BACKGROUND: Adult-onset still’s disease and septic arthritis share similar symptoms—fever, joint pain, and limited mobility—making postoperative diagnosis difficult after combined anterior cruciate ligament and posterior cruciate ligament reconstruction. In this case, through a series of examinations and diagnostic treatment, the final diagnosis was adult-onset still's disease. CASE PRESENTATION: A 41-year-old male developed recurrent fever and polyarthritis one week after undergoing arthroscopic combined anterior cruciate ligament and posterior cruciate ligament reconstruction. Clinical signs and tests were inconclusive. A multidisciplinary team was assembled to determine the diagnosis and establish a treatment plan. Despite broad-spectrum antibiotics, symptoms persisted. Typical adult-onset still's disease signs—rash, pharyngalgia, leukocytosis—emerged. Treatment with methylprednisolone, aspirin, and tocilizumab led to rapid improvement. Diagnosis was confirmed using Yamaguchi criteria. The patient was discharged in stable condition and remained symptom-free during follow-up. Knee function fully recovered. DISCUSSION AND CONCLUSION: This may be the first reported case of adult-onset still's disease following combined anterior cruciate ligament and posterior cruciate ligament reconstruction. In conjunction with the relevant literature, we summarize the differences in clinical symptoms between septic arthritis and adult-onset still's disease. Reviewing the patient's hospitalization process, we discuss the "controversial" diagnostic and therapeutic measures taken by the multidisciplinary team, along with any doubts and considerations. The case highlights the diagnostic challenge of differentiating adult-onset still's disease from postoperative joint infection.

The management of anterior colliculus fractures in combination with deltoid ligament injuries is a topic of debate, and there is a need to improve surgical outcomes. The purpose of the present study was to describe the application of a modified double-row suture bridge technique and evaluate its early clinical outcomes in the management of anterior colliculus fracture combined with deltoid ligament injury. From 2020 to 2022, 12 patients with anterior colliculus fracture combined with deltoid ligament injury were treated using a modified double-row suture bridge technique. For clinical outcome evaluation, objective data are presented through clinical examination findings; radiographic assessments, including X-rays and computed tomography (CT); and follow-up analysis utilizing American Orthopaedic Foot Ankle Society ankle‒hindfoot (AOFAS) scores, Olerud Molander Ankle Scores (OMAS), and visual analogue scale (VAS) scores. Preoperative and follow-up scores were compared with Student’s t test. (p < .05). The mean age of the patients was 52.67 ± 9.42 years (range: 39–74). The mean duration of follow-up was 14.42 ± 1.51 months (range: 12–17). At the final follow-up, the mean AOFAS score (P < 0.001) improved to 91.50 ± 2.65 points (range: 87–96), the mean OMAS (P < 0.001) improved to 77.08 ± 3.97 points (range: 70–85), and the mean VAS score (P < 0.001) improved to 0.25 ± 0.45 points (range: 0–1). Nine patients achieved excellent outcomes, and three achieved good outcomes according to the AOFAS score. Follow-up imaging evaluation indicated satisfactory alignment of the fracture and complete healing. Clinical examination suggested good mobility of the ankle. At the last follow-up, ankle dorsiflexion mobility was 14–18 degrees, plantar flexion mobility was 42–45 degrees, inversion mobility was 27–32 degrees, and eversion mobility was 22–25 degrees. The modified double-row suture bridge technique is effective for achieving anatomic reduction of anterior colliculus fractures, and the technique also provides substantial benefit to the injured deltoid ligament. With this technique, the clinical outcomes can be significant and encouraging, indicating a new stage in its application and development.

The management of recurrent anterior shoulder dislocations with massive glenoid bone defects typically involves arthroscopic intervention. Autologous iliac bone grafting with double-row elastic fixation reportedly yields excellent outcomes. In this article, we introduce a specialized technique for iliac bone grafting that uses double-row elastic fixation and double antirotating anchors. Implementation of this technique prevents the occurrence of iliac graft rotation.

Arthroscopic tenodesis of the long head of the biceps tendon (LHBT) is a common procedure in a series of bicipital tendinopathies, including tendinitis, SLAP lesions, and tendon instability. Locating and exposing the LHBT during arthroscopy present a technical challenge in tenodesis. Blind exploration of the subacromial space may result in inadvertent tendon transection and iatrogenic damage to surrounding structures, leading to increased patient trauma, bleeding, and operation time. Using the tubercle-traction and touch-tendon method facilitates a roadmap-style, accurate, prompt exposure of the LHBT, minimizing blind exploration-related damage to the subacromial bursal area and adjacent structures, which is conducive to early and rapid postoperative shoulder recovery for patients.

BACKGROUND:To preserve the meniscus's function, repairing the torn meniscus has become a common understanding. After which, the search for the ideal suture material is continuous. However, it is still controversial about the efficacy of suture absorbability on meniscus healing.METHODS:This review is designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.INCLUSION CRITERIA:(1) Studies on meniscus repair; (2) Second-look arthroscopy was performed; (3) The meniscus was repaired by absorbable and non-absorbable sutures; (4) The healing condition of repaired meniscus via second-look arthroscopy was described.EXCLUSION CRITERIA:(1) Animal studies, cadaveric studies, or in vitro research; (2) Meniscus transplantation; (3) Open meniscus repair; (4) Reviews, meta-analysis, case reports, letters, and comments; (5) non-English studies. MEDLINE, Embase, and Cochrane Database were searched up to October 2022. Risk of bias and methodology quality of included literature were assessed according to ROBINS-I and the modified Coleman Methodological Scale (MCMS). Descriptive analysis was performed, and meta-analysis was completed by RevMan5.4.1.RESULTS:Four studies were included in the systematic review. Among them, three studies were brought into the meta-analysis, including 1 cohort study and 2 case series studies about 130 patients with meniscal tears combined with anterior cruciate ligament injury. Forty-two cases were repaired by absorbable sutures, and 88 were repaired by non-absorbable sutures. Using the fixed effect model, there was a statistical difference in the healing success rate between the absorbable and the non-absorbable groups [RR1.20, 95%CI (1.03, 1.40)].CONCLUSION:In early and limited studies, insufficient evidence supports that non-absorbable sutures in meniscus repair surgery could improve meniscal healing success rate under second-look arthroscopy compared with absorbable sutures. In contrast, available data suggest that absorbable sutures have an advantage in meniscal healing.TRIAL REGISTRATION:The review was registered in the PROSPERO System Review International Pre-Registration System (Registration number CRD42021283739).

The knee joint is one of the most important joints in the human body, and the diagnosis and treatment of related diseases has been a hot research topic in the field of bone and joint surgery. Deep learning technology has the advantages of high efficiency, low cost and high consistency, and can theoretically solve a series of pain points in clinical treatment. However, as a new technology that has not yet fully matured, deep learning technology faces the obstacles of insufficient interpretability and lack of high-quality datasets in the process of clinical extension. This paper attempted to provide a brief overview of the current state of research on deep learning technology in knee diseases in terms of its current strengths, weaknesses and future directions.

Purpose: Budesonide (Bud) is a nonhalogenated glucocorticoid with high anti-inflammatory potency and low systemic side effects. However, the poor water solubility of Bud affects its dissolution and release behavior, thus influencing its anti-inflammatory effect. This study was aimed at synthesizing and evaluating novel conjugates of Bud, hoping to increase the anti-inflammatory activity of Bud by improving its water solubility. Materials and methods: Seven novel Bud conjugates (3a-3g) were designed and synthesized in this study. Besides, the equilibrium solubility, cell viability, in vitro and in vivo anti-inflammatory activity, and the hydrolysis behavior of the conjugates in different pH solutions, rat and human plasma, and rat lung homogenate were studied in detail. Results: As compared to Bud, the equilibrium solubility of 3a, 3c, and 3e was significantly increased; 3a, 3b, and 3c significantly inhibited the interleukin-6 production in lipopolysaccharide-induced A549 cells; 3a and 3e could significantly decrease the xylene-induced ear edema; and 3a and 3c were gradually and slowly hydrolyzed into Bud in the alveolar fluid and lung homogenate and broken down quickly in plasma. Conclusion: The amino acid ester compounds budesonide-21-glycine ester (3a) and budesonide-21-alanine ester (3c) were selected as potential conjugates of Bud. This study would provide a theoretical and an experimental basis for the in vivo process of glucocorticoids and the treatment of inflammatory diseases.