.8% (95% confidence interval [CI]: 40.1%, 71.5%) for grade ≥II pivot shift and 23.0% (95% CI: 15.8%, 30.3%) for grade III pivot shift. Lower body mass index (BMI; mean difference [MD], -0.42), higher Beighton score (odds ratio [OR], 1.15), complete ACL tear (OR, 6.23), and concomitant injuries to medial collateral ligament (MCL; OR, 2.86), anterolateral complex (ALC; OR, 6.66), lateral meniscus (OR, 1.62), lateral meniscus posterior horn (OR, 2.39), medial meniscus (OR, 1.32) and medial meniscus posterior horn (OR, 1.75) were identified as risk factors for high-grade pivot shift in patients with ACL injury. CONCLUSION:Lower BMI, higher Beighton score, complete ACL tear, concomitant injuries to MCL, ALC, lateral meniscus, lateral meniscus posterior horn, medial meniscus and medial meniscus posterior horn were significantly associated with an increase of risk for high-grade pivot shift in patients with ACL injury. Clinicians are supposed to pay more attention to these risk factors to effectively identify patients with potential rotational instability. LEVEL OF EVIDENCE:Level III.

OBJECTIVE:To investigate the midterm clinical efficacy of medial patellofemoral complex (MPFC) reconstruction for recurrent patellar dislocation with high-grade trochlear dysplasia. METHODS:A retrospective analysis was carried out among adult patients who underwent arthroscopically assisted MPFC reconstruction between January 2014 and December 2020. Dejour classification was evaluated to grade trochlear dysplasia; tibial tubercle-trochlear groove (TT-TG) distance and Insall-Salvati index were measured. Preoperative and postoperative patient-reported outcome measures (PROMs) were compared, including International Knee Documentation Committee (IKDC) score, Kujala score, Lysholm score and Tegner score. Information regarding returning-to-sport rate, re-instability events and complications was collected. Patellar tilt (PT), lateral patellar displacement (LPD) and bisect offset (BSO) ratio were measured based on axial computed tomography before and after surgery to assess the patellofemoral congruence. RESULTS:A total of 46 MPFC reconstructions in 43 patients were enrolled, including 16 male and 27 female. Mean age at surgery was (22.2±7.6) years (range: 14-44 years). Mean follow-up was (49.9±22.6) months (range: 18-102 months). The percentages of Dejour B, C and D dysplasia were 37.0% (17/46), 43.5% (20/46), and 19.6% (9/46), respectively. Mean Insall-Salvati index was 1.2±0.2 (range: 0.85-1.44), and mean TT-TG distance was (19.6±3.5) mm (range: 10.6-28.7 mm). At latest follow-up, there were significant improvements in all PROMs (P < 0.001): IKDC score, from 56.3±15.1 to 86.2±8.1; Kujala score, from 58.9±15.6 to 92.6±5.4; Lysholm score, from 63.7±15.0 to 94.0±5.7; Tegner score, from 3.1±1.4 to 4.7±1.4, and there were no significant differences in the improvements of the scores between the patients with Dejour B, C and D dysplasia. Overall, ninety percent of the patients returned to their preoperative sports level. One patient reported a postoperative subluxation, while no cases of infection, limited range of motion or patella fracture were observed. PT, LPD and BSO ratio were all significant altered (P < 0.001) after MPFC reconstruction. CONCLUSION:Arthroscopically assisted MPFC reconstruction yielded satisfactory midterm clinical results for recurrent patellar dislocation with high-grade trochlear dysplasia. No significant differences of improvements in knee function were observed among the three types of high-grade trochlear dysplasia.

Background: Identifying patients at high risk for failure of primary anterior cruciate ligament reconstruction (ACLR) on the basis of preoperative magnetic resonance imaging (MRI) measurements has received considerable attention. In this study, we aimed to identify potential risk factors for primary ACLR failure from preoperative MRI measurements and to determine optimal cutoff values for clinical relevance. Methods: Retrospective review and follow-up were conducted in this nested case-control study of patients who underwent primary single-bundle ACLR using hamstring tendon autograft at our institution from August 2016 to January 2018. The failed ACLR group included 72 patients with graft failure within 5 years after primary ACLR, while the control group included 144 propensity score-matched patients without failure during the 5-year follow-up period. Preoperative MRI measurements were compared between the 2 groups. Receiver operating characteristic (ROC) curve analyses were conducted to determine the optimal cutoff values for the significant risk factors. Odds ratios (ORs) were calculated, and survival analyses were performed to evaluate the clinical relevance of the determined thresholds. Results: A greater lateral femoral condyle ratio (LFCR) (p = 0.0076), greater posterior tibial slope in the lateral compartment (LPTS) (p = 0.0002), and greater internal rotational tibial subluxation (IRTS) (p < 0.0001) were identified in the failed ACLR group compared with the control group. ROC analyses showed that the optimal cutoff values for IRTS and LPTS were 5.8 mm (area under the curve [AUC], 0.708; specificity, 89.6%; sensitivity, 41.7%) and 8.5° (AUC, 0.655; specificity, 71.5%; sensitivity, 62.5%), respectively. Patients who met the IRTS (OR, 6.14; hazard ratio [HR], 3.87) or LPTS threshold (OR, 4.19; HR, 3.07) demonstrated a higher risk of primary ACLR failure and were significantly more likely to experience ACLR failure in a shorter time period. Conclusions: Preoperative MRI measurements of increased IRTS, LPTS, and LFCR were identified as risk factors for primary ACLR failure. The optimal cutoff value of 5.8 mm for IRTS and 8.5° for LPTS could be valuable in the perioperative management of primary ACLR. Level of Evidence: Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Background: Identifying patients at high risk for failure of primary anterior cruciate ligament reconstruction (ACLR) on the basis of preoperative magnetic resonance imaging (MRI) measurements has received considerable attention. In this study, we aimed to identify potential risk factors for primary ACLR failure from preoperative MRI measurements and to determine optimal cutoff values for clinical relevance. Methods: Retrospective review and follow-up were conducted in this nested case-control study of patients who underwent primary single-bundle ACLR using hamstring tendon autograft at our institution from August 2016 to January 2018. The failed ACLR group included 72 patients with graft failure within 5 years after primary ACLR, while the control group included 144 propensity score-matched patients without failure during the 5-year follow-up period. Preoperative MRI measurements were compared between the 2 groups. Receiver operating characteristic (ROC) curve analyses were conducted to determine the optimal cutoff values for the significant risk factors. Odds ratios (ORs) were calculated, and survival analyses were performed to evaluate the clinical relevance of the determined thresholds. Results: A greater lateral femoral condyle ratio (LFCR) (p = 0.0076), greater posterior tibial slope in the lateral compartment (LPTS) (p = 0.0002), and greater internal rotational tibial subluxation (IRTS) (p < 0.0001) were identified in the failed ACLR group compared with the control group. ROC analyses showed that the optimal cutoff values for IRTS and LPTS were 5.8 mm (area under the curve [AUC], 0.708; specificity, 89.6%; sensitivity, 41.7%) and 8.5 degrees (AUC, 0.655; specificity, 71.5%; sensitivity, 62.5%), respectively. Patients who met the IRTS (OR, 6.14; hazard ratio [HR], 3.87) or LPTS threshold (OR, 4.19; HR, 3.07) demonstrated a higher risk of primary ACLR failure and were significantly more likely to experience ACLR failure in a shorter time period. Conclusions: Preoperative MRI measurements of increased IRTS, LPTS, and LFCR were identified as risk factors for primary ACLR failure. The optimal cutoff value of 5.8 mm for IRTS and 8.5 degrees for LPTS could be valuable in the perioperative management of primary ACLR.

Viral replication is an energy-intensive process that often induces energy stress in host cells, and efficient mobilization of host cell energy resources facilitates optimal viral replication. The mechanisms by which Newcastle disease virus (NDV) regulates the host energy metabolism to facilitate its replication remain incompletely understood. For this purpose, transcriptomic analysis was conducted to delineate the transcriptional changes during NDV infection. The results demonstrated that NDV infection downregulated the transcriptional levels of enzymes associated with de novo fatty acid synthesis. Subsequent investigations demonstrated that the active form of the sterol regulatory element-binding protein 1c (SREBP1c) a master transcription factor governing lipid biosynthesis pathways, exhibits reduced expression following viral infection. Notably, SREBP1c activation is negatively regulated by folliculin (FLCN), a tumor suppressor protein that undergoes during NDV infection. The de novo fatty acid synthesis pathway is an energy-intensive process, and the degradation of FLCN may suppress this pathway to maintain cellular energy homeostasis, thereby supporting viral replication. In summary, our findings demonstrate that NDV facilitates its replication by inducing degradation of FLCN, thereby modulating the host cell energy metabolism.

The effective and translational strategy to regenerate knee meniscal fibrocartilage remained challenging. Herein, we first identified vascular smooth muscle cells (VSMCs) transdifferentiated into fibrochondrocytes and participated in spontaneous meniscal regeneration using smooth muscle cell lineage tracing transgenic mice meniscal defect model. Then, we identified low-intensity pulsed ultrasound (LIPUS) acoustic stimulus enhanced fibrochondrogenic transdifferentiation of VSMCs in vitro and in vivo. Mechanistically, LIPUS stimulus could up-regulate mechanosensitive ion channel Piezo1 expression and then activate the transforming growth factor β1 (TGFβ1) signal, following repression of the Notch signal, consequently enhancing fibrochondrogenic transdifferentiation of VSMCs. Finally, we demonstrated that the regular LIPUS stimulus enhanced anisotropic native-like meniscal fibrocartilage tissue regeneration in a beagle canine subtotal meniscectomy model at 6 months postoperatively. The single-cell RNA sequencing analysis confirmed the role of VSMC fibrochondrogenic transdifferentiation in meniscal regeneration.

Abstract Background From the perspective of graft protection and early rehabilitation during the maturation and remodeling phases of graft healing, suture augmentation (SA) for anterior cruciate ligament reconstruction (ACLR) has attracted more and more attention. Study Design Retrospective study. Purpose To determine whether the additional SA affects clinical results, graft maturation and graft-bone interface healing during two years follow-up after ACLR. Methods 20 ACLRs with additional SA (ACLR-SA group) and 20 ACLRs without additional SA (ACLR group) were performed between January 2020 and December 2021 by the same surgeon and were retrospectively analyzed. Pre- and postoperative International Knee Documentation Committee (IKDC) scores, Lysholm scores, graft failure and reoperation were evaluated. The signal/noise quotient (SNQ) of autografts and the signal intensity of graft-bone interface were analyzed. All 40 patients in ACLR-SA group and ACLR group completed 2-years follow-up. Results There was no patient in the two cohorts experienced graft failure and reoperation. The postoperative IKDC and Lysholm scores have been significantly improved compared with preoperative scored in both ACLR-SA group and ACLR group, however, there was no significant difference between two groups. The SNQ of proximal graft of ACLR-SA group (14.78 ± 8.62 vs. 8.1 ± 5.5, p = 0.041) was significantly greater while the grades of graft-bone interface healing of posterior tibial was significantly lower than that of ACLR group at 1-year postoperatively (p = 0.03), respectively. There were no significant differences between the two groups of the SNQ of proximal, distal medial graft segments, and the graft-bone interface healing grades of anterior femoral, posterior femoral, anterior tibial and posterior tibial at other time points (p>0.05). Conclusions The additional SA in ACLR had no effect on IKDC scores, Lysholm scores, graft maturation and graft-bone interface healing at 2-year postoperatively. Our research does not support the routine use of SA in ACLR.

Objective Systematic summary of the epidemiology of patellar dislocation is rare. This study aims to investigate sex‐, age‐, type‐, injury causing events‐, incidence of bone bruise and time from last injury (TFLI)‐specific characteristics, and detail the epidemiological characteristics of patellar dislocation. Method In this descriptive epidemiological study, a total of 743 patients who have a history of lateral patellar dislocation with either first‐time patellar dislocation (FPD) or recurrent patellar dislocation (RPD) between August 2017 and June 2022 at our institution met the inclusion criteria and were selected in this study. Patient characteristics including the type, gender, age, events leading to patellar dislocation, incidence of patellar bone bruise, and the time from last injury (TFLI) of patellar dislocation were retrospectively obtained and described. Magnetic resonance imaging scans (MRI) of the knee were reviewed for insuring bone bruise. Results Among the 743 patients with patellar dislocation who required surgical reconstruction of the medial retinaculum, 418 (56.2%) had RPD and 325 (43.8%) had FPD. There were more females (65.0%) than males (35.0%) in patellar dislocation patients. Among the female patients, those aged <18 years had higher incidence (31.4%) of patellar dislocation. Among the male patients, those aged <18 and 19–28 years had higher incidence (16.8%) of patellar dislocation. Of all age groups, the prevalence rate of patellar dislocation was high in juvenile population and females, but with no statistical significance. The most common patellar dislocation‐causing event was sport accidents (40.1%), followed by life accidents (23.2%). The incidence of left‐knee patellar dislocation was slightly higher than that of right‐knee patellar dislocation. The incidence of patellar bone bruise of RPD (63.2%) was significantly lower (p < 0.05) than that of FPD (82.2%). Patellar dislocation patients with bone bruise had shorter time from last injury (TFLI) than those without patellar bone bruise (p < 0.05). Conclusions The incidence of bone bruise of RPD was lower than that of FPD, and patients with patellar bone bruise may have a shorter time from last injury than those without bone bruise.

Most somatic cells secrete vesicles called exosomes, which contain a variety of biomolecules. Recent research indicates that macrophage-derived exosomes are strongly correlated with tumors, infectious diseases, chronic inflammation, and tissue fibrosis. Therefore, the purpose of this review is to delve into the mechanisms of pathological states and how macrophage-derived exosomes react to them. We also discuss the biological effects of exosomes and how they affect disease. In addition, we have examined the possible uses of exosomes in illness treatment, highlighting both the benefits and drawbacks of these applications.

BackgroundOsteoarthritis (OA) is a debilitating joint disorder characterized by progressive cartilage degeneration. During OA, subchondral bone undergoes microstructural and molecular changes that precede cartilage degradation. However, specific mechanisms underlying metabolic dysregulation of the bone-cartilage unit remain unclear. This study aims to investigate the role of receptor-interacting protein kinase-3 (RIP3) in OA progression, focusing on bone-cartilage metabolic homeostasis.MethodsRIP3-mediated pathological and metabolic alterations in chondrocytes, osteoblasts, and bone marrow-derived macrophages (BMMs) were evaluated. RIP3-mediated OA manifestations in cartilage and more importantly, subchondral bone were determined by intra-articular overexpression of RIP3 in rats. The protective effect of RIP3 deficiency on the bone-cartilage unit during OA was systematically investigated using Rip3 knockout mice. The CMap database was used to screen for compounds that abrogate RIP3-induced OA pathological changes.ResultsRIP3 was upregulated in the cartilage and subchondral bone of OA patients and post-traumatic OA mouse model. RIP3 overexpression not only inhibited extracellular matrix (ECM) anabolism in chondrocytes but also attenuated osteoblast differentiation, whereas RIP3 deficiency blunted receptor activator of NF-kappaB ligand-mediated osteoclastogenesis of BMMs. Intra-articular RIP3 overexpression induced the imbalance of SP7+ osteoblasts/tartrate-resistant acid phosphatase (TRAP)+ osteoclasts within the subchondral bone in addition to cartilage degeneration in rats, while Rip3 deletion significantly improved structural outcomes of the bone-cartilage unit, and achieved pain relief as well as functional improvement in surgery-induced and spontaneous OA mouse models. Mechanistically, RIP3 initiates OA by perturbing critical events, including cartilage metabolism, inflammatory responses, senescence, and osteoclast differentiation. Clofibrate, a hypolipidemic drug, was identified as a novel RIP3 inhibitor that reverses ECM catabolism in OA.ConclusionsRIP3 is an essential governor of whole joint metabolic homeostasis by regulating both cartilage metabolism and subchondral bone remodeling. Reconstruction of the bone-cartilage unit by targeting RIP3 might provide a two-birds-one-stone approach for the development of future OA therapies.

Purpose: The purpose of this study is to investigate whether increased anterior tibial subluxation (ATS) and differences between ATS in the lateral and medial compartments (ATS(L-M)) are associated with primary anterior cruciate ligament (ACL) reconstruction (ACLR) failure. Methods: PubMed, Scopus, Embase and Web of Science were systematically searched from their inception through 21 November 2023. The focus was on comparative studies reporting ATS in patients who experienced primary ACLR failure, in contrast to patients after primary ACLR with no evidence of graft failure. A random-effects model was employed to calculate the overall standardized mean difference between the two groups. Results: A total of eight studies involving 963 patients were included in the final review. Three studies (64 cases and 171 controls) measured ATS on radiographs. The failed ACLR group exhibited a significantly increased ATS on radiographs compared to the control group (p < 0.001). Six studies (324 cases and 488 controls) measured lateral ATS on magnetic resonance imaging and five of them (285 cases and 374 controls) also measured medial ATS. The average values of lateral and medial ATS, as well as ATS(L-M), were calculated and compared between the two groups. The failed ACLR group demonstrated significantly increased lateral (p < 0.001) and medial ATS (p < 0.001), the average value of lateral and medial ATS (p < 0.001) and ATS(L-M) (p = 0.039) compared to the control group. Conclusion: Increased ATS and ATS(L-M) are associated with primary ACLR failure. The measurement of tibiofemoral position shows promise for its application in preoperative planning and postoperative management of ACLR.

Background:Anterior cruciate ligament (ACL) reconstruction has been the gold standard for primary ACL rupture since the 1990s. In the past decade, ACL repair has received renewed attention and increased research. Purpose:To compare the clinical outcomes of modern augmented ACL repair versus autograft reconstruction for ACL ruptures. Study Design:Systematic review; Level of evidence, 3. Methods:A search of the PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Library databases was conducted for prospective or retrospective comparative studies published between January 1, 2010, and January 3, 2023, with a minimum 2-year follow-up. Two independent reviewers performed data extraction and methodological quality assessment. Sensitivity analysis was performed to maintain the stability of results. Results:Nine studies were included (minimum follow-up period, 24-60 months). The total sample size was 833 patients (augmented repair group: 358 patients; autograft ACL reconstruction group: 475 patients). There were 4 randomized controlled trials (level 1), 1 prospective comparative study (level 2), 2 retrospective comparative studies (level 3), and 2 case-control studies (level 3). The augmented ACL repair group attained significantly higher Lysholm score (weighted mean difference [WMD] = 1.57; 95% confidence interval [CI], 0.14-3.01; P = .03) and hamstring strength (WMD = 36.69; 95% CI, 29.07-44.31; P < .01) but had higher rates of hardware removal (odds ratio [OR] = 6.30; 95% CI, 2.44-16.23; P = .0001), reoperation (OR = 1.87; 95% CI, 1.33-2.62; P = .0003), and failure (OR = 1.58; 95% CI, 1.03-2.43; P = .0003) compared with the autograft ACL reconstruction group. No significant differences were observed between the repair and reconstruction groups regarding postoperative International Knee Documentation Committee scores, Tegner scores, knee laxity, satisfaction, ACL revisions, complications, and reoperation rather than revision. Conclusion:Augmented ACL repair was associated with higher rates of reoperation, hardware removal, and failure compared with autograft ACL reconstruction in studies with minimum 2-year follow-up data. However, augmented ACL repair had higher Lysholm scores and hamstring strength versus autograft ACL reconstruction.

Au nano-clusters (Au NCs) were promising electrochemiluminescence (ECL) nano-materials. However, the small size of Au NCs presented a challenge in terms of their immobilization during the construction of an ECL biosensing platform. This limitation significantly hindered the wider application of Au NCs in the ECL field. In this work, we successfully used the reducibility of Ti3C2 to fabricate in situ a self-enhanced nano-probe Ti3C2-TiO2-Au NCs. The strategy of in situ generation not only improved the immobilization of Au NCs on the probe but also eliminated the requirement of adding reducing agents during preparation. In addition, in situ generated TiO2 could serve as a co-reaction accelerator, shortening the electron transfer distance between S2O82and Au NCs, thereby improving the utilization of intermediates and enhancing the ECL response of Au NCs. The constructed ECL sensing platform could achieve sensitive detection of polynucleotide kinase (PNK). At the same time, the 5 '-end phosphate group of DNA phosphorylation could chelate with a large amount of Ti on the surface of Ti3C2, thereby achieving the goal of specific detection of PNK. The sensor based on self-enhanced ECL probes had a broad dynamic range spanning for PNK detection from 10.0 to 1.0 x 107 mu U mL-1, with a limit of detection of 1.6 mu U mL-1. Moreover, the ECL sensor showed satisfactory detection performance in HeLa cell lysate and serum. This study not only provided insights for addressing the issue of ECL luminescence efficiency in Au NCs but also presented novel concepts for ECL self-enhancement strategies.

Total ankle replacement (TAR) or ankle arthrodesis (AA) is the main surgical treatment for end-stage ankle osteoarthritis. However, the therapeutic effect of the two surgical procedures at different follow-up times remains controversial. The purpose of this meta-analysis is to compare the short-term, medium-term, and long-term safety and efficiency of the two modern surgical treatments. We conducted a comprehensive search in PubMed, EMBASE, Cochrane library databases, Web of Science, and Scopus. The main results were the patient’s reported outcome measure (PROM) score, satisfaction, complications, reoperation, and surgery success rate. Different follow-up times and implant designs were used to evaluate the source of heterogeneity. We used a fixed effects model for meta-analysis and I2 statistic for evaluating heterogeneity. Thirty-seven comparative studies were included. In the short term, TAR significantly improved clinical scores (AOFAS score: WMD = 7.07, 95% Cl: 0.41–13.74, I2 = 0.0%; SF-36 PCS score: WMD = 2.40, 95% Cl: 2.22–2.58, I2 = 0.0%; SF-36 MCS score: WMD = 0.40, 95% Cl: 0.22–0.57, I2 = 0.0%; VAS for pain: WMD =  − 0.50, 95% Cl: − 0.56–0.44, I2 = 44.3%) and had the lower incidence of revision (RR = 0.43, 95% CI: 0.23–0.81, I2 = 0.0%) and complications (RR = 0.67, 95% Cl: 0.50–0.90, I2 = 0.0%). In the medium term, there were still higher improvements in both the clinical scores (SF-36 PCS score: WMD = 1.57, 95% Cl: 1.36–1.78, I2 = 20.9%; SF-36 MCS score: WMD = 0.81, 95% Cl: 0.63–0.99, I2 = 48.8%) and the patient satisfaction (RR = 1.24, 95% Cl: 1.08–1.41, I2 = 12.1%) in the TAR group, but its total complications rate (RR = 1.84, 95% Cl: 1.26–2.68, I2 = 14.9%) and revision rate (RR = 1.58, 95% CI: 1.17–2.14, I2 = 84.6%) were significantly higher than that of the AA group. In the long term, there was no significant difference in clinical score and satisfaction, and a higher incidence of revision (RR = 2.32, 95% Cl: 1.70–3.16, I2 = 0.0%) and complications (RR = 3.18, 95% Cl: 1.69–5.99, I2 = 0.0%) was observed in TAR than in AA. The result of the third-generation design subgroup was consistent with that of the above pooled results. TAR had advantages over AA in the short term due to better performance in terms of PROMs, complications, and reoperation rates, but its complications become a disadvantage in the medium term. In the long term, AA seems to be favored because of lower complications and revision rates, although there is no difference in clinical scores.

Purpose: To evaluate the clinical outcomes of arthroscopically assisted double-bundle medial patellofemoral complex reconstruction (MPFC-R). Methods: A retrospective review was carried out among adult patients who experienced at least 2 patellar dislocations and underwent primary arthroscopically assisted MPFC-R between January 2014 and November 2019. Dejour classification, tibial tubercle-trochlear groove (TT-TG) distance, and patellar height (with Insall-Salvati index) were measured. Pre-and postoperative patellar tilt were compared. Information on outcome scores, ability to return to sports, postoperative recurrent dislocations, and complications was recorded. Results: A total of 42 MPFC-Rs in 39 patients were included. Mean age at surgery was 22.2 +/- 7.6 years; 69.2% of patients were female. Mean follow-up was 47.3 +/- 20.2 months. Seventy-four percent of cases had Dejour B (19.0%), C (33.3%), and D (21.4%) trochlear dysplasia; mean TT-TG distance was 19.6 +/- 3.5 mm, and mean Insall-Salvati index was 1.21 +/- 0.17. Mean patellar tilt decreased from 27.6 +/- 11.6 degrees to 9.4 +/- 6.5 degrees (P < .001). All patients had statistically significant (P < .001) improvement in mean International Knee Documentation Committee (IKDC) (44.9 +/- 18.2 to 87.5 +/- 6.9), Lysholm (61.4 +/- 16.6 to 94.1 +/- 6.4), Kujala (56.0 +/- 16.8 to 92.9 +/- 5.3), and Tegner score (2.7 +/- 1.3 to 4.6 +/- 1.4). The majority of patients (96.9%) returned to sports, with 90.3% returning to the same or greater level of activity. No postoperative dislocations or subluxations were reported. Conclusions: Arthroscopically assisted double-bundle MPFC-R is a promising procedure to treat recurrent patellar instability at 2-to 7-year mid-term follow-up, despite the presence of trochlear dysplasia, elevated TT-TG distance and patellar alta. The improvement of IKDC score exceeded the minimal clinically important dif-ference in 95.2% patients, and 66.7% surpassed the patient acceptable symptomatic state based on postoperative IKDC score with no redislocations being reported at latest follow-up. Level of Evidence: Level IV, case series, retrospective.

目的:总结外侧半月板前角-前体部损伤的临床分型及相应手术策略并评估治疗效果.方法:回顾性分析2020年1月至2020年12月收治的87例外侧半月板前角-前体部损伤患者病例资料,总结撕裂类型和手术策略,根据术前和末次随访的国际膝关节评分委员会(IKDC)评分和Lysholm膝关节评分评估治疗效果.结果:前角-前体部损伤占所有外侧半月板损伤的10.8％.依据撕裂类型将外侧半月板前角-前体部损伤分为5型,其中Ⅰ型为复合撕裂,表现为水平撕裂合并某一层垂直撕裂,并根据垂直撕裂的部位分为Ⅰa、Ⅰb、Ⅰc三种亚型;Ⅱ型为水平撕裂;Ⅲ型为垂直撕裂,并根据移位情况和形态分为Ⅲa、Ⅲb、Ⅲc三种亚型;Ⅳ型为松散型,发生在前角;Ⅴ型为缺失型,半月板前角-前体部消磨殆尽.对于常规手术入路无法处理的Ⅰb型和Ⅱ型损伤,附加外下入路进行操作并视情况进行Outside-in缝合.87例患者均获得随访,平均随访25.1±5.7月(19～31月).末次随访时IKDC评分和Lysholm评分均显著高于术前(分别为64.5±7.4 vs 84.3±6.9和73.3±5.1 vs 90.1±5.0,均P<0.05).结论:基于不同分型采取相应手术策略是治疗外侧半月板前角-前体部损伤的有效方法.

内侧半月板桶柄样撕裂(bucket handle tear,BHT)临床常见,损伤范围较大并严重影响膝关节功能,主要继发于前交叉韧带(anterior cruciate ligament,ACL)断裂或ACL重建术后膝关节前后松弛和旋转不稳定.ACL早期重建、正确放置胫骨隧道位置,或联合前外侧结构增强控制膝关节旋转不稳定,有利于降低内侧半月板BHT的发生.内侧半月板BHT最优治疗方法尚有争议,应根据损伤症状、部位、范围、类型和病程选择不同治疗方式,包括支具固定、理疗、富血小板血浆注射、运动疗法等保守治疗,以及半月板修整、修复等手术治疗,但疗效尚缺乏高质量临床证据.内侧半月板BHT通常发生在有血供区域,具有一定愈合能力,随着修复技术的进步及半月板保留策略的倡导,BHT修复在临床中的应用越来越多.本文综述内侧半月板桶柄样撕裂损伤机制和治疗研究进展,为临床决策和康复理念更新提供参考.