The aim of this study is to investigate the effect of arthroscopic synovectomy (AS) on disease status in patients with rheumatoid arthritis (RA). A prospective study was conducted among patients with RA who underwent AS of the elbow or knee joints due to persistent swelling following conventional treatment, as well as control individuals who only received conventional treatment. All patients were evaluated at baseline and 4, 12, 24, 48, 96 weeks after AS. The coprimary outcomes were week 96 disease activity score (DAS)-28 remission and American College of Rheumatology improvement criteria (ACR20/50/70) remission. Key secondary outcomes were changes from baseline to week 96 in Mayo score, Lysoholm score, Health Assessment questionnaire (HAQ), patient’s visual analogue scale, Magnetic Resonance Imaging in AS group. The correlation between synovial tissue biology and clinical response was analyzed. A total of 51 patients were included, with 17 accepted AS and conventional treatment, 34 only accepted conventional treatment. At week 96, more patients in AS group achieved DAS-28 remission [52.9

Background:Knee joint pain is very common in clinical practice, with a complex etiology in which osteoarthritis is the most frequent cause. Among the various types of osteoarthritis, tibiofemoral osteoarthritis (TFOA) is the most prevalent. Patients with lateral patellar compression syndrome (LPCS) also present with knee joint pain. This study aims to compare meniscal and articular cartilage injuries in patients with LPCS and those with TFOA. This study could provide insights into the clinical characteristics and radiological features that distinguish these two conditions. Methods:This study recruited 206 eligible patients from the Department of Sports Medicine at a hospital from March 2018 to February 2023. Patients were divided into two groups of 103: LPCS and TFOA. Magnetic resonance imaging was conducted using standardized protocols. Image analyses were undertaken by experienced radiologists to assess meniscal and cartilage injuries. Results:The mean age was 58.0±10.9 years in the LPCS group and 54.3±10.3 years in the TFOA group, with a significant difference between groups (P=0.01). Patients with LPCS exhibited a higher proportion of meniscal injuries (55.34% vs. 39.81%, P=0.03) and a significantly higher prevalence of posterior root tears of the medial meniscus (34.95% vs. 3.88%, P<0.001) compared with patients with TFOA. Significant differences in the grading of cartilage injuries were observed, particularly in the medial tibiofemoral compartment, where patients in LPCS group had higher grades of injury compared with TFOA patients (P<0.001). Specifically, in the medial compartment, grade 4 cartilage injuries were more frequent in the LPCS group (34.95% vs. 24.27%), while grade 1 injuries were more frequent in the TFOA group (53.40% vs. 29.13%). Among LPCS patients aged ≤50 years, 55% (11/20) had higher-grade cartilage injuries in the lateral compartment than in the medial compartment, suggesting more rapid cartilage damage progression in younger patients with LPCS. Conclusions:This study underscores the significant differences in meniscal and articular cartilage injuries between patients suffering from LPCS and patients with TFOA. The results highlight the importance of radiological features for accurate clinical differentiation and the need for 'tailored' treatment strategies.

Arthroscopic lateral retinacular release (LRR) is an effective treatment for lateral patellar compression syndrome (LPCS), but postoperative rehabilitation remains crucial. Low-load blood flow restriction training (LL-BFRT) has been shown to be beneficial in sports medicine; however, its effect on postoperative recovery in LPCS is unclear. In this randomized controlled trial, 60 patients after LRR were assigned to receive either routine rehabilitation with LL-BFRT or routine rehabilitation alone for 4 weeks. Outcomes included Lysholm score, knee extension peak torque, quadriceps thickness, thigh circumference, VAS, and ROM. Within- and between-group comparisons were conducted using paired and unpaired t-tests or their non-parametric equivalents, according to data distribution and homogeneity of variance (SPSS; P < 0.05 was considered statistically significant). A total of 51 patients (Control: n = 26, age 45.3 ± 11.6 years, BMI 24.0 ± 3.1; LL-BFRT: n = 25, age 42.4 ± 10.2 years, BMI 25.2 ± 3.4) completed the trial. While both groups showed post-intervention improvements, the LL-BFRT group demonstrated greater gains than the control group in knee extensor strength at 60°/s (mean increase 20.85 vs. 8.24 N·m), vastus medialis thickness (0.33 vs. 0.12 cm), and thigh circumference (2.34 vs. 1.15 cm). Although the between-group differences in VAS and Lysholm scores were not statistically significant, the mean changes in the LL-BFRT group exceeded the minimal clinically important difference (MCID) thresholds for both outcomes (VAS: 2 cm; Lysholm: 11.1 points), indicating clinically meaningful within-group improvement. LL-BFRT augments routine rehabilitation by specifically improving knee extensor strength, vastus medialis hypertrophy, and thigh circumference in patients with LPCS after LRR, and may represent an effective strategy to enhance postoperative recovery.

Abstract Purpose To track the 24‐month longitudinal changes in tibiofemoral alignment characterised by passive anterior tibial subluxation (PATS) following anterior cruciate ligament reconstruction (ACLR), and to investigate associated factors. Methods Fifty‐one patients who underwent primary ACLR using hamstring tendon autografts between March 2021 and February 2022 were enrolled. Clinical and magnetic resonance imaging (MRI) evaluations were performed at baseline (within 3 days preoperatively) and at 6‐, 12‐ and 24‐month follow‐ups to examine the graft integrity and tibiofemoral alignment. Lateral PATS (L‐PATS), medial PATS (M‐PATS), global PATS (G‐PATS) and rotational PATS (R‐PATS) were measured on serial MRI. The repeated‐measures one‐way analysis of variance was applied to test the longitudinal changes in PATS. Univariable and multivariable linear regression analyses were performed to identify associations between preoperative and postoperative PATS, adjusting for a priori‐defined covariates including time from injury to surgery, tibial slopes, meniscal injuries and anterolateral ligament (ALL) abnormality. Results The graft integrity was clinically and radiographically confirmed in all patients at the 24‐month follow‐up. However, serial MRI revealed significant increases in L‐PATS, M‐PATS and G‐PATS (all p < 0.001) following the primary ACLR. The increases in L‐PATS (1.5 mm, 95%CI [0.6,2.5], p < 0.001), M‐PATS (1.2 mm, 95%CI [0.5,1.9], p < 0.001) and G‐PATS (1.4 mm, 95%CI [0.6,2.1], p < 0.001) from baseline became the most prominent at 12 months and remained stable thereafter. Strong correlations were identified between preoperative and 24‐month postoperative values for L‐PATS (β = 0.60, p < 0.001), M‐PATS (β = 0.43, p < 0.001), G‐PATS (β = 0.48, p < 0.001) and R‐PATS (β = 0.70, p < 0.001). ALL abnormality was associated with increased L‐PATS (β = 1.85, p = 0.008) and G‐PATS (β = 1.31, p = 0.009), while medial meniscal injury was associated with increased M‐PATS (β = 1.12, p = 0.036) and G‐PATS (β = 0.96, p = 0.048) measured at 24 months postoperatively. Conclusions Residual tibiofemoral malalignment characterised by increased L‐PATS, M‐PATS and G‐PATS persists following ACLR using hamstring tendon autografts. Excessive preoperative PATS, ALL abnormality and medial meniscal injury are associated with increased postoperative PATS. Level of Evidence Level IV.

Lateral patellar compression syndrome (LPCS) is characterized by abnormal pressure elevation in the lateral patellofemoral joint. The histopathological basis of LPCS, particularly regarding microvascular and inflammatory changes in the lateral joint capsule and lateral retinaculum, remains unclear. This study aimed to systematically compare the histological characteristics of these tissues between patients with LPCS and controls to characterize tissue-level features associated with LPCS and to explore the potential implications of these findings for understanding pathophysiology and informing future research on surgical strategy selection. This retrospective case–control study included 26 patients with LPCS and 23 control patients (with meniscal injuries, patellar dislocation, patellofemoral osteoarthritis, or synovial cyst). Intraoperative tissue specimens of the lateral joint capsule and lateral retinaculum were obtained. Histological evaluation was performed using immunohistochemical staining for Factor Ⅷ (F8, microvessels), CD3 (T cells), CD20 (B cells), and CD68 (macrophages). Microvessel density and inflammatory cell density were quantified and compared between groups. Microvessel density was significantly higher in both the lateral joint capsule (48.84 ± 14.12/mm2 vs. 34.72 ± 15.40/mm2, P = 0.002) and the lateral retinaculum (27.50 ± 11.33/mm2 vs. 17.13 ± 9.26/mm2, P = 0.007) of patients with LPCS compared to controls, with large effect sizes (Cohen's d > 1.0). Within both groups, microvessel density was significantly higher in the joint capsule than in the retinaculum (both P < 0.001). In contrast, no statistically significant between-group differences were detected in the densities of CD3 + T cells, CD20 + B cells, or CD68 + macrophages in either tissue. However, in multivariate regression models adjusting for age and sex, the between-group differences in microvessel density were attenuated and no longer statistically significant; interaction terms were also not significant. Unadjusted analyses showed increased microvessel density in the lateral joint capsule and lateral retinaculum of patients with LPCS while no statistically significant between-group differences were detected in classical inflammatory cell densities (CD3 + , CD20 + , CD68 +) under the current immunohistochemical panel. Because the association with microvessel density was not statistically significant after adjustment for age and sex, these findings should be interpreted as hypothesis-generating and potentially influenced by demographic factors. Larger age- and sex-matched studies, ideally with clinical correlation, are needed to determine whether angiogenesis is an independent pathological feature of LPCS and whether it relates to outcomes.

BackgroundThis study analyzed patients treated for skiing injuries at Chongli Campus, Peking University Third Hospital during the 2024–2025 ski season to clarify the epidemiological patterns and associated factors of skiing injuries, and to provide data support for developing preventive measures.MethodsA retrospective study design was adopted. Clinical data from 4,270 patients with skiing injuries treated between November 2024 and April 2025 were collected. Chi-square tests (with Cramér's V effect sizes) and multinomial logistic regression were used for statistical analysis.ResultsInjury location were significantly associated with gender, annual skiing expenditure, skiing equipment, skiing experience and skill level (all P < 0.001). Low-consumption skiers were mainly beginners with <2 years of experience and predominantly sustained lower extremity injuries, whereas high-consumption skiers were mostly expert-level skiers with >5 years of experience and had a higher prevalence of upper extremity injuries. Multinomial logistic regression showed that age, male gender (OR for head/neck vs. upper extremity = 0.77, 95% CI: 0.63–0.94), low consumption (OR for head/neck = 1.79, 95% CI: 1.14–2.80), and beginner skill level (OR for lower extremity vs. upper extremity = 4.58, 95% CI: 2.13–9.81) were independent predictors of injury location.ConclusionsDifferentiated and individualized preventive measures should be implemented for different groups of skiers to reduce the occurrence of skiing injuries and promote the healthy development of ice and snow sports.

BACKGROUND:Insertional reattachment of the Achilles tendon is the recommended surgical treatment for acute sleeve avulsion fractures at the tendon insertion in patients fit for surgery and who are comfortable taking the risks associated with the procedure. However, there is a paucity of evidence regarding the longitudinal clinical outcomes and sustained sports participation at minimum 2- and 5-year follow-up after this procedure. QUESTIONS/PURPOSES:(1) What are the 2- and 5-year patient-reported outcomes after insertional reattachment for acute sleeve avulsion fractures of the Achilles tendon? (2) What proportion of patients return to sports after insertional reattachment for acute sleeve avulsion fractures of the Achilles tendon? (3) What patient factors are associated with inferior patient-reported outcomes, including the VAS, the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score, the Foot Function Index (FFI), and Tegner scores, at minimum 5-year follow-up? METHODS:A retrospective study was performed that evaluated patients who underwent insertional reattachment for acute sleeve avulsion fractures of the Achilles tendon between December 2011 and December 2019 at our institution. During this period, we treated 55 patients for this injury. Surgery was generally offered to patients who presented with acute posterior heel pain and functional loss consistent with insertional rupture, radiographic or MRI evidence of a proximally displaced avulsion fragment, and a Pomeranz classification ≥ Type IB; these criteria were applied consistently throughout the study period. Patients with anesthesia contraindications, immunosuppressive disease, or those who refused surgery were treated nonoperatively and were not included. Five patients met the exclusion criteria, leaving 50 patients, of whom 78% (39) completed both minimum 2- and 5-year follow-up; their results were analyzed in this study. Baseline data were recorded: mean ± SD age was 45 ± 11 years, 92% (36 of 39) of patients were men, mean ± SD BMI was 27.2 ± 2.9 kg/m 2 , 69% (27 of 39) of patients sustained high-energy injuries, 41% (16 of 39) of patients had preinjury insertional pain, and 10% (4 of 39) of patients had prior steroid injection. Patient-reported outcomes (PROs)-including the VAS for pain, the AOFAS Ankle-Hindfoot score, the FFI, and the Tegner activity scale-were collected preoperatively, at minimum 2- and 5-year follow-up. Sports participation, time to return to sport, single-leg heel-rise performance, delayed wound healing, and rerupture were also assessed. A Spearman correlation analysis was used to explore factors associated with minimum 5-year PROs. RESULTS:Overall, PROs consistently improved and remained improved out to 5 years postoperatively. VAS pain scores improved at 2 years and remained improved at 5 years (4.7 ± 1.3 preoperatively versus 1.6 ± 1.4 at 2 years and 0.7 ± 1.0 at 5 years, mean differences -3.1 and -0.9, respectively; p < 0.001 for both). AOFAS scores improved at 2 years and remained improved at 5 years (50 ± 17 preoperatively versus 88 ± 7 at 2 years and 96 ± 5 at 5 years, mean differences 38 and 8, respectively; p < 0.001 for both). FFI scores improved at 2 years and remained improved at 5 years (110 ± 20 preoperatively versus 11 ± 10 at 2 years and 5 ± 4 at 5 years, mean differences -99 and -6, respectively; p < 0.001 for both). Tegner scores improved at 2 years and remained stable at 5 years (1 ± 1 preoperatively versus 4 ± 1 at 2 years and 4 ± 2 at 5 years, mean differences 3 and 0, respectively; p < 0.001 and p = 0.18). At minimum 5-year follow-up, 64% (25 of 39) of patients were engaged in sports activities, with a mean ± SD time to return to sport of 8 ± 3 months. For those with preinjury sporting demands, 78% (25 of 32) were still participating in sports at minimum 5-year follow-up. In all, 90% (35 of 39) of patients completed a single-leg heel-rise test. Delayed wound healing occurred in 13% (5 of 39), and rerupture occurred in 8% (3 of 39). Increasing age was modestly associated with poorer 5-year Tegner activity score (r = -0.47 [95% CI -0.71 to -0.16]; p = 0.002). A preinjury history of insertional pain was modestly to substantially associated with poorer postoperative VAS (r = 0.32 [95% CI 0.00 to 0.62]; p = 0.047), AOFAS (r = -0.35 [95% CI -0.63 to -0.04]; p = 0.03), and FFI scores (r = 0.52 [95% CI 0.24 to 0.73]; p = 0.001). Similarly, a history of corticosteroid injection was negatively correlated with FFI scores (r = 0.41 [95% CI 0.16 to 0.60]; p = 0.01). Calcaneoplasty performed during surgery was positively correlated with better postoperative AOFAS scores (r = 0.36 [95% CI 0.17 to 0.52]; p = 0.03). No correlations were found between clinical outcomes and other variables. CONCLUSION:Insertional reattachment for acute Achilles sleeve avulsion fractures yields meaningful and durable improvements in pain, function, and activity level at minimum 2- and 5-year follow-up. Most patients experience continued improvement over time, with stable sports participation at the minimum 5-year follow-up. Importantly, among patients engaged in sports preinjury, nearly 80% maintained sports participation at 5 years, highlighting the durability of this operation. However, a history of preinjury insertional pain and prior corticosteroid injection, features suggestive of underlying tendinopathy, may be associated with poorer minimum 5-year outcomes. LEVEL OF EVIDENCE:Level III, therapeutic study.

Purpose This study describes the technical approach for extracapsular endoscopic management of refractory medial epicondylitis and assesses patient outcomes based on postoperative follow-up. Methods This retrospective study analyzed data from 13 patients (mean age 46.4 years, range 26–66 years; 14 elbows involved) with definite refractory medial epicondylitis who underwent extra-articular arthroscopic surgery between January 2016 and October 2024. Exclusion criteria comprised infection, recent ipsilateral limb surgery, other joint diseases, and severe systemic disorders. Clinical outcomes were evaluated pre- and post-operatively using the visual analog scale for pain, medial epicondylar tenderness assessment, the disabilities of the arm, shoulder, and hand questionnaire, and the Mayo elbow performance score. Results No postoperative complications (e.g., infection) occurred. Histopathological analysis of debrided tissue from the medial epicondyle was performed in select cases. Of the 13 patients, 7 were lost to follow-up; and thus, outcome data were available for the remaining 6 patients. No postoperative follow-up data demonstrated favorable joint status, with a mean visual analog scale pain score of 1, mean medial epicondylar tenderness score of 1.5, mean Mayo elbow performance score of 85, and mean disabilities of the arm, shoulder, and hand score of 0.83. Conclusion In our cohort, extra-articular arthroscopy demonstrated a straightforward procedural workflow and yielded favorable outcomes in pain relief, reduced elbow tenderness, and functional restoration. These findings suggest that this technique is effective and safe for treating refractory medial epicondylitis in surgical candidates.

PURPOSE:To investigate whether primary anterior cruciate ligament reconstruction (ACLR) in the setting of adult irreducible tibial eminence fracture could achieve comparable clinical outcomes to suture fixation (SF) in reducible cases. METHODS:Patients who were diagnosed with displaced tibial eminence fracture and underwent either ACLR or SF were retrospectively analyzed. The treatment modalities were determined intra-operatively based on the intra-operative evaluation of the osseous and ligamentous status, according to which native ACL preservation by SF was applied in reducible cases and ACLR for irreducible cases. The primary outcome was patient-reported outcome measures at a minimum 2-year follow-up. Secondary outcomes include ipsilateral reinjury at the ACL-injured limb, contralateral injury, range of motion loss, arthrofibrosis, return to sport, and patient satisfaction at the most recent follow-up. Patient-acceptable symptomatic state was determined by the anchor question: "Taking into account your daily activities and functional performance, do you find your current condition satisfactory?". RESULTS:A total of 31 patients in the ACLR group and 43 patients in the SF group were included. Patients' characteristics were comparable between groups, except for time from injury to surgery (ACLR vs SF: mean [range], 11.8 [0.1, 84.0] months vs 1.2 [0.0, 12.0] months, P < .001) and lateral meniscal injury (ACLR vs SF: 45.2% vs 16.3%, P = .023). The mean follow-up was 77 months. Univariate comparison revealed no significant intergroup difference for the primary and secondary outcomes (all P > .05). Multivariable linear regressions revealed no significant association between treatment modalities and clinical outcomes in terms of the Tegner, Lysholm, and International Knee Documentation Committee scores (all P > .05). Subgroup analyses based on fracture types and sex also suggested similar results. Multivariable logistic regressions revealed no difference in ipsilateral reinjury, contralateral injury, range of motion loss, arthrofibrosis, return to sport, and patient satisfaction between groups (all P > .05). A total of 63 (85.1%) participants reported achieving patient-acceptable symptomatic state, with no significant difference between the ACLR and SF groups (26/31 vs 37/43, P > .999). CONCLUSIONS:Primary ACLR using hamstring autograft in the setting of adult irreducible tibial eminence fracture achieved clinical outcomes comparable to SF in reducible cases. The percentage of patients reported achieving patient-acceptable symptomatic state was similar between the 2 groups. LEVEL OF EVIDENCE:Level III, retrospective comparative case series.

The utilization of biological therapeutic agents in the treatment of tendon injuries represents a promising avenue, with particular attention drawn to adipose mesenchymal stem-cell-derived exosomes (ADSCs-exos) owing to their pivotal role in regenerative medicine. Identifying a therapeutic strategy to prolong exosome retention at the injury site for effective tendon repair remains challenging. In this study, we explored the potential of ADSC-exosomes in vitro, demonstrating their ability to promote the behavior of tendon stem/progenitor cells (TSPCs). Additionally, we designed a fibroin (SF) sponge as a biodegradable platform for enzyme-responsive exosome delivery. Subsequently, we used biodegradable SF sponges to deliver ADSC exosomes into the patellar tendon defect in rats. The results showed that, in vivo, exosomes were gradually released from the SF sponges, remained in the defect area for an extended period, and exerted functional benefits locally. These findings were supported by the upregulation of tendon-associated protein expression and improved mechanical properties observed in the in vivo specimens. In summary, we substantiated the advantageous role of ADSCs-exos in facilitating tendon regeneration. Moreover, the utilization of a SF-exos sponge delivery system emerged as an efficacious local treatment strategy for exosome delivery. These findings hold promise for the future application of exosomes in innovative therapies tailored to address tendon injuries.

We describe the arthroscopic tibial tubercle osteophyte debridement and gout crystal clearance for treating Osgood-Schlatter disease combined with gout in patients experiencing anterior knee pain. Preoperative assessment includes medical history review, physical examination, and imaging studies. The surgical procedure involves arthroscopic entry, osteophyte and calcification clearance, and crystal removal. Postoperative rehabilitation allows for full weightbearing, with moderate knee flexion exercises. This approach offers a promising treatment option for patients with Osgood-Schlatter disease and gout, providing new insights into surgical management strategies.

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:Lateral patellar compression syndrome (LPCS) is characterized by increased lateral patellofemoral joint pressure due to chronic lateral patellar tilt, tightened lateral retinaculum, and imbalanced stress between the lateral and medial femoral condyles. However, there is currently no well-established or widely accepted diagnostic standard for LPCS. This study aimed to explore the feasibility of various structural measurement parameters of magnetic resonance imaging (MRI) of the knee to diagnose LPCS and to identify new MRI diagnostic indicators as references and guidance for LPCS clinical diagnosis. Methods:This study enrolled 168 patients, who were divided into three groups: the LPCS group, the knee osteoarthritis (KOA) group, and the structurally normal group (n=56 participants per group). A standardized magnetic resonance scanning protocol was used, including sagittal and coronal fat-suppressed proton density-weighted imaging and sagittal T1-weighted imaging. Two radiologists analyzed the MRI and measured the patellar-patellar tibial angle (P-PTA), the quadriceps-patellar angle (Q-PA), the length of patellar (LP), the length of patellar tendon (LT), the LP/LT ratio, the Insall-Salvati ratio (ISR). Results:The LPCS group had significantly lower P-PTA and LP values, but higher LT and ISR values, compared with those in the normal and KOA groups (all P<0.05). Compared with those in the structurally normal group, the LPCS groups' Q-PA value was higher (P=0.034). According to receiver operating characteristic analysis, the optimal cut-off values for P-PTA, LP, LP/LT, and ISR were 146.45°, 41.10 mm, 0.85, and 1.19, with sensitivities and specificities of 67.86%/59.82%, 78.57%/55.36%, 67.86%/58.93%, and 66.07%/60.71%, respectively. Conclusions:Measurement parameters of MRI, particularly P-PTA, LP and ISR, can serve as important tools to assist in the diagnosis of LPCS. Assessment of these parameters should be included in the clinical diagnostic process for LPCS to improve diagnostic accuracy.

Background:Arthroscopic loose-body removal and synovectomy are recommended for the treatment of knee synovial chondromatosis (SC). However, there are limited data on clinical outcomes and survivorship after arthroscopic treatment for knee SC. Purposes/Hypothesis:The purpose was to evaluate the clinical outcomes and survivorship of arthroscopic loose-body removal and synovectomy in patients with knee SC, as well as to investigate the potential effect of concomitant chondral lesions on these outcomes. It was hypothesized that arthroscopic treatment for knee SC could yield satisfactory clinical outcomes, with concomitant chondral lesions negatively affecting clinical efficacy. Study Design:Case series; Level of evidence, 4. Methods:A consecutive cohort of patients diagnosed with knee SC and treated with arthroscopy between 2016 and 2022 was included in the study. Patient-reported outcomes (PROs) were collected preoperatively and at the final follow-up, including the Knee injury and Osteoarthritis Outcome Score, the subjective International Knee Documentation Committee (IKDC) score, the Lysholm score, and the visual analog scale for pain score. Data on arthroscopic findings, patient satisfaction, complications, and survivorship rates were also documented. The percentage of patients achieving the minimal clinically important difference (MCID) was calculated. Clinical outcomes were then compared between patients with and without chondral lesions identified during arthroscopy. Results:A total of 51 patients (54 knees) were included in the study, with a mean age at surgery of 42.3 ± 14.7 years and a mean follow-up period of 5.6 years. All PROs showed significant improvements at the final follow-up (P < .001), with >90% of patients achieving the MCID. Six knees (11.1%) experienced symptomatic recurrence confirmed by magnetic resonance imaging, and 3 knees (5.6%) underwent reoperation. The survivorship rates free from recurrence and reoperation were 85.1% and 93.9% at 8 years, respectively. At the final follow-up, no significant differences were found between knees with (n = 32) and without (n = 22) chondral lesions in all postoperative scores and survivorship rate. Conclusion:Arthroscopic treatment for knee SC yields favorable clinical outcomes with symptom relief and functional improvement. However, there remains a risk of recurrence and the need for reoperation. Additionally, patients with concomitant chondral lesions could achieve clinical outcomes and survivorship comparable to those of patients without chondral lesions.

PURPOSE:Lateral patellar compression syndrome (LPCS) is characterized by a persistent abnormally high stress exerted on the lateral articular surface of the patella due to lateral patellar tilt without dislocation and lateral retinaculum contracture, leading to anterior knee pain. The purpose of this study is to evaluate the efficacy and prognosis of lateral retinaculum release (LRR) combined with chondroplasty in the treatment of LPCS. METHODS:This retrospective study evaluated 40 patients who underwent LRR combined with chondroplasty for LPCS between 2020 and 2021. The assessment included improvement in postoperative tenderness and knee joint function. Patients were evaluated using the Lysholm, Tegner, and International Knee Documentation Committee 2000 scoring systems, as well as the visual analog scale, both preoperatively and postoperatively, with the paired comparisons analyzed using a t-test. Additionally, intraoperative observations were made regarding knee joint lesions, including cartilage damage and osteophyte formation, with analysis by the Chi-square test. RESULTS:The visual analog scale score for tenderness showed a significant decrease after surgery (p < 0.001). Evaluation of knee joint function also indicated significant improvements, as demonstrated by increased Lysholm, Tegner, and International Knee Documentation Committee 2000 scores postoperatively (p < 0.001, p = 0.011, p < 0.001, respectively). Furthermore, all LPCS patients included in the study presented with cartilage injuries and osteophyte formation. Significant differences were noted in the incidence of cartilage damage and osteophyte formation at different locations within the knee among patients with LPCS. CONCLUSION:LRR combined with chondroplasty is an effective surgical approach for treating patients with LPCS, with satisfactory recovery observed at the 1-year follow-up. Additionally, the incidence of cartilage damage and osteophyte formation in LPCS patients varies significantly depending on the specific location within the knee joint.

Purpose To retrospectively compare the clinical outcomes of intra-capsular vs. extra-capsular release of the lateral patellar retinaculum using 2 novel surgical techniques: the capsule-uncut immaculate lateral retinacular release (CUI method), and the L-shaped lateral retinacular release (L-shaped release). Methods This is a retrospective comparative study. The clinical data of patients admitted to our department between October 2010 and October 2020 were retrospectively analyzed. Patients diagnosed with excessive lateral pressure syndrome and treated with arthroscopic retinacular release, with complete imaging data, and followed up for >1 year were included in the study. Previous history of knee surgery, cruciate ligament or collateral ligament ruptures, neoplastic diseases of the knee, patellar instability, history of knee fracture, varus/valgus of the knee joint, or Q angle >20° were exclusion criteria. All the included cases were divided into 2 groups based on the surgical method and subsequently stratified by age. The visual analogue pain scale was used to evaluate the degree of knee pain. Lysholm score and the International Knee Documentation Committee knee evaluation form score were used to evaluate knee function and activity. The preoperative and postoperative patellar tilt angles of the affected knee were measured. Comparison between groups was performed by the Wilcoxon test or the Mann-Whitney U test. Count data was represented by frequency, and comparison between groups was performed by χ2 test. Mann-Whitney U test and multiple linear regression model were used for univariate and multivariate analysis. Results The clinical data of 200 patients were retrospectively analyzed. After screening by inclusion and exclusion criteria, 90 cases met the inclusion and exclusion criteria and were included in this study. The postoperative visual analogue scale scores of both groups were significantly lower than those before operation (p<0.001), and the postoperative Lysholm score and the score of the postoperative International Knee Documentation Committee knee evaluation form of the 2 groups were significantly higher than those before operation (p<0.001). The L-shaped release group was significantly higher than the CUI method group in Lysholm score (p=0.008). In the age ≥50 years group, the Lysholm score of the CUI method group was significantly lower than the L-shaped release group (p<0.001), and the changes in patellar tilt angle were significantly larger in the CUI method group than in the L-shaped release group (p=0.016). In the age <50 years group, there was no significant difference. Conclusions Both the surgical methods have good clinical effects. L-shaped release is superior to the CUI method in improving knee function in the elderly patients (≥50 years old), while the CUI method is superior to L-shaped release in correcting patellar tilt in the elderly patients. In young patients, the CUI method has the same clinical effect as L-shaped release. The L-shaped release is relatively simple with a short learning curve, making it suitable for beginners treating younger patients with mild lateral contracture. However, the CUI method is more recommended for patients with severe lateral patellar tilt, obvious lateral contracture thickening, and elderly patients.

OBJECTIVE:The pain-relieving effect and safety of compound aminopyrine phenacetin tablets, tramcontin (tramadol hydrochloride sustained-release tablets) and dolantin in the early stage of autologous tendon reconstruction of the anterior cruciate ligament (ACL) of the knee joint were compared. METHODS:Retrospective analysis of postoperative pain and drug analgesia in 45 patients performed by the same group from November 2018 to February 2019. The random area group design was divided into two groups according to whether ACL rupture was combined with meniscal injury, group A was 24 patients with ACL reconstruction of knee joint and group B was 21 patients with ACL fracture combined with meniscus injury. The two groups were divided into three subgroups respectively according to the actual treatment of postoperative analgesic drugs received by the patients, including 4 cases of compound aminopyrine phenacetin tablets, 11 cases of oral tramcontin, 9 cases of intramuscular dolantin combined with phenergan in group A; 3 cases of compound aminopyrine phenacetin tablets, 10 cases of oral tramcontin, and 8 cases of intramuscular dolantin combined with phenergan in group B. When the early postoperative patients complain about pain and actively ask for analgesia. When the patients complained about pain after the operation and actively asked for analgesia, they were randomly given painkillers, tramcontin or dolantin combined with phenergan to relieve pain. Pain visual analogue scale (VAS) was used to evaluate pain relief and observe the occurrence of adverse reactions. RESULTS:There were no significant dif-ferences in gender, age, body mass index, and time of hospital stay between the two groups of patients (P > 0.05). In the patients who used tramcontin and dolantin combined with phenergan to relieve pain judging by VAS score before and 1 h after taking the drug, it was found that the pain situation of the patient was significantly relieved, and the difference before and after taking the drug had statistical significance (P < 0.05). Pairwise comparisons of the three drugs applied in the two groups showed significantly greater pain relief in the dolantin combined with phenergan group than in the remaining two drugs. There was no significant difference (P > 0.05). Dolantin was prone to nausea and vomiting, but the application of phenergan was also used to reduce side effects. In terms of adverse reactions, only 1 case of nausea occurred in the tramcontin group for simple ACL reconstruction, and none of the patients in the other groups showed serious complications and allergic reactions. CONCLUSION:Whether in cruciate ligament reconstruction alone or combined with meniscus molding or suture, compound aminopyrine phenacetin tablets, tramcontin, dolantin combined with phenergan can effectively relieve pain. Among the three drugs, dolantin caused the largest pain relief. At the same time, the combination of phenergan effectively reduced the adverse reactions, such as vomiting and nausea, and increased the drug safety.

Purpose: To evaluate the clinical outcomes following arthroscopic anterior cruciate ligament (ACL) reconstruction (ACLR) in patients over 60 years and to investigate the potential impact of preoperative osteoarthritis (OA) on these outcomes. Methods: A retrospective study included ACL-injured patients over 60 years who underwent primary arthroscopic ACLR between 2010 and 2020. The Lysholm score and the International Knee Documentation Committee (IKDC) score were assessed preoperatively and at the final follow-up. The Tegner activity scale was performed to evaluate patients' activity levels. Data on return to sports, patient satisfaction, subsequent injuries and complications were collected. Preoperative radiographs were used to grade OA according to the Kellgrene-Lawrence classification. Correlation analysis between OA and clinical outcomes was performed. The rates of achieving the minimal clinically significant difference and patient-acceptable symptoms state were documented. Results: A total of 37 patients were included in this study. The mean age at surgery was 62.3 +/- 2.3 years, with a mean follow-up of 6.3 +/- 3.2 years (range: 2.1-12.4). Patients showed statistically significant (all p < 0.001) improvements in the mean IKDC (38.9 +/- 9.4-66.8 +/- 12.5), Lysholm (48.8 +/- 15.4-83.0 +/- 12.8) and Tegner (1-3) scores. Fourteen patients (37.8%) returned to sports. No correlation was observed between the degree of preoperative OA and clinical outcomes (n.s.). Conclusion: Patients over 60 years with symptomatic ACL-deficient knees could benefit from ACLR, even when mild to moderate OA is present preoperatively. Level of EvidenceLevel IV.

Background Lateral patellofemoral compression syndrome (LPCS) is a condition characterized by increased lateral patellofemoral joint pressure caused by long-standing lateral patella tilt, adaptive lateral retinaculum tightening, and an imbalance in stress between the lateral and medial femoral condyles. Diagnosis of LPCS is challenging because of its complex and diverse etiology and pain mechanisms, thus we lack objective diagnostic criteria. Purpose This study aimed to explore the feasibility of various structural measurement parameters of MRI of the knee to diagnose LPCS and to identify new MRI diagnostic indicators to as references and guidance for LPCS clinical diagnosis. Methods This study enrolled 168 patients, who were divided into three groups: The LPCS group, the simple osteoarthritis (SO) group, and the normal control group (n = 56 participants per group). Diagnosis of all patients was carried out at the Department of Sports Medicine, Peking University Third Hospital. A standardized MR scanning protocol was used, including sagittal and coronal fat-suppressed proton density-weighted imaging and sagittal T1-weighted imaging. Two radiologists used the picture archiving and communication system to analyze the MR images and measure the patellarpatellar tibial angle (P-PTA), the quadriceps-patellar angle (Q-PA), the patellar length (LP), the patellar tendon length (LT), the LP/LT ratio, and the Insall-Salvati ratio (ISR). Results The LPCS group had significantly lower P-PTA and LP values, but higher LT and ISR values, compared with those in the normal and SO groups (all P < 0.05). Compared with that in the normal group, the LPCS groups' Q-PA value was higher (P = 0.034). According to receiver operating characteristic analysis, the optimal cut-off values for PPTA, LP, LP/LT, and ISR were 146.45°, 41.10mm, 0.85, and 1.19, with sensitivities and specificities of 67.86%/59.82%, 78.57%/55.36%, 67.86%/58.93%, and 66.07%/60.71%, respectively. Conclusion Measurement parameters of MRI, particularly P-PTA and ISR, can serve as important tools to assist in the diagnosis of LPCS. Assessment of these parameters should be included in the clinical diagnostic process for LPCS to improve diagnostic accuracy.

We aimed to investigate the preventive effect of vitamin D2 on COVID-19 and the improvement of symptoms after COVID-19 infection. The study recruited 228 health care workers who tested negative PCR or antigen for COVID-19. Subjects were randomly allocated to vitamin D2 or non-intervention at a ratio 1:1. Subjects recorded PCR or antigen tests and the symptoms of COVID-19 twice a week during the follow-up visit. The concentration of serum 25-hydroxyvitamin D (25(OH)D), C-reaction protein (CRP), complement component C1q and inflammatory cytokines were measured. The rates of COVID-19 infection were 50.5% in the vitamin D2 group and 52.4% in the non-intervention group (P = 0.785). There was no difference in the COVID-19 symptoms between the two groups. The mean 25(OH)D level significantly increased from 14.1 to 31.1 ng/mL after administration (P < 0.001). The difference between the two groups was not significant for the concentrations of CRP, C1q and inflammatory cytokines on the thirtieth day of the trial. According to the second level of vitamin D, there was a 14.3% difference in positive infection rates between the vitamin D adequate (> 30 ng/mL) and deficient groups (< 20 ng/mL). Adequate vitamin D had a tendency to prevent COVID-19. Trial registration: ClinicalTrials.gov NCT05673980, dated: 12/2022.