To assess the clinical efficacy of medial patellofemoral ligament reconstruction (MPFL-R) combined with medial-approach derotational distal femoral osteotomy (DDFO) in the treatment of recurrent patellar dislocation (RPD). In this retrospective Level IV case series, we reviewed 45 patients with recurrent patellar dislocation (2 males, 43 females; age 13–44 years, mean 22.8 ± 6.0 years) and a femoral anteversion angle (FAA) > 30° as measured using the Jarrett method (Kaiser et al. in Arch Orthop Trauma Surg 136(9):1259, 2016), who underwent combined medial patellofemoral ligament reconstruction (MPFL-R) and medial-approach derotational distal femoral osteotomy (DDFO) between January 2018 and January 2022. Clinical and radiographic parameters were assessed preoperatively and at a minimum two-year follow-up, including J-sign grading, visual analogue scale (VAS) pain score, Caton–Deschamps index (CD-I), FAA, patellar tilt angle (PTA), tibial tubercle–trochlear groove (TT–TG) distance, and patient-reported outcome measures (PROM) scores (Tegner, Kujala, and Lysholm). A subgroup analysis compared outcomes between patients who did and did not undergo adjunctive tibial tubercle osteotomy (TTO). At the two-year follow-up, patients demonstrated significant improvements in J-sign grading, VAS pain scores, femoral anteversion angle, patellar tilt angle, TT–TG distance, and functional outcomes (Tegner, Kujala, and Lysholm scores) (all P < 0.05). The Caton–Deschamps index showed no significant change (P > 0.05). In subgroup analysis, the TTO cohort experienced a greater reduction in TT–TG distance than the non-TTO cohort (P < 0.05), whereas postoperative VAS, Kujala, and Lysholm scores did not differ significantly between groups (P > 0.05). Medial patellofemoral ligament reconstruction combined with medial-approach derotational distal femoral osteotomy effectively restores patellofemoral stability and enhances functional outcomes in patients with recurrent patellar dislocation and excessive femoral anteversion. The indication for concomitant tibial tubercle osteotomy should be individualized according to each patient’s specific anatomical and clinical characteristics.

To analyze the effects of different plate placement positions on the efficacy and safety of Derotational Distal Femoral Osteotomy (DDFO) combined with Medial Patellofemoral Ligament Reconstruction (MPFL) surgery in the treatment of Recurrent Patellar Dislocation (RPD). A retrospective analysis was conducted on 33 patients with Recurrent Patellar Dislocation (RPD) who underwent surgical treatment from January 2020 to January 2022. Preoperative general data were collected for both groups, as well as J-sign grading, VAS scores, Caton index, femoral anteversion angle, patellar tilt angle, TT–TG value, Tegner score, Kujala score, and Lysholm score measured preoperatively and at 1.5 years postoperatively. Bone healing was evaluated on follow-up radiographs, and the time to bone union was defined as the duration from surgery to the presence of continuous cortical bridging at the osteotomy site on at least three cortices. Delayed union was defined as bone union exceeding six months after surgery. In addition, effect sizes (Cohen’s h/d) and post hoc power analyses were performed to further evaluate the adequacy of the sample size, particularly for the comparisons between medial and lateral plating. At 1.5 years postoperatively, the incidence of discomfort related to plate placement was significantly lower in the medial plate group compared with the lateral plate group (P < 0.05). Additionally, the rate of plate removal was significantly lower in the medial plate group than in the lateral plate group (P < 0.05). Both groups showed significant improvements in J-sign grading, VAS scores, Caton index, femoral anteversion angle, patellar tilt angle, TT–TG value, Tegner score, Kujala score, and Lysholm score at 1.5 years postoperatively compared with preoperative values (P < 0.001). All osteotomy sites achieved bone union without nonunion, and the mean time to bone union was 5.9 ± 1.1 months in the medial plate group and 5.8 ± 0.5 months in the lateral plate group (P = 0.71). All patient incisions healed at stage I, and there were no complications such as knee joint stiffness, infection, or recurrent patellar dislocation. Post hoc power analysis further confirmed adequate statistical power (Cohen’s h = 1.01 for discomfort; 0.87 for plate removal, both with > 99

To evaluate the technical feasibility, short-term safety, and clinical outcomes of an incomplete osteotomy at the femoral insertion of the lateral collateral ligament (LCL) for expanding a tight lateral compartment during arthroscopic lateral meniscus repair. A single-institution retrospective case series was conducted in patients with lateral meniscus tears and a tight lateral compartment who underwent LCL femoral insertion osteotomy between January 2020 and December 2022. Osteotomy was performed only when standard exposure maneuvers, including the figure-four position, portal adjustment, and gentle varus stress, failed to provide safe visualization and instrument access. The primary outcome was technical success, defined as adequate arthroscopic exposure and completion of the planned meniscal repair. Secondary outcomes included Lysholm score, International Knee Documentation Committee (IKDC) score, Visual Analog Scale (VAS) score for knee pain, osteotomy healing on computed tomography (CT), meniscal healing on magnetic resonance imaging (MRI), and complications. Twenty-five knees were included and followed for 12 months. Adequate exposure of the lateral meniscus and completion of meniscal repair were achieved in all cases. At 12 months, Lysholm, IKDC, and VAS scores improved significantly compared with preoperative values (all P < 0.001). CT at 3 months showed satisfactory osteotomy healing without displacement in all patients. MRI at 12 months demonstrated meniscal healing in 19 patients (76

Abstract Background Multimodal analgesia based on ultrasound-guided regional block is widely used after total knee arthroplasty (TKA). The goal of this study was to investigate the analgesic efficiency and knee motor function of programmed intermittent infusion combined with adductor hiatus block in total knee arthroplasty. Methods This prospective randomized controlled trial was approved by the Medical Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (ethical approval number: 2024-302-01) and was registered in the Chinese Clinical Trial Registry ( http://www.chictr.org.cn , ChiCTR2400090031); the study was conducted from October 2024 to March 2025. A total of 148 patients undergoing unilateral total knee arthroplasty with general anesthesia were assigned to the continuous adductor canal block (CACB) group (G1, n = 50), the continuous adductor hiatus block (CAHB) group (G2, n = 50), or the programmed intermittent adductor hiatus block (PIAHB) group (G3, n = 48). The main outcome was the active flexion angle of the knee joint. The secondary outcomes were performance on the timed up-and-go (TUG) test; the muscle strength of the quadriceps femoris, ankle dorsiflexors, and metatarsal flexor; and Visual Analogue Scale (VAS) scores of anterior and posterior sides of the knee at rest and during active 30-degree flexion. Results The PIAHB group had a significantly greater active knee flexion angle than the CAHB and CACB groups on the 1st, 2nd, and 3rd post-operative days (F = 14.313, p < 0.001; F = 16.793, p < 0.001; and F = 18.097, p < 0.001, respectively); the TUG times in the PIAHB group were shorter than those in the CAHB and CACB groups on the 1st and 2nd post-operative days (F = 26.059, p < 0.001) (F = 18.102, p < 0.001), but there was no difference in TUG test results on the 3rd post-operative day. There was no significant difference in the muscle strength of lower limb; VAS scores of the posterior side of the knee at rest and during active flexion were significantly lower in the PIAHB group than in the CAHB and CACB groups (F = 5.860, p = 0.004; F = 80.015, p < 0.001), but there was no difference in the VAS scores of the anterior side of the knee. The number of patients receiving remedial analgesia within 72 h was reduced in the PIAHB group (F = 7.405, p = 0.030), and the consumption of ropivacaine was significantly reduced in that group (F = 24.995, p < 0.001), but there was no difference in the incidence of postoperative complications or in HSS (post-operativeHospital for Special Surgery) scores 6 months post-operatively. Conclusions PIAHB increased the analgesic effect on the popliteal fossa without decreasing the strength of the quadriceps femoris, resulting in improved ROM on the 1st and 2nd post-operative days in patients who underwent TKA.

Rotator cuff injuries are common, particularly among older adults, and are often treated with arthroscopic repair. However, retear rates remain high. This study compares clinical and structural outcomes between arthroscopic double-row suture bridge repairs using either suture tape anchors (STAs) with knotless medial fixation, or traditional knotted suture anchors (TSAs) with knotted medial fixation. This retrospective cohort study compared arthroscopic double-row suture bridge repairs performed from January 2021 to July 2023 using either knotless STAs or knotted TSAs. Eligible patients had medium (1–3 cm), large (3–5 cm), or massive (> 5 cm) full-thickness rotator cuff tears (DeOrio-Cofield classification) with no greater than Goutallier grade 3 fatty infiltration. Clinical outcomes were measured using VAS, Constant, UCLA, and ASES scores, both preoperatively and at 1-year postoperative follow-up. Muscle strength was assessed using manual muscle testing (0–5 scale) with the arm positioned at 30° scapular elevation. Structural outcomes were evaluated via MRI, where two trained surgeons assessed tendon thickness using the Sugaya classification and identified retears according to the Cho classification. Statistical analysis was conducted using SPSS. The study included 86 consecutive patients undergoing arthroscopic rotator cuff repair, with 36 patients in the STA group (median follow-up 15.0 months, range 12–19 months) and 50 patients in the traditional suture anchor (TSA) group (median follow-up 16.5 months, range 12–20 months). Both groups showed significant improvements in functional scores (VAS, Constant, UCLA, ASES) postoperatively (P < 0.05), with no significant differences between the two groups (P > 0.05). The STAs group had significantly lower tendon thinning and higher tendon thickness and supraspinatus muscle strength compared to the TSAs group (P < 0.05). The retear rate was similar between the two groups (12.0

Dyslipidaemia has been implicated in osteonecrosis through some clinical studies. However, a direct causal relationship between hyperlipidaemia and osteonecrosis remains unconfirmed, and whether lipid-lowering agents could be used to treat osteonecrosis remains unclear. This study aimed to investigate the causal role of lipid traits in osteonecrosis using Mendelian randomisation (MR) analysis, assess the potential effects and mechanisms of lipid-lowering drug targets on osteonecrosis risk and validate these findings through experimental approaches. Genome-wide association study (GWAS) data were used to analyse lipid traits, drug targets and FinnGen osteonecrosis. Statin effects were further studied in a rat model of steroid-induced osteonecrosis and in vitro cell models. MR analysis revealed a significant association between LDL-C and increased osteonecrosis risk. Genetic mimicry of HMGCR inhibitors was associated with reduced osteonecrosis risk, which was validated through colocalisation. Stem cell growth factor-β (SCGF-β) was identified as a mediator of 21.3% of HMGCR inhibitors' effect on osteonecrosis risk. Further studies confirmed simvastatin's alleviating effect on SONFH, suggesting that simvastatin promotes osteogenesis and inhibits adipogenesis of mesenchymal stem cells (MSCs), partly mediated by SCGF-β upregulation, which activates the Wnt signalling pathway. Our findings supported dyslipidaemia as a causal factor for osteonecrosis, highlighting HMGCR as a promising therapeutic target.

BACKGROUND:Steroid-induced osteonecrosis of the femoral head (SONFH) drives irreversible bone collapse, yet current therapies inadequately target the disrupted angiogenic-osteogenic coupling central to its pathogenesis. Although pathological adipocyte hyperplasia is a hallmark of SONFH, the mechanisms by which adipogenic bone marrow mesenchymal stem cells (BMSCs) suppress angiogenesis remain unresolved. Emerging evidence implicates exosomes as mediators of adipose-vascular crosstalk, yet their role in SONFH-associated vasculopathy remains unexplored. Here, we elucidate how adipogenic BMSCs impair angiogenesis in SONFH through exosomal delivery of SPRY4. METHODS:Adipogenic BMSCs and human umbilical vein endothelial cells (HUVECs) were co-cultured in vitro. RT-PCR was employed to assess the expression of angiogenic genes. Transwell and wound healing assays were conducted to evaluate the migratory capacity of HUVECs. Tube formation assays were performed to investigate HUVEC angiogenesis. RNA sequencing (RNAseq) was utilized to identify potential regulatory factors within exosomes derived from adipogenic BMSCs. The target relationship between SPRY4 and PTPRB was predicted and validated through co-immunoprecipitation and mass spectrometry. Western blotting (WB) was used to confirm the signaling pathway involved in SPRY4-mediated angiogenesis disorders. Hematoxylin and eosin (HE) staining and immunohistochemistry (IHC) were employed to examine the in vivo effects of exosomes derived from adipogenic BMSCs. RESULTS:This study demonstrates that adipogenic BMSCs impair angiogenesis in SONFH through exosome-mediated delivery of SPRY4. Key findings reveal: (1) exosomes derived from adipogenic BMSCs suppressed endothelial cell migration, impaired angiogenesis, and downregulated angiogenic gene expression. (2) SPRY4 as a key exosomal effector, which enhanced phosphatase activity of PTPRB through direct interaction. This SPRY4-PTPRB axis inhibited TIE2 receptor autophosphorylation and downstream PI3K/AKT signaling. (3) In vivo, SPRY4 overexpression exacerbated the impairment of bone mass and microvascular density in SD rat model with SONFH, whereas shSPRY4 lentiviral intervention or pharmacological modulation of PTPRB and PI3K signaling using AKB9778 and YS-49 effectively reversing pathological manifestations. CONCLUSION:Exosomes derived from adipogenic BMSCs containing SPRY4 can induce SONFH-like injury by targeting PTPRB to suppress the TIE2/PI3K/AKT pathway, proposing targeted disruption of adipose-endothelial crosstalk as a novel therapeutic strategy for osteonecrosis.

Objective: To assess the clinical efficacy of arthroscopic medial patellofemoral ligament reconstruction (MPFL-R) combined with medial-approach derotational distal femoral osteotomy (DDFO) in the treatment of recurrent patellar dislocation (RPD). Methods: We retrospectively reviewed 45 patients with recurrent patellar dislocation (2 males, 43 females; age 13–44 years, mean 22.8 ± 6.0 years) and a femoral anteversion angle (FAA) > 30°, who underwent combined arthroscopic medial patellofemoral ligament reconstruction (MPFL-R) and medial-approach derotational distal femoral osteotomy (DDFO) at the First Affiliated Hospital of Chongqing Medical University between January 2018 and January 2022. Clinical and radiographic parameters were assessed preoperatively and at a minimum two-year follow-up, including J-sign grading, visual analogue scale (VAS) pain score, Caton–Deschamps index (CD-I), FAA, patellar tilt angle (PTA), tibial tubercle–trochlear groove (TT–TG) distance, and functional scores (Tegner, Kujala, and Lysholm). A subgroup analysis compared outcomes between patients who did and did not undergo adjunctive tibial tubercle osteotomy (TTO). Results: At the two-year follow-up, patients demonstrated significant improvements in J-sign grading, VAS pain scores, femoral anteversion angle, patellar tilt angle, TT–TG distance, and functional outcomes (Tegner, Kujala, and Lysholm scores) (all P < 0.05). The Caton–Deschamps index showed no significant change (P > 0.05). In subgroup analysis, the TTO cohort experienced a greater reduction in TT–TG distance than the non-TTO cohort (P < 0.05), whereas postoperative VAS, Kujala, and Lysholm scores did not differ significantly between groups (P > 0.05). Conclusion Arthroscopic medial patellofemoral ligament reconstruction combined with medial-approach derotational distal femoral osteotomy effectively restores patellofemoral stability and enhances functional outcomes in patients with recurrent patellar dislocation and excessive femoral anteversion. The indication for concomitant tibial tubercle osteotomy should be individualized according to each patient’s specific anatomical and clinical characteristics.

Objectives: To identify the specific serum biochemical markers that exhibit causal associations with the risk rheumatoid arthritis (RA) Methods: A cross-sectional study based on the NHANES database was conducted to investigate which serum biochemical markers were significantly associated with RA. Two-sample Mendelian randomization (MR) and Generalized summary data-based Mendelian randomization (GSMR) analysis were employed to analyze the causal relationships between biomarkers exhibiting differential expression identified within the NHANES database. The primary MR analysis utilized the inverse variance weighted (IVW) method. Restricted cubic spline (RCS) regression was conducted to explore non-linear associations between variables. Results: The NHANES cohort included 1,416 participants with clinically diagnosed RA and 3,744 control participants without RA. GSMR analysis revealed a significant causal relationship between serum albumin and RA risk (OR = 0.80, 95% CI: 0.72-0.89, P = 3.67×10−5). The IVW meta-analysis also confirmed that decreased albumin expression significantly associated with decreased risk of RA (P = 0.002). A four-node RCS model demonstrated non-linear correlations between albumin, uric acid, and RA (all P non-linear < 0.05), while calcium, globulin, and lactate dehydrogenase (LDH) exhibited linear relationships (all P non-linear > 0.05). However, multiple MR methods did not show any significant causal association between calcium, LDH, urate, and RA risk. Conclusion: This study found a linear association between calcium, globulin, LDH, and RA risk, while a U-shaped non-linear relationship between albumin, uric and RA was observed. MR analysis revealed a significant causal association between albumin and RA. However, the molecular mechanisms by which albumin affects the risk of RA remain to be further elucidated.

Current suturing techniques used in meniscal allograft transplantation pose risks of damaging blood vessels and nerves, and they conflict with patients’ esthetic needs, impacting the prognosis of the graft and patient satisfaction. This article introduces an all-inside all-suture technique for suturing and securing grafts during meniscal allograft transplantation procedures. This technique offers a more physiological alignment and fixation for the graft and joint capsule, ensuring graft stability while significantly reducing the risk of vascular and neural injuries in the knee joint and postoperative complications. Additionally, it eliminates the need for extra safety incisions, improving postoperative esthetics and patient satisfaction.

We aimed to investigate the mechanism of high mobility group box 1 (HMGB1) in the accelerated fracture healing process during Traumatic brain injury (TBI). The lateral ventricles of mice in the TBI model group were injected with adenovirus-packaged short hairpin RNA (shRNA)-HMGB1 or overexpressing (ov)-HMGB1 vector. We found HMGB1 levels were higher in bone tissue at the fracture end of TBI combined with fracture model mice. Compared with the TBI combined with fracture model mice, the mice in the ov-HMGB1 group healed faster and the expression levels of mitochondrial autophagy-related proteins were higher. Compared to the ov-HMGB1 group, mice in the ov-HMGB1 + autophagy inhibitor cyclosporin A (CsA) and ov-HMGB1 + shRNA-phosphatase and tensin homolog-induced kinase 1 (PINK1) groups showed slower healing and lower expression of mitochondrial autophagy-associated proteins. The expression of osteocalcin (OCN), SOX9, and bone morphogenetic protein (BMP)-2 in bone tissue at the fracture end of the ov-HMGB1 + shRNA-PINK1 group was lower than that in the ov-HMGB1 group. The mRNA expression levels of chondrogenic differentiation markers in bone tissue at the fracture end of the ov-HMGB1 + shRNAPINK1 group were lower than those in the ov-HMGB1 group. Fracture healing was accelerated during TBI, especially when HMGB1 was highly expressed, and HMGB1 promote accelerated fracture healing during TBI through PINK1/Parkin-mediated mitochondrial autophagy.

Enhanced adipogenic differentiation of mesenchymal stem cells (MSCs) is considered as a major risk factor for steroid-induced osteonecrosis of the femoral head (SOFNH). The role of microRNAs during this process has sparked interest. miR-486-5p expression was down-regulated significantly in femoral head bone tissues of both SONFH patients and rat models. The purpose of this study was to reveal the role of miR-486-5p on MSCs adipogenesis and SONFH progression. The present study showed that miR-486-5p could significantly inhibit adipogenesis of 3T3-L1 cells by suppressing mitotic clonal expansion (MCE). And upregulated expression of P21, which was caused by miR-486-5p mediated TBX2 decrease, was responsible for inhibited MCE. Further, miR-486-5p was demonstrated to effectively inhibit steroid-induced fat formation in the femoral head and prevented SONFH progression in a rat model. Considering the potent effects of miR-486-5p on attenuating adipogenesis, it seems to be a promising target for the treatment of SONFH.

目的 探讨高迁移率族蛋白1(HMGB1)通过PTEN诱导假定激酶1(PINK1)/帕金蛋白(Par-kin)介导的线粒体自噬对骨髓干细胞的趋化及成骨分化的影响.方法 将人骨髓间充质干细胞(hBM-SCs)分为7组:control组、siRNA-NC组、siRNA-HMGB1组、pcDNA-NC组、pcDNA-HMGB1组、pcDNA-HMGB1+siRNA-NC组、pcDNA-HMGB1+siRNA-PINK1组.采用Transwell检测细胞迁移能力;茜素红染色检测各组细胞中钙结节数目;ELISA检测骨桥蛋白(OPN)、碱性磷酸酶(ALP)的含量;RT-qPCR检测各组细胞中成骨细胞特异性转录因子(Osterix)、HMGB1及Runt相关转录因子2(RUNX2)、转录因子CCAAT/增强子结合蛋白(C/EBPα)、过氧化物酶体增殖物激活受体γ(PPARγ)水平;透射电镜检测线粒体自噬小体数目;Western Blot检测hBMSCs中Parkin及微管相关蛋白1A/1B-轻链3(LC3Ⅱ/Ⅰ)、选择性自噬接头蛋白62(P62)和自噬关键分子酵母Atg6同系物(Beclin1)等线粒体自噬相关蛋白的表达.结果 HMGB1通过PINK1/Parkin介导的线粒体自噬对hBMSCs的趋化作用研究表明:与pcDNA-NC组相比,pcDNA-HMGB1组HMGB1表达、细胞迁移率、线粒体自噬数目及自噬相关蛋白Beclin-1、LC3B-Ⅱ/Ⅰ的表达增加,Parkin、P62等蛋白的表达降低(P＜0.05);与siRNA-NC组相比,siRNA-HMGB1组HMGB1表达、细胞迁移率、线粒体自噬数目及Beclin-1、LC3B-Ⅱ/Ⅰ等表达降低,Parkin、P62表达增高(P＜0.01).HMGB1通过PINK1/Parkin介导的线粒体自噬对hBMSCs的成骨分化作用研究结果显示:与pcDNA-NC组相比,pcDNA-HMGB1组钙结节数量、Osterix及RUNX2含量、ALP及OPN的表达升高(P＜0.01),PPARγ、C/EBPα的表达降低(P＜0.05);与pcDNA-HMGB1+siRNA-NC组相比,pcDNA HMGB1+siRNA-PINK1组钙结节数量、Osterix及RUNX2含量、ALP及OPN的表达降低(P＜0.05),PPARγ、C/EBPα的表达升高(P＜0.05).结论 HMGB1高表达能通过PINK1/Parkin介导的线粒体自噬促进hBMSCs的趋化、成骨细胞分化及抑制成脂细胞分化,可能是骨质疏松症的潜在治疗靶点.

Background and Objectives: Tunnel enlargement (TE) is a widely reported phenomenon after anterior cruciate ligament reconstruction (ACLR). Given the paucity of knowledge in the literature, it remains unclear whether screw position in the tunnel affects TE. This retrospective cohort study evaluated differences in postoperative tunnel enlargement rates (TER) and clinical results between anterior and posterior tibial interference screw insertion during single-bundle ACLR using autologous hamstring grafts. Materials and Methods: A group of consecutive patients that underwent primary arthroscopic single-bundle ACLR in our hospital were screened and divided into two groups based on the position of the tibial interference screw (determined by Computer Tomography within 3 days after surgery): anterior screw position group (A) and posterior screw position group (B). The bone tunnel size was measured using magnetic resonance imaging (MRI) performed 1 year after surgery. International Knee Documentation Committee (IKDC) score and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were used for clinical results 1 year postoperatively. Results: 87 patients were included. The TER of Group A is higher than that of Group B (43.17% vs. 33.80%, p = 0.024). Group A showed a significant increase (12.1%) in enlargement rates at the joint line level than group B (43.77% vs. 31.67%, p = 0.004). Moreover, KOOS and IKDC scores improved in both groups. There were no significant differences in clinical outcomes between the two groups. Conclusions: One year after ACLR, patients with posterior screw showed significantly lower TE than patients with anterior screw. However, the position of screw did not lead to differences in clinical results over our follow-up period. Posterior screw position in the tibial tunnel maybe a better choice in terms of reducing TE. Whether the different screw positions affect the long-term TE and long-term clinical outcomes needs to be confirmed by further studies.

The imbalance between osteogenic and adipogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) is not only the primary pathological feature but also a major contributor to the pathogenesis of steroid-induced osteonecrosis of the femoral head (SONFH). Cellular senescence is one of the main causes of imbalanced BMSCs differentiation. The purpose of this study was to reveal whether cellular senescence could participate in the progression of SONFH and the related mechanisms. The rat SONFH model was constructed, and rat BMSCs were extracted. Aging-related indicators were detected by SA-β-Gal staining, qRT-PCR and Western Blot experiments. Using H2O2 to construct a senescent cell model, and overexpressing and knocking down miR-601 and SIRT1 in hBMSCs, the effect on BMSCs differentiation was explored by qRT-PCR, Western Blot experiment, oil red O staining (ORO), alizarin red staining (ARS), and luciferase reporter gene experiment. A rat SONFH model was established to test the effects of miR-601 and metformin in vivo. The current study showed that glucocorticoids (GCs)-induced BMSCs senescence, which caused imbalanced osteogenesis and adipogenesis of BMSCs, was responsible for the SONFH progression. Further, elevated miR-601 caused by GCs was demonstrated to contribute to BMSCs senescence through targeting SIRT1. In addition, the anti-aging drug metformin was shown to be able to alleviate GCs-induced BMSCs senescence and SONFH progression. Considering the role of BMSCs aging in the progression of SONFH, this provides a new idea for the prevention and treatment of SONFH.

Objectives To 1) figure out the difference in tibial morphologies between patients with posterior cruciate ligament (PCL) injury and those without, 2) identify any tibial anatomical variations contributing to PCL rupture. Design Retrospective case-control study, level of evidence III. Methods 45 patients with PCL rupture from 2015 to 2020 in our hospital, and 45 patients matched by age and sex with intact PCL were enrolled in our study. The intraclass correlation coefficient (ICC) was used to assess the reliability of each parameter. The independent t-test was conducted to identify the differences in tibial morphometric characteristics between the PCL-injured and PCL-intact individuals, including the posterior tibial slope (PTS), meniscal slope (MS), medial tibial depth (MTD). A binary logistic regression model was established to evaluate the roles of those anatomic parameters of interest play in PCL injuries. Results The interobserver reliability of each parameter showed excellent agreement. Significant differences in the medial (P= .023) and lateral (P= .009) PTS were found between the PCL-injured group (3.68 ± 2.70 and 4.55 ± 3.19, respectively) and the controls (5.00 ± 2.73 and 6.39 ± 3.29, respectively). And the MTD was 1.98 ± 0.64 mm in the PCL-injured group and 2.37 ± 0.55 mm in the control group (P=0.007). Binary logistic regression analysis showed that smaller lateral PTS and MTD were directly associated with PCL injury, with an OR of 1.17 and OR of 3.14, respectively. The medial PTS was independent to PCL injures. Conclusion In patients with PCL injury, lateral PTS, medial PTS, and MTD were found smaller compared to PCL intact controls. Decreased lateral PTS and MTD were underlying anatomic risk factors for PCL injury, with each unit reduction, the risks of PCL injury were 1.2 and 3.1-fold higher, respectively.

Background This study aims to present a radiomic application in diagnosing the long head of biceps (LHB) tendinitis. Moreover, we evaluated whether machine learning-derived radiomic features recognize LHB tendinitis.Patients and methods A total of 170 patients were reviewed. All LHB tendinitis patients were diagnosed under arthroscopy. Radiomic features were extracted from preoperative magnetic resonance imaging (MRI), and the input dataset was divided into a training set and a test set. For feature selection, the t test and least absolute shrinkage and selection operator (LASSO) methods were used, and random forest (RF) and support vector machine (SVM) were used as machine learning classifiers. The sensitivity, specificity, accuracy, and area under the curve (AUC) of each model's receiver operating characteristic (ROC) curves were calculated to evaluate model performance.Results In total, 851 radiomic features were extracted, with 109 radiomic features extracted using a t test and 20 radiomic features extracted using the LASSO method. The random forest classifier shows the highest sensitivity, specificity, accuracy, and AUC (0.52, 0.92, 0.73, and 0.72).Conclusion The classifier contract by 20 radiomic features demonstrated a good ability to predict extra-articular LHB tendinitis.However because of poor segmentation reliability, the value of Radiomic in LHB tendinitis still needs to be further explored.

Abstract Objectives To research whether medial PTS, lateral PTS and MTD were different between the PCL injury group and the PCL intact group. Design Retrospective case–control study, level of evidence III. Methods Fifty patients with PCL rupture from 2015 to 2020 in our hospital, and 50 patients matched by age and sex with intact PCL were enrolled in our study. The intraclass correlation coefficient (ICC) was used to assess the reliability of each parameter. The independent t-test was conducted to identify the differences in tibial morphometric characteristics between the PCL-injured and PCL-intact individuals, including the posterior tibial slope (PTS), meniscal slope (MS), medial tibial depth (MTD). A binary logistic regression model was established to evaluate the roles of those anatomic parameters of interest play in PCL injuries. Results The interobserver reliability of each parameter showed excellent agreement. Significant differences in the medial (P = .023) and lateral (P = .009) PTS were found between the PCL-injured group (3.68 ± 2.70 and 4.55 ± 3.19, respectively) and the controls (5.00 ± 2.73 and 6.39 ± 3.29, respectively). And the MTD was 1.98 ± 0.64 mm in the PCL-injured group and 2.37 ± 0.55 mm in the control group (P = 0.007). Binary logistic regression analysis showed that smaller lateral PTS and MTD were directly associated with PCL injury, with an OR of 1.17 and OR of 3.14, respectively. The medial PTS was independent to PCL injures. Conclusion Decreased lateral PTS and MTD were underlying anatomic risk factors for PCL injury.

Background A functionally deficient anterior cruciate ligament (ACL) is considered one of the contraindications in unicompartmental knee arthroplasty (UKA). But there is still a lack of standardized and reproducible methods to assess ACL functional integrity in patients with advanced anteromedial osteoarthritis of the knee (AMOA). This study explores the value of passive anterior tibial subluxation (PATS) on axial MRI in evaluating ACL status in this population. Methods Patients who met UKA indications between November 2017 and September 2020 were included and grouped into “intact” (ACLI) or “deficient” (ACLD) group according to their ACL status during surgery. All participants underwent MRI with a standardized protocol. The measurements of medial and lateral PATS were conducted on axial MRI, and the mean of them was calculated as global PATS. Then the reliability and diagnostic ability of PATS were determined. Results A total of 85 patients (45 for ACLI group, 40 for ACLD group) were included after selection. The measurements of PATS showed excellent intra- and inter-observer reliabilities (with an intraclass correlation coefficient of at least 0.986). The global PATS of the ACLI group was significantly lower than that of the ACLD group (− 2.30 ± 1.96 vs. 1.03 ± 1.96 mm, P <0.0001). The diagnostic ability of global PATS was good (area under the curve = 0.897), and a threshold of 1.2 mm had a specificity of 100%, a sensitivity of 55%, and an accuracy of 78.82%. Conclusion An axial global PATS of 1.2 mm on MRI is greatly specific for identifying a functionally deficient ACL in patients with advanced AMOA.

Although patellar dislocation is a knee disorder prevalent in adolescence and young adults, the evaluation and treatment of patients are complex and even enigmatic. Much of the literature fails to provide a detailed description of patient management. The purpose of this study is to introduce a method for the evaluation and treatment of patellar dislocation. This Technical Note will help guide clinicians in the clinical evaluation of patients and formulation of treatment plans.