With the aging population trend, knee osteoarthritis (KOA) has gradually become one of the leading causes of disability and deformity among middle-aged and elderly people in China. As a key component of the stepped care approach for KOA, intra-articular injection (IA) plays a critical role in alleviating mild KOA and delaying the need for surgical intervention. However, despite advancements in intra-articular injection techniques and understanding, there remain numerous controversies regarding its clinical application both domestically and internationally. How to provide precise, standardized, and effective intra-articular injection therapy for KOA patients is an urgent clinical issue to address. In light of this, the expert panel of this consensus referred to international standards, the latest research evidence, guidelines, and consensus documents from China and abroad, integrating opinions from multidisciplinary experts to develop this consensus. The consensus aims to guide clinicians in the safe and standardized use of intra-articular injections, thereby improving the diagnosis and treatment level of intra-articular injection therapy within KOA stepped care. The consensus puts forward 10 recommendations, covering aspects such as the target population for KOA intra-articular injection therapy, treatment goals, selection of injectable drugs, medication strategies, and the exploration and application of new intra-articular injection biological agents. The consensus emphasizes that intra-articular injection therapy for KOA patients should be based on comprehensive individual assessment and implemented properly according to actual clinical circumstances.

To investigate the clinical value of trabecular metal augments in revision surgery for Paprosky typeⅢcomplicated acetabular bone defects, and evaluate the effectiveness in intraoperative stability, the acetabular rotation center reconstruction, and hip function improvement.

A retrospective analysis was conducted on patients with Paprosky typeⅢacetabular bone defects who underwent revision surgery at Zhejiang Provincial Hospital of Traditional Chinese Medicine between January 2016 and December 2022. Inclusion criteria: age≥18 years; total hip arthroplasty history requiring acetabular revision due to prosthetic loosening or osteolysis; radiographic confirmation of Paprosky typeⅢacetabular bone defects; complete follow-up data with a follow-up duration of at least 12 months. Exclusion criteria: active infection or unresolved previous periprosthetic joint infection; severe comorbidities precluding surgical tolerance; pathological fractures or tumor-related bone defects; incomplete clinical or radiographic data. A total of six patients were enrolled. Among them, three patients with typeⅢA defects underwent reconstruction using trabecular metal augments combined with a porous tantalum metal cup, while three patients with typeⅢB defects were treated with a cage combined with an augment. The vertical and horizontal offsets of the hip center relative to the anatomical hip center were measured, and implant stability was evaluated based on radiographic findings. Intraoperative blood loss, operative time, perioperative complications, and domain-specific Harris hip scores before surgery and at the final follow-up were recorded to assess clinical efficacy and safety. Statistical analysis was performed using paired t tests or the Wilcoxon signed-rank test as appropriate. Difference was considered statistically significant if P<0.05.

All the patients completed the follow-up. At the final follow-up, implant position remained stable, with no evidence of dislocation, screw breakage, or obvious migration, and radiographic findings indicated satisfactory osseointegration. The total Harris score increased from the (54.2±4.2) before operation to (86.9±3.0) at the final follow-up (t=12.18, P<0.01). Pain scores improved from (15.5±5.7) to (40.0±3.2) (t=9.36, P<0.01), and function scores improved from (31.8±5.3) to (39.0±4.5) (t=3.74, P<0.05). The vertical offset of the hip center decreased from (20.1±3.7) mm before operation to (6.9±2.5) mm at the final follow-up (t=8.47, P<0.01), while the horizontal offset decreased from (10.8±2.9) mm to (4.7±2.0) mm (t=6.92, P<0.01).

Augment provides effective mechanical support and favorable osseointegration in revision surgery for Paprosky typeⅢ complex acetabular defects, enabling subtype-specific reconstruction strategies across different Paprosky Ⅲ subtypes. Short- to mid-term follow-up outcomes were satisfactory.

To analyze the impact of a perioperative blood management program based on multidisciplinary collaboration on blood loss and blood transfusion rate during total knee arthroplasty (TKA).

Patients who underwent TKA in the First Affiliated Hospital of Harbin Medical University from March 2022 to February 2024 were selected. After the inclusion criteria (primary TKA for end-stage knee disease, preoperative hemoglobin≤100 g/L, normal coagulation function) and exclusion criteria (bilateral TKA, tranexamic acid allergy or contraindication, high risk or history of thrombosis, severe cardiovascular and cerebrovascular diseases) screening, 86 patients were finally enrolled the study. According to the random number table method, the participants were divided into the control group (given routine blood management scheme) and the observation group (perioperative blood management scheme based on multidisciplinary collaboration), with 43 cases in each group. T test, chi square test and other statistical methods were used to analyze and compare the intraoperative blood loss, blood transfusion rate, operation time, hemoglobin (Hb) and complications between the two groups, as well as the satisfaction of the two groups.

The intraoperative blood loss and perioperative blood transfusion volume in the observation group were less than those in the control group, the blood transfusion rate was lower than that in the control group, and the operation time was shorter than that in the control group (t=6.197, 12.742, 5.988, χ²=4.440), and the differences were statistically significant (all P<0.05). On the third day after the operation, Hb levels of both groups decreased compared with those before the operation, while Hb level of the observation group was higher than that of the control group, and the difference was statistically significant (t=3.339, P< 0.05). The total incidence of complications in the observation group was lower than that in the control group, the average length of hospital stay was shorter than that in the control group, and the patient satisfaction score was higher than that in the control group (χ²=4.440, t=2.917, 5.747), and the differences between the two groups were statistically significant (all P<0.05).

The multidisciplinary blood management program, through precise hemostasis techniques, dynamic monitoring and precise execution by the nursing team, and anemia pretreatment, can reduce blood loss and blood transfusion requirements in patients with total knee arthroplasty (TKA). Nursing plays a crucial role in carrying out medical orders, warning of complications and promoting early rehabilitation, thereby accelerating the rehabilitation process and enhancing patient satisfaction.

To evaluate the stiffness of peri-knee muscles in patients with knee osteoarthritis (KOA) using shear wave elastography (SWE) and to analyze its correlation with knee joint function.

This study was conducted at Henan Provincial Luoyang Orthopedic Hospital (Henan Provincial Orthopedic Hospital). Participants included KOA patients and healthy controls. KOA diagnosis was based on the Chinese Guideline for Diagnosis and Treatment of Osteoarthritis (2024 edition) with Kellgren-Lawrence gradesⅠtoⅢ; individuals with conditions or medication history potentially affecting lower limb muscles were excluded. Healthy control group had no relevant history and no strenuous exercise, alcohol, or caffeine intake 48 h prior. Propensity score matching (PSM) was used to balance the two groups. Shear wave elastography was used to assess the elastic modulus, reflecting muscle stiffness, of the quadriceps (vastus medialis, rectus femoris, vastus lateralis), hamstrings (semimembranosus, semitendinosus, biceps femoris long head), and gastrocnemius (medial/lateral heads). KOA patients were assessed using the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and knee range of motion (ROM). Pearson or Spearman correlation analysis was performed between muscle stiffness and WOMAC scores/knee ROM.

Compared with healthy group, KOA patients showed increased stiffness in the rectus femoris (Z=–2.45, P=0.014), semimembranosus (Z=–2.15, P=0.032), semitendinosus (Z=–3.97, P<0.001), and biceps femoris long head (Z=–2.49, P=0.013), and the differences were statistically significant. After correction, correlation analysis in KOA patients showed that hamstring stiffness was positively correlated with total WOMAC score and its subscales (pain, stiffness, physical function) and negatively correlated with knee ROM. Specifically, semimembranosus stiffness correlated positively with total WOMAC (r=0.596), pain (r=0.463), stiffness (r=0.478), and physical function (r=0.632) (all P<0.01), and negatively with ROM (r=–0.641, P<0.001). Semitendinosus stiffness correlated positively with total WOMAC (r=0.437), pain (r=0.451), stiffness (r=0.458), and physical function (r=0.420) (all P<0.05), and negatively with ROM (r=–0.507, P<0.01). Biceps femoris long head stiffness correlated positively with total WOMAC (r=0.585), pain (r=0.587), stiffness (r=0.510), and physical function (r=0.547) (all P<0.001), and negatively with ROM (r=–0.485, P<0.01).

Increased hamstring stiffness is associated with worse knee function and reduced ROM in KOA. Targeted intervention on these specific muscles may represent a novel strategy for improving knee function in KOA patients.

To study the mechanical characteristics of the meniscus after ramp injury using the method of finite element analysis and provide a reference for clinical management.

A detailed finite element model of the knee joint bone, cartilage, meniscus, and major ligaments (patellar ligament, anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and lateral collateral ligament) was constructed by combining computed tomography and magnetic resonance imaging, of based on which a knee model of meniscal ramp injuries was constructed built, covering the four types of injuries in the Thaunat classification (type Ⅱ to type Ⅴ). A vertical load (650 N) and an anterior load (134 N) were applied to simulate the force patterns at different knee flexion angles (0°, 30°, 60°, 90°) to evaluate the stresses and displacements at the meniscal ramp injury.

The angle of flexion increased, the changes in displacement and stress at the meniscal tear were more significant in the finite element models of type Ⅳ and V ramp injuries compared to type Ⅱand Ⅲ meniscal ramp injuries. When the knee flexed at 60°, the maximum stress at the type Ⅳ and Ⅴ meniscal ramp injuries was approximately 3.5 to 4.2 times higher than that of the intact meniscus, and the displacements at the injuries were nearly four to five times higher than those of the intact meniscus. When the knee flexed at 90°, the maximum stress and displacements at the ramp injury were approximately 2.4 to 2.9 and 3.5 to 3.9 times higher than those of the intact meniscus for type Ⅳ and type Ⅴ menisci, respectively. The meniscus was most stressed in the 60° flexion condition in these two subtypes of ramp injury. Except for 60° and 90° of flexion and internal rotation, no remarkable difference existed between the Ⅳ and Ⅴ meniscal ramp injury models and the intact meniscus.

When the knee is stable and the tear length is less than two centimetres, type Ⅱand Ⅲ meniscal ramp injuries can be treated non-operatively, while surgical repair may be chosen for type Ⅳ and Ⅴ meniscal ramp injuries .

To systematically evaluate the effect of virtual reality exercise in patients with knee osteoarthritis and provide evidence for clinical practice.

Computerized searches of PubMed, Web of Science, the Cochrane Library, Excerpta Medica Database (Embase), China National Knowledge Infrastructure(CNKI), China Science and Technology Journal Database (VIP), Wanfang Data Knowledge Service Platform, and the Chinese Biomedical Literature Database were conducted from inception to 30 April 2025. Randomized controlled trials (RCTs) comparing the efficacy of virtual-reality-based exercise interventions with usual care in individuals with knee osteoarthritis were eligible for inclusion. Primary outcomes included pain intensity, functional scores, or walking-related tests. Non-primary publications, duplicate reports, non-English or non-Chinese articles, and studies for which full texts were unobtainable were excluded. Study selection, data extraction, and quality assessment were performed independently by two reviewers. Meta-analysis was conducted using RevMan software 5.4. Sensitivity analysis and publication bias assessment were performed using Stata 18.0.

Eleven studies involving 613 patients were included. The meta-analysis showed that compared to the control group, the virtual reality exercise intervention group demonstrated significant improvements in pain score [standardized mean difference (SMD)= -1.30, 95% confidence interval (CI) (-2.10, -0.51), P=0.001], total WOMAC score [SMD= -1.51, 95% CI (-2.46, -0.55), P=0.002], and Hospital for Special Surgery (HSS) knee score [mean difference (MD)= 5.80, 95% CI (4.60, 7.00), P<0.001]. However, no statistically significant difference was found in the 10-meter walk test [MD= 2.24, 95% CI (-2.26, 6.75), P>0.05].

Virtual reality exercise can alleviate pain and improve functional outcomes in patients with knee osteoarthritis. Future high-quality, large-sample RCTs are required to further validate these effects and optimize intervention protocols.

Osteoarthritis (OA), as a whole-joint degenerative disease, is difficult to reverse cartilage degeneration through traditional treatments. Mesenchymal stem cell-derived exosomes (MSC-Exo) have shown great potential due to their stability, low immunogenicity, and targeted delivery ability. MSC-Exo can delay the progression of OA by regulating the metabolic balance of chondrocytes, enhancing cartilage matrix production, and macrophage polarization, and inhibiting the inflammatory cascade reaction. In recent years, research on engineered exosomes has made breakthroughs, such as optimizing the drug-loading capacity and therapeutic effect of exosomes through targeted peptide modification or nanotechnology, providing new ideas for OA treatment. However, the clinical translation of MSC-Exo still faces many challenges, including the standardization of preparation methods, in-depth analysis of mechanisms of action, and the lack of clinical research data. This article reviewed the application prospects and challenges of MSC-Exo in OA treatment.

Osteoarthritis is a common joint disease characterized by cartilage damage and chronic inflammation, significantly affecting the quality of life of patients. Recent studies suggest that neutrophils, as important immune cells, play a critical role in the pathogenesis of osteoarthritis. Neutrophils are involved not only in inflammatory responses but may also influence the cartilage repair process. However, current research on the role of neutrophils in osteoarthritis still requires further investigation. This review aimed to summarize the role of neutrophils in osteoarthritis and its underlying mechanisms, and assess the therapeutic potential of targeting neutrophils, providing new insights and directions for future research and treatment.

Osteonecrosis of the femoral head (ONFH) represents a debilitating progressive disorder driven by multifactorial etiologies that impair osseous vascularization and trigger osteocyte death, with no definitive therapeutic intervention currently established. Pathological progression involves apoptotic cascades within osteocytic networks and trabecular microarchitectural deterioration, culminating in catastrophic biomechanical failure of the femoral head through subchondral collapse and articular cartilage disintegration. Contemporary management prioritizes early-stage joint preservation strategies to decelerate disease advancement and avert structural collapse. Core decompression (CD), while serving as the cornerstone surgical modality for necrotic debridement, paradoxically destabilizes subchondral mechanical integrity, thereby potentiating collapse acceleration. To mitigate this iatrogenic risk, CD is increasingly augmented with osteoconductive grafts or synthetic bone substitutes to simultaneously reconstitute load-bearing frameworks and stimulate endogenous osteogenesis. Modern synthetic bone scaffolds have gained prominence in ONFH therapy due to their exceptional biocompatibility, osteogenic potential, and scalable manufacturing. Recent paradigm shifts in material design transcend conventional paradigms of biocompatibility and passive osteoconduction, instead prioritizing convergent engineering approaches that synchronize osteoimmunomodulatory precision with biomechanical resilience. This strategic integration aims to orchestrate a harmonious equilibrium between immunometabolic bone niche modulation and structural reinforcement. The present review critically evaluated state of the art innovations in bioengineered bone substitutes for ONFH, offering evidence-based perspectives to refine clinical translation and material optimization.

Steroid-induced osteonecrosis of the femoral head (SONFH) is a non-traumatic osteonecrotic disorder characterized by persistent disruption of the bone marrow microenvironment, a process that cannot be fully explained by vascular insufficiency or bone tissue necrosis alone. Emerging evidence has identified marrow adipogenic lineage precursors (MALPs) as a bone marrow-specific mesenchymal cell subpopulation that plays a critical role in regulating marrow homeostasis, vascular remodeling, and bone turnover. However, the functional significance and pathological involvement of MALPs in SONFH remain insufficiently defined.This review integrated recent advances in MALP biology with the traditional Chinese medicine (TCM) theory of Wei deficiency-blood stasis-marrow atrophy, and systematically analyze the potential stage-dependent roles of MALPs in the initiation and progression of SONFH from the perspective of global bone marrow microenvironmental imbalance. Available evidence suggests that during Wei deficiency stage, long-term or high-dose glucocorticoid use may induce abnormal expansion of MALPs, accompanied by impaired marrow homeostatic regulation. During the blood stasis stage, MALPs participate in vascular regulation through the secretion of angiogenic factors, while their functional dysregulation disrupts microcirculatory reconstruction and markedly promotes osteoclastogenesis in a receptor activator of nuclear ractor kappa B ligand (RANKL)-dependent manner, thereby amplifying the coupling between vascular dysfunction and excessive bone resorption. In the marrow atrophy stage, MALPs undergo further fate shifts toward adipocytes and myofibroblasts, resulting in sustained loss of regulatory and reparative capacity, progressive exhaustion of marrow regenerative potential, and ultimately irreversible vascular compromise and structural bone damage.Collectively, MALPs should not be regarded merely as adipogenesis-related cells in SONFH, but rather as central regulatory nodes that dynamically participate in bone marrow microenvironmental remodeling across disease stages. Wei deficiency-blood stasis-marrow atrophy theory provides a coherent conceptual framework for understanding the stage-specific functional transitions of MALPs in SONFH. Further investigation into MALP plasticity and microenvironmental regulatory functions may offer novel mechanistic insights and support the optimization of TCM -based therapeutic strategies for SONFH.

This review aimed to sort out the current development status of imaging examination techniques for early knee degenerative disease (knee osteoarthritis) and the integrated application of these techniques with artificial intelligence deep learning technology, so as to provide references for the optimization of clinical diagnosis and relevant academic research. By searching two English literature databases, relevant research literatures were collected using appropriate keywords; after excluding duplicate, low-relevance, and low-quality literatures, 46 high-quality literatures were finally selected for systematic analysis. Clinically common imaging examination techniques each have their own characteristics and can help detect some lesion features in the early stage of the disease, while some novel imaging techniques can capture subtle changes of lesions more accurately. The combination of deep learning technology with these imaging examinations has exhibited good performance in automatically identifying lesion locations, judging disease severity, and predicting disease progression trends, which significantly improves the efficiency and accuracy of diagnosis. However, the related technologies currently still have problems such as insufficient generalization ability and the need for improved standardization. Imaging examination techniques for early knee degenerative disease are continuously developing, and their integration with deep learning provides a new path for precise and efficient disease assessment in clinical practice. In the future, it is necessary to further optimize the stability and clinical adaptability of the technologies to promote their wider application in clinical practice.

To investigate the clinical effect of a novel arthroscopic suspension fixation without coracoid bone tunnel in the treatment of acute acromioclavicular joint dislocation (ACJD).

A retrospective analysis was carrideout on the clinical data of patients who underwent arthroscopic suspension fixation without coracoid bone tunnel for ACJD treatment at Jiangning Hospital affiliated with Nanjing Medical University during January 2022 to December 2024 were included. Clinical data collected included age, sex, Rockwood classification, operative time, pre- and postoperative visual analog scale (VAS) pain scores on the first postoperative day, and Constant-Murley shoulder scores at six months after surgery. The size of the coracoclavicular interval was measured through X rays before surgery, one day, one and six months after surgery to monitor any loss of reduction.Paired non-parametric tests, paired t tests, and one-way repeated-measures analysis of variance were used separately to compare preoperative and postoperative VAS scores, shoulder joint scores, and changes in the coracoclavicular interval.

A total of 21 patients with ACJD were included, all treated with arthroscopic suspension fixation without coracoid bone tunneltechnique. Among them, there were 11 males and 10 females, with a median age of 39 years. The average duration from injury to surgery was (2.8±1.0) d, and the mean surgical duration was (118±11) min. Postoperative VAS scores significantly decreased (Z=-230.0, P<0.001). The Constant-Murley score also significantly improved (t=30.90, P<0.001). The coracoclavicular distances before surgery,one day, one and six months after surgery were (24.0±4.1) mm, (5.2±1.0) mm, (5.6±1.1) mm, and (5.7±1.1) mm, respectively. The differences of coracoclavicular intervals among the time points of before surgery, one day, one month and six months after surgery were statistically significant (corrected F=467.10, P<0.001). The coracoclavicular intervals at one day, one month, and six months after surgery were significantly smaller than the preoperative values (all P<0.001), while there was no significant difference in the coracoclavicular distance between one day, one and six months after surgery (all P>0.05).

Arthroscopic suspension fixation without coracoid bone tunnel for ACJD can relieve shoulder joint pain, maintain shoulder joint function, and achieve satisfactory clinical efficacy.

To overcome the drawbacks of traditional open surgery and the risk of iatrogenic injury of percutaneous needle techniques by developing a fully visualized, minimally invasive approach for trigger-digit release.

A hybrid shield needle (hybrid-J shield needle, HJ) was designed that combined a blunt stylet and cannula. Under continuous high-resolution ultrasound guidance, a curved needle carrying a thread loop was passed around the A1 pulley; the loop was then used to cut and release the tendon sheath without sharp instrumentation, so that the tendon and adjacent neurovascular structures were protected.

The procedure was technically feasible and provided immediate and adequate release with minimal trauma, while few post-operative complications was observed.

The modified Ultrasound-guided curved-needle loop release offers a minimally invasive, safe, and fully visualized alternative for trigger-digit stenosing tenosynovitis, while longer follow-up and larger series are required to confirm its broad applicability and sustained efficacy.

To develop a reliable classification system based on the anatomical characteristics of distal femoral fractures combined with dislocations, thereby providing a reference for clinical management.

Patients with femoral condylar fractures and knee dislocations caused by trauma, who had complete imaging data (X-ray and CT), were included between August 2012 and January 2024. Those with pathological or old fractures, unclear or missing imaging data, or incomplete follow-up records were excluded. To establish the fracture-dislocation classification system, a research team consisting of one director and nine attending physicians in orthopedic trauma reviewed and discussed 90 cases, ultimately developing a new classification system. Inter- and intra-observer reliability was determined using Fleiss’ kappa and Cohen’s kappa tests by ten independent evaluators, leading to the proposal of a standardized clinical management protocol.

The newly established classification system categorized cases into three types. Type A: distal femoral fracture with patellofemoral joint dislocation; type B: distal femoral fracture with tibiofemoral joint dislocation; type C: distal femoral Hoffa fracture with knee joint dislocation.The mean intra-observer agreement was κ= 0.923 among the ten research team members, and the mean intra-observer agreement was κ=0.931 among the ten evaluators. Based on the new classification system, a standardized clinical diagnostic and treatment workflow was established.

The study demonstrates that the new classification system for distal femoral fracture-dislocations exhibits high inter-observer reliability. By integrating both fracture and dislocation components, this system effectively addresses injury patterns that traditional classifications fail to categorize, thereby assisting clinicians in optimizing workflow and selecting appropriate treatment strategies.

To investigate the preliminary clinical efficacy of arthroscopic microfracture combined with platelet-rich plasma (PRP) in the treatment of knee osteoarthritis.

From January 2020 to January 2022, 70 patients with knee osteoarthritis admitted to the orthopedics department of Zhongshan Torch Development Zone People’s Hospital were randomly divided into the experimental group and the control group using a double-blind method, 35 cases in each group. The control group underwent arthroscopic microfracture treatment, while the experimental group received PRP gel treatment in addition to the same procedure. The incidence of complications, as well as changes in pain and range of motion of the affected knee at three, six and 12 months after surgery, were compared between the two groups using the visual analogue scale (VAS) and Western Ontario and McMaster Universities osteoarthritis index (WOMAC). MRI changes of the affected knee at three, six and 12 months after surgery were also compared. Continuous data were analyzed using t test or mixed-effect model, and categorical data were analyzed by chi square test.

At 12 months after treatment, the total effective rate in the experimental group was 94%, which was significantly higher than that (83%) of the control group, with a statistically significant difference (χ²=4.12, P<0.05). There was no statistically significant difference in VAS scores between the experimental group and the control group at three months after treatment (P>0.05). VAS scores in the experimental group were significantly lower than those in the control group at six and 12 months after treatment (six months: t=2.163, P=0.038; 12 months: t=5.632, P<0.001). WOMAC functional scores of the knee in the experimental group were lower than those in the control group at three, six and 12 months after treatment (three months: t=3.463, P=0.001; six months: t=3.417, P=0.002; 12 months: t=4.343, P<0.001). Furthermore, at the 12-month follow-up after treatment, MRI showed varying degrees of improvement in the range of knee cartilage defects in both groups.

For middle-aged and elderly patients with knee osteoarthritis, arthroscopic microfracture combined with PRP treatment can significantly alleviate pain, improve knee joint function, and promote favorable postoperative recovery. This approach is worthy of clinical application and promotion.