ObjectiveBuilding on prior device development and bench-based visual-field validation, this exploratory study evaluated the feasibility of an adjustable-angle arthroscope for ACL femoral tunnel creation in an ex vivo porcine knee model and descriptively compared femoral tunnel position measurements and procedural time with a conventional 30° arthroscope.MethodsTen fresh porcine knee specimens were allocated to an adjustable-angle arthroscope group or a conventional 30° arthroscope group (n = 5 each). The operational target point was defined as the intersection 5 mm from the inferior and posterior cartilage margins of the medial wall of the lateral femoral condyle; this standardized experimental target was not assumed to represent the native porcine or human ACL footprint center. All procedures were performed by one orthopaedic surgeon who was experienced in ACL reconstruction and was a member of the device-development team. CT-based three-dimensional reconstruction and gross anatomical measurement were used to determine distances A and B, and operative time and measurement reliability were recorded. Group-level outcomes were summarized descriptively.ResultsOn CT three-dimensional reconstruction, distances A and B were 4.93 ± 0.79 mm and 7.27 ± 0.85 mm, respectively, in the adjustable-angle group and 6.68 ± 1.15 mm and 8.98 ± 1.17 mm, respectively, in the 30° group. Gross anatomical measurements were 4.9 ± 0.7 mm and 7.1 ± 0.8 mm in the adjustable-angle group and 6.7 ± 1.2 mm and 9.0 ± 1.3 mm in the 30° group. Mean operative time was 14.23 ± 1.00 min and 14.46 ± 1.21 min, respectively. Interobserver ICCs were 0.91 and 0.90, and intraobserver ICCs were 0.97 and 0.97.ConclusionThis study successfully developed an adjustable-angle arthroscope based on a hinge-linkage mechanism and demonstrated, through quantitative testing, that it provided greater visual-field coverage than conventional 30° and 70° fixed-angle arthroscopes. By enabling dynamic multiangle visualization within a single arthroscopic system, this device may provide a more flexible visualization strategy for complex arthroscopic procedures and has potential clinical applicability.

The effectiveness of the Ilizarov technique combined with telescopic rod technique in the treatment of equinocavovarus foot deformities in adults was undefined. All 72 adult patients (76 feet) who underwent the Ilizarov technique combined with telescopic rod technique for correction of equinovarus foot deformities between February 2012 and May 2022 were included. Clinical outcomes were assessed preoperatively and at the last follow-up by the Visual Analog Scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score, and the Short Form-36 (SF-36) questionnaire. The radiographic outcomes were measured on weight-bearing ankle and foot radiographs taken preoperatively and at the last follow-up. The postoperative VAS and AOFAS ankle-hind foot scores significantly improved compared to the preoperative (P < 0.0001 for each). The postoperative SF-36 scores significantly increased referring to physical function, role-physical, body pain, general health, vitality, social function, role-emotional, mental health, and health transition (P < 0.0001 for each). Early complications were found in 20 feet (27 %) and late complications were found in 8 feet (10.8 %). In addition, the postoperative tibio-talar angle, tibial-sole angle, talus-first metatarsal angle, talo-calcaneal angle and hindfoot alignment view angle significantly improved compared to the preoperative. Sixty-three (87.5 %) patients were satisfied with the treatment effect. The Ilizarov technique combined with telescopic rod technique is an effective and reliable method in correcting equinocavovarus foot deformity, with high satisfaction and few complications.

The deltoid ligament (medial collateral ligament) and the syndesmosis (a composite ligamentous structure at the distal tibiofibular junction) are critical for maintaining ankle stability. In cases of high-energy ankle fractures, these structures are often injured simultaneously, leading to instability and potential long-term complications such as post-traumatic arthritis. This review aims to explore advancements in minimally invasive techniques for the treatment of combined deltoid ligament and syndesmosis injuries, with a focus on optimizing surgical outcomes and reducing patient morbidity. Current treatment strategies primarily involve cortical screws for syndesmosis stabilization and anchor fixation for deltoid ligament repair. Recent innovations, such as bioabsorbable screws, suture-button devices with elastic micromotion, and syndesmotic plates, have demonstrated potential in improving biomechanical stability while minimizing complications. Furthermore, minimally invasive techniques, including arthroscopic repairs with suture anchors, as well as ligament reconstruction using autografts, allografts, or synthetic ligaments, are becoming increasingly popular. By incorporating these advancements, the field is moving toward more effective and patient-centered approaches to achieve anatomical and functional restoration under minimally invasive principles. Future research should focus on further validating these techniques and identifying the most effective strategies for complex injuries.

ABSTRACTObjectiveInferior pole patellar fractures (IPPFs) pose a significant challenge due to their complex fracture patterns and high risk of complications associated with current treatment methods. This study aims to (1) characterize the fracture patterns of IPPFs using fracture mapping and (2) compare the biomechanical stability and clinical outcomes of treatment with anchor suture with patellar cerclage versus Kirschner‐wire tension band combined with patellar cerclage.Methods(1) A retrospective analysis was conducted on 61 patients with IPPF. For each case, fracture reduction was manually simulated, with fracture lines and fragments overlaid onto a complete patella template to identify fracture patterns. (2) Finite‐element models were used to analyze the mechanical properties of anchor suture and titanium cable cerclage treatment and Kirschner‐wire tension band combined with patellar cerclage in treating IPPFs. Additionally, a retrospective analysis of clinical data was performed on 57 patients with IPPF (AO/OTA 34 A1) treated at our institution between January 1, 2023, and December 25, 2023. Of these, 18 patients underwent anchor suture and titanium cable cerclage (Group A), and 39 underwent Kirschner‐wire tension band combined with patellar cerclage (Group B). We compared operative time, final knee range of motion, incidence of secondary surgery, postoperative complications, and functional recovery between the two groups based on medical records and follow‐up results.Results(1) IPPFs were predominantly comminuted, with fracture lines on the anterior view concentrated laterally and near the superior surface of the inferior pole. Fracture lines became more sparse as they approached the distal patella. The posterior view was similar to the anterior, with the majority of fractures near the superior surface of the inferior pole. (2) Finite‐element analysis revealed no significant differences between the two groups in terms of displacement and stress. Operative time was similar between the groups (p > 0.05), as were final knee range of motion (p > 0.05) and postoperative Bostman scores (p > 0.05). Group A had no postoperative complications or readmissions, while Group B had two cases of hardware irritation and one case of knee joint infection.ConclusionThe fracture lines of IPPF are varied, often comminuted, and correlate with the mechanism of injury. Biomechanical and clinical outcomes suggest that anchor suture with patellar cerclage is a viable option for stabilizing IPPF.Trial Registration: ClinicalTrials.gov identifier: NCT06736639

Recently, there has been increased attention on the treatment of cartilage repair. Overall, we constructed PHBVHHx-COL, a composite hydrogel of PHBVHHx-co-PEG and collagen, and evaluated its cartilage repair efficacy through in vitro and in vivo studies using hydrogel loaded with peripheral blood-derived mesenchymal stem cells (PBMSCs). Rheological properties and compressive mechanical properties of the hydrogels were systematically evaluated. The cytocompatibility of the hydrogels was evaluated using the Cell Counting Kit-8 test, live/dead staining, scratch test, and transwell test. The effect of chondrogenic differentiation of PBMSCs on hydrogels was evaluated using immunofluorescence staining and reverse transcription-polymerase chain reaction. Furthermore, the in vivo cartilage repair ability of the hydrogels was confirmed following in situ injections in rabbit chondral defect models. Finally, the induced polarization of the hydrogel scaffold on macrophages was explored by the expression of CD86 and CD206. In vitro experimental results confirmed that PHBVHHx-COL-gel led to better cell migration, proliferation, and chondrogenic differentiation than PHBVHHx-PEG and COL hydrogels. Hematoxylin and eosin staining indicated that the tissue of the repaired area in the PHBVHHx-COL group was nearly in fusion with the surrounding normal tissue and the reconstruction of subchondral bone was good. Safranin-O staining and COL-2 immunohistochemistry indicated that the tissue of the repaired area in the PHBVHHx-COL group had more cartilage-specific matrix secretion. The PHBVHHx-COL group exhibited more M2 macrophage infiltration and less M1 macrophage presentation than the other groups. This study demonstrated that PHBVHHx-COL scaffolds loaded with PBMSCs significantly promoted the repair of cartilage injury through immune regulation by M2 polarization and could be potential candidates for cartilage tissue engineering.

While anabolic agents are highly effective in stimulating bone formation, their benefits are transient and tend to plateau after prolonged use. This necessitates a transition to anti-resorptive therapies. We aimed to estimate anti-osteoporosis effect and compliance of different anabolic and anti-resorptive agents to explore the optimal cycling strategy. PubMed, Embase, Web of Science, and Cochrane Library were searched for randomized controlled trials comparing anabolic or anti-resorptive agents with placebo or each other in postmenopausal women with osteoporosis or osteopenia, reporting outcomes on bone mineral density (BMD) change, fracture incidence, or treatment discontinuation from inception to February 1, 2024. The frequentist random-effect model for network meta-analysis was performed to summarize the evidence, and the Grading of Recommendations Assessment, Development, and Evaluation frameworks was applied to rate the certainty of evidence. A total of 16,231 citations were identified, and 227 trials with 140,230 participants met the inclusion criteria. The anti-sclerostin (AS) antibody was the most effective anabolic agent, significantly increasing BMD at the femoral neck (Mean difference (MD): 6.00; 95

To confirm which method provides lower rate of recurrent instability and superior clinical outcomes. We searched PubMed, Embase and Web of Science for the trials involving one intervention or both for patellar instability: medial patellofemoral ligament reconstruction (MPFLR) with and without tibial tubercle osteotomy (TTO). The postoperative Kujala score, Lysholm score, Tegner scores and the rate of recurrent instability (dislocation or subluxation) were analyzed as the primary clinical outcome parameters in a random or fixed effects meta-analysis. In total, 43 articles met inclusion criteria after full-text review. A total of 2046 patients were analyzed. The overall mean age was 20.3 years (range, 9.5–60.0 years), with a mean follow-up time of 3.2 years (range, 1–8 years). The mean Kujala scores in MPFLR and MPFLR + TTO were 89.04 and 84.44, respectively. There was significant difference in Kujala scores between MPFLR and MPFLR + TTO (MD = 4.60, 95

Background: The optimal method for postoperative analgesia after arthroscopic rotator cuff repair (ARCR) is still unclear. Purpose: To compare the efficacy of postoperative analgesic methods after ARCR through network meta-analysis of randomized controlled trials and prospective controlled trials. Study Design: Systematic review; Level of evidence, 2. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched PubMed, Embase, and Web of Science from inception until April 12, 2022, for randomized controlled trials and prospective controlled trials evaluating neuraxial analgesia, peripheral nerve block, periarticular local anesthetic infiltration, intravenous patient-controlled analgesia, oral analgesia, or any combination of these methods for pain management after ARCR. Outcomes included pain scores at rest, morphine consumption, and complications (nausea and vomiting). Study quality was assessed using the Cochrane risk-of-bias tool. Network meta-analysis was used to assess the relative efficacy of the methods for postoperative analgesia. The best choice for postoperative analgesia was defined as the one with significant differences in pain scores and morphine consumption compared with placebo, with no significant difference in complications, during the initial 48 hours postoperatively. Results: Included were 42 studies with 3110 patients. Only suprascapular nerve block (SSNB) was significantly superior to placebo in pain scores (mean difference [MD], –0.93 [95% CI, –1.31 to –0.54] at 6 hours; MD, –2.34 [95% CI, –3.49 to –1.19] at 12 hours) and morphine consumption (MD, –17.70 [95% CI, –32.98 to –2.42] at 24 hours) ( P < .05 for all), with no difference in complications (odds ratio, 0.96 [95% CI, 0.21 to 4.32]; P > .05). Pain scores were significantly lower with interscalene nerve block compared with SSNB (MD, –0.69 [95% CI, –1.17 to –0.20] at 6 hours; MD, –1.44 [95% CI, –2.21 to –0.67] at 12 hours) and with SSNB + axillary nerve block compared with SSNB (MD, –3.09 [95% CI, –4.18 to –1.99] at 6 hours; MD, –0.87 [95% CI, –1.71 to –0.03] at 12 hours) ( P < .05 for all). Conclusion: Based on the current evidence, most analgesic methods lowered pain and morphine consumption compared with placebo. There were significant differences in pain scores between interscalene nerve block and SSNB during the first 12 hours postoperatively, and adding axillary nerve block to SSNB enhanced the analgesic effect.

The purpose of this study was to compare the complication risk of different treatments for displaced intra-articular calcaneal fractures (DIACFs). Randomized controlled trials comparing interventions for DIACFs were included: (1) interventions with conservative treatment, surgery with a minimally invasive approach (MIA) (sinus tarsi or small longitudinal), surgery with a percutaneous approach (PA) and open surgery with the extensive "L" lateral approach (ELA), and (2) complications and wound infections were also assessed. Twenty-six published trials met the inclusion criteria. The trials involved a total of 2538 patients surgically treated for acute DIACFs. For total complications, the mean incidence rate in the ELA was significantly higher than the rates in other treatments (conservative treatment vs ELA: odds ratio (OR), 0.36; p < .001; MIA vs ELA: OR, 0.23; p = .002; and PA vs ELA: OR, 0.18; p < .001). For wound infections, there were no significant differences among the groups (MIA vs PA: OR, 0.98; 95% CI, 0.32-3.01; p = .977; MIA vs ELA: OR, 0.45; 95% CI, 0.19-1.10; p = .081; and PA vs ELA: OR, 0.46; 95% CI, 0.19-1.11; p = .085). According to the surface under the cumulative ranking curve, the PA was most likely to be the best management for minimizing complications (surface under the cumulative ranking curve = 86.2). The ELA was significantly related to a higher risk of complications among all management methods. The PA was most likely to be the ideal choice when only complications were considered.