Knee osteoarthritis (KOA) is a common degenerative joint disorder that substantially affects the quality of life of a large proportion of the aging population worldwide. Since the publication of ＜the 2018 Expert consensus on the stepped treatment of knee osteoarthritis＞, the stepped treatment of knee osteoarthritis has been widely implemented and clinically validated, demonstrating significant benefits in symptom relief and functional improvement. As a core therapeutic concept, the stepped treatment approach emphasizes the selection of individualized interventions according to disease stage and symptom severity. Through sequential and progressive treatment strategies, it aims to provide effective management for patients with KOA at different stages, alleviate pain, improve joint function, and enhance health-related quality of life. This updated expert consensus retains the fundamental principles of stepped treatment while incorporating recent advances in therapeutic techniques and scientific evidence. Emerging biological therapies have demonstrated potential in the management of early-to moderate-stage KOA, providing additional treatment options within the stepped care framework. Furthermore, the integration of digital-assisted technologies has enabled more personalized and precise treatment strategies, particularly in surgical management, by improving procedural accuracy and potentially optimizing postoperative outcomes. This revision focused on updating novel concepts, emerging approaches, and advances in KOA stepped treatment. The objective of this consensus is to provide evidence-based, standardized, and practical recommendations for healthcare providers, medical institutions, and clinicians at different levels of care, thereby facilitating the effective implementation of stepped treatment t strategies for KOA.

To observe and compare the clinical efficacy differences between the modified single-row enhanced technique (sunglasses loop) repair and the traditional double-row suture bridge repair in the treatment of medium-sized rotator cuff tears, and to provide theoretical basis and technical support for optimizing the rotator cuff repair plan.

Inclusion criteria: preoperative MRI-confirmed supraspinatus tear of three to five centimetres, failed conservative treatment, repairable tendon, and follow-up at least 12 months. Exclusion criteria: previous ipsilateral shoulder surgery, infection, severe arthritis, irreparable defect, etc. According to the inclusion and exclusion criteria, a total of 116 patients with moderate rotator cuff tears who underwent arthroscopic rotator cuff repair in Zhuhai People’s Hospital from May 2022 to May 2024 were selected and divided into the sunglasses loop group (n=61) and the double-row suture bridge group (n=55) according to the surgical methods. All the patients in both groups had MRI examinations before the operation to confirm supraspinatus tendon tears, with the tear range beingthree to five centimeters, and all were unilateral lesions. The observation indicators included the operation time during the surgery, the Constant-Murley shoulder function score and visual analogue scale (VAS) before the operation and at one, three, six and 12 months after the operation, as well as the MRI assessment of healing at 12 months after the operation. Continuous variables comparison performed by independent t test, categorical variables analysis used chi square test.

Both groups showed significant improvement in Constant and VAS scores postoperatively (paired t test, P<0.05). The sunglasses loop group had significantly higher Constant scores at three, six and 12 months than the double-row suture bridge group (t=3.39, 2.69, 2.86, all P<0.01), and significantly lower VAS scores (t=-2.48, -2.63, -2.80, all P<0.05). Operation time was significantly shorter in the sunglasses loop group (t=-10.14, P<0.001). Postoperative MRI showed a complete healing rate of 88.5% in the sunglasses loop group, which was superior to 76.4% in the double-row suture bridge group.

For medium-sized rotator cuff tears, the modified single-row enhanced technique (sunglasses loop) shows shorter operation time, better mid-term functional and pain scores, and a higher imaging-documented healing rate compared to the traditional double-row suture bridge repair, it may provide an effective alternative in clinical practice. This conclusion is derived from a retrospective analysis and warrant further validation through well-designed prospective, randomized controlled studies to confirm its efficacy and superiority.

To analyse the effect of foot and ankle functional trainer combined with visual feedback balance function training in postoperative motor ability of elderly hip fracture patients based on propensity score matching (PSM).

From December 2022 to June 2024, 120 elderly patients with hip fractures who were admitted to Xuzhou Central Hospital were selected as the research subjects. Inclusion criteria: (1) age ≥60 years; (2) clinically diagnosed with hip fractures through imaging; (3) received surgical treatment for hip fractures during their hospital stay. Exclusion criteria: (1) pathological fractures caused by tumors, hyperparathyroidism, etc.; (2) concurrent fractures in other parts or previous hip surgeries; (3) severe neurological diseases or dementia; (4) incomplete clinical data. The patients were divided into the combined group (n=52) and the control group (n=68) based on different training methods. After 1∶1 matching using PSM, 46 patients were in each group. Among them, the combined group received combined training with a foot and ankle functional trainer and visual feedback balance function training, while the control group received training with a single foot and ankle functional trainer. The differences in the lower limb part of the Fugl-Meyer motor function rating scale (FMA-L), Harris hip fuction score (HHS-F), and Berg balance scale (BBS) before and after treatment were compared between the two groups. Count data were expressed as the number of cases (n) and rate (%), and chi square test was performed; for data that met normal distribution, they were expressed using and independent sample t test was used for group comparison.

After PSM, there was no statistically significant difference in the baseline data between the two groups (all P>0.05). After eight weeks of intervention, the FMA-L scores of both groups were higher than those before the intervention, and the combined group (33.1±3.1) points were higher than the control group (22.0±3.0) points (t=17.448, P<0.05); the HHS-F scores of both groups were higher than those before the intervention, and the HHS-F score of the combined group (85±5) points and its excellent rate (89.1%) were higher than those of the control group (82±5) points, (78.3%) (t=2.788, P<0.05); the BBS scores of both groups were higher than those before the intervention, and the combined group was (45.5±3.5) points higher than the control group (33.8±3.2) points (t=16.666, P<0.05).

Foot and ankle functional trainer combined with visual feedback balance function training can effectively improve the postoperative motor ability as well as balance function of elderly hip fracture patients, and PSM analysis supports the reliability of its effect, which has clinical promotion value.

To investigate the effect of esketamine on postoperative cognitive function in elderly hip arthroplasty patients.

This prospective study enrolled 114 elderly patients who underwent hip replacement surgery at Chengdu Western Hospital between December 2020 and December 2022. Inclusion criteria: age >60 years, American Society of Anesthesiologists (ASA) classification Ⅱ to Ⅲ, and undergoing unilateral hip replacement surgery. Exclusion criteria: severe cardiac, hepatic or renal insufficiency; history of allergy to anesthetic agents; severe psychiatric or neurological disorders; and long-term use of sedatives, anticoagulants, or similar medications. The patients were randomly assigned to two groups using a random number table, the control group and the intervention group with 57 patients in each. The control group received anesthesia with an equivalent volume of normal saline, while the intervention group received anesthesia with esketamine. Cognitive function was assessed using the mini-mental state examination (MMSE). Repeated-measures analysis of variance (ANOVA) was used to compare MMSE scores between the two groups on the day before surgery and on one, three and seven days after surgery; independent-sample t test was used to compare postoperative recovery outcomes (time to respiratory recovery, time to eye opening, time to first ambulation, and length of hospital stay) between the two groups; repeated-measures analysis of variance was used to compare heart rate (HR), mean arterial pressure (MAP), and Ramsay sedation scores between the two groups at five minutes before anesthesia induction (T0), at the time of induction (T1), one minute after intubation (T2), one minute after skin incision (T3), and at the end of surgery (T4). Independent-sample t test was used to compare stress response indicators between the two groups on the day before surgery and the day after surgery; and chi square test was used to analyze the incidence of adverse reactions in the two groups.

The MMSE score of the study group was significantly higher than that of the control group on the first, third and seventh day after operation (t=9.394, 10.719, 6.352, all P<0.05). There was no statistically significant difference between the two groups in respiratory recovery time, time to open eyes and time to get out of bed for the first time (all P>0.05). Compared with the control group, the hospitalization time of the study group was significantly shorter (t=2.994, P<0.05), and the postoperative delirium rate of the study group (8.8% vs 29.8%) was significantly lower (χ²=8.111, P<0.05). Ramsay sedation score in the study group was significantly higher than that in the control group at T1, T2, T3 and T4 (t=7.363, 6.062, 16.187, 15.735, all P<0.05). The levels of epinephrine, norepinephrine, factor-α (TNF-α), C-reactive protein (CRP), and interleukin (IL) -6 were lower in the study group than in the control group at one day after operation (t=6.063, 3.865, 2.582, 9.083, 2.810, all P<0.05). The incidence of adverse reactions between the study group and the control group (40.3% vs 38.6%) was not statistically significant (P>0.05).

The application of esketamine in elderly patients with hip arthroplasty can effectively reduce the stress response, improve the sedation effect, reduce the postoperative cognitive impairment, and promote the early recovery of patients.

To investigate the associations of six-degree-of-freedom (6-DOF) continuous gait characteristics of the hip, knee, and ankle joints and dual-task cost (DTC) with fall risk in hospitalized older adults under single-task walking and dual-task walking (DTW) conditions with different cognitive loads.

A total of 156 older patients admitted to Taikang Xianlin Drum Tower Hospital, Nanjing, from May 2024 to June 2025 were enrolled. Patients aged ≥60 years who were conscious, able to walk independently for >10 m, and willing to participate were included. Patients who were unable to complete the walking tests because of severe trauma or other conditions, whose falls were caused by external violence or acute diseases, or who declined participation were excluded. Demographic characteristics and lower-limb six-degrees of freedom gait data were collected at baseline during single-task walking and three DTW conditions, including (100-1) DTW, (100-7) DTW, and digit-memory DTW, and DTC was calculated. Falls were recorded during a one-year follow-up. Depending on data distribution, between-group comparisons were performed using the independent-samples t test or Mann-Whitney U test. Continuous six-degrees of freedom gait curves were compared using one-dimensional statistical parametric mapping (SPM1D), and receiver operating characteristic analysis was used to evaluate the discriminative ability of DTC for fall risk.

Among the 156 patients, 46 experienced falls, corresponding to a fall rate of 29.5%. During single-task walking, no significant between-group differences were observed in gait speed (t=0.342), gait cycle (Z=0.312), step length (Z=0.734), or cadence (t=0.354) (all P>0.05). Under all three DTW conditions, the fall group showed lower gait speed, step length, and cadence and a longer gait cycle (all P<0.05). DTC was significantly higher in the fall group during (100-1) DTW, (100-7) DTW, and digit-memory DTW (t=3.885, 4.221, and 5.112, respectively; all P<0.001). Analysis of the six-degrees of freedom gait curves showed reduced upward displacement of both knees in the fall group. The minimum SPM{t} values for the left knee during single-task walking, (100-1) DTW, (100-7) DTW, and digit-memory DTW were −4.3, −4.7, −4.6, and −5.6, respectively, while those for the right knee were −2.5, −3.7, −4.7, and −5.2, respectively (all P<0.01). Right-knee extension angles were greater in the fall group, with corresponding maximum SPM{t} values of 4.6, 5.2, 6.1, and 6.3, respectively (all P<0.05). Under DTW conditions, ankle extension angles were greater in the fall group during several phases of the gait cycle; the maximum SPM{t} values were 3.7 for the left ankle and 5.8 for the right ankle during (100-1) DTW, 5.0 for the right ankle during (100-7) DTW, and 4.1 for the right ankle during digit-memory DTW. In addition, the right-hip abduction angle was greater in the fall group during 7%–73% of the gait cycle in (100-7) DTW [maximum SPM{t}=2.93, P<0.01] and during 8% to 71% of the gait cycle in digit-memory DTW [maximum SPM{t}=2.89, P<0.01]. During digit-memory DTW, the left-knee abduction angle was greater during 67%–94% of the gait cycle [maximum SPM{t}=2.16, P=0.014]. The left-ankle adduction angle was also greater during 26%–65% of the gait cycle in (100-1) DTW [maximum SPM{t}=4.40] and during 26% to 32% and 40% to 65% of the gait cycle in (100-7) DTW [maximum SPM{t}=4.20].

Compared with single-task walking, dual-task walking may further reveal gait abnormalities in older patients at risk of falls, characterized by deterioration in conventional gait parameters, increased DTC, and altered 6-DOF movement patterns of the hip, knee, and ankle joints during specific phases of the gait cycle. Continuous 6-DOF gait analysis combined with DTC may provide objective kinematic evidence for identifying fall risk in hospitalized older adults.

To investigate the safety and feasibility of opioid-free anesthesia with esketaminein patients undergoing total knee arthroplasty (TKA).

A total of 202 patients aged 18 to 75 years who underwent TKA in Panzhihua Central Hospital were enrolled, with American Society of Anesthesiologists (ASA) grades Ⅱ to Ⅲ, body mass index (BMI) of 18 to 30 kg/m², and without coagulation abnormalities before surgery or history of anesthetic drug allergy. Using a computer generated random number table, patients were randomly divided into the opioid anesthesia (OA) group (n=101) and the opioid-free anesthesia (OFA) group (n=101) according to odd/even numbers. Independent samples t test, chi square test, and repeated measures analysis of variance were used to compare the two groups in terms of anesthesia-related indicators, analgesic and sedative effects, hemodynamic indicators, incidence of postoperative chronic woundpain, and incidence of adverse reactions.

Compared with the OA group, the OFA group showed significant reductions in wake-up time, time to extubation, post-anesthesia care unit (PACU) stay, time to first ambulation, and total dosage of sufentanilin 48 h after surgery (t=12.558, 15.065, 11.830, 15.126, 30.852, all P<0.05). There were statistically significant differences in the visual analogue scale (VAS) scores in resting and motion states, and Ramsay sedation scale (RSS) scores in terms of interaction, inter-group, and time effects (F=13.111, 42.860, 57.079; F=9.683, 28.574, 42.106; F=9.091, 32.258, 65.217; all P<0.05). Compared with the OA group, the OFA group had lower VAS scoresin resting state at four, six, 12, 24 and 48 h after surgery (t=32.648, 21.55, 24.448, 24.428, 29.700, all P<0.05), andlower RSS scores at 6 h and 12 h after surgery (t=11.126, 31.115; all P<0.05). There were statistically significant differences in heart rate, mean arterial pressure and bispectral index (BIS) values in terms of interaction effect (F=15.789, 98.765, 12.346; F=13.462, 78.947, 10.870; F=3.875, 43.478, 57.011; all P<0.05). Compared with the OA group, the OFA group had significantly higher heart rate, mean arterial pressure and BIS values at T1, T2, T3, and T4 (t=11.751, 10.081, 7.688, 3.108; t=14.235, 9.270, 4.612, 2.085; t=5.624, 6.857, 5.813, 6.717, all P<0.05). The incidence of chronic wound pain was significantly lower in the OFA group than in the OA group at one, three, and six months after surgery (χ²=6.931, 9.727, 15.732, all P<0.05). The incidence rates of postoperative nausea and vomiting, and respiratory depression were significantly lower in the OFA group (χ²=4.028, 6.733, all P<0.05).

Opioid-free anesthesia with esketamine can achieve good anesthetic and analgesic effects on patients undergoing TKA, with clear advantages in reducing perioperative opioid dosage, stabilizing perioperative hemodynamics, and reducing postoperative chronic pain.

To investigate the clinical efficacy of the screwcement technique for reconstructing noncontained posteromedial tibial plateau bone defects during total knee arthroplasty (TKA) in patients with Kashin-Beck disease (KBD).

This study included patients who underwent TKA between November 2018 and December 2023 and met the following criteria: diagnosis of KBD according to the Chinese diagnostic standard (WS/T 10026—2024), failure of conservative treatment, presence of non contained posteromedial tibial plateau defects with varus deformity, and no contraindications to surgery. Exclusion criteria: knee surgery or fracture histories, valgus or other extra-articular knee deformities, neurological disorders affecting function, and active infection. Patients were stratified by defect depth: those with defects ≤10 mm were assigned to the shallow defect group, and those with defects >10 mm to the deep defect group. All the patients underwent bone defect reconstruction using the screw cement technique. Preoperative and final follow-up data were recorded, including the Knee Society score (KSS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC) score, range of motion (ROM), radiographic findings, and tibiofemoral angle (TFA). Prosthesis implantation and the number of screws used were also documented. Paired t tests were used for within group comparisons between preoperative and postoperative continuous variables, equivalence testing was applied for intergroup efficacy comparisons, and chi square test was used to compare the incidence of radiolucent lines.

A total of 48 patients (50 knees) were enrolled, including two patients with bilateral involvement. The shallow defect and deep defect groups each comprised 25 knees. The mean defect depths were (6.4±2.9) mm and (15.1±3.2) mm, respectively. There were no statistically significant differences in gender, age, or body mass index between the two groups (all P>0.05). The follow up duration was (49±11) months for the shallow defect group and (54±18) months for the deep defect group. Both groups showed significant improvements in KSS clinical (t=-37.516, -19.859) and functional scores (t=-110.667, -40.208) , WOMAC scores (t=19.105, 11.941) and ROM (t=-33.963, -15.531) after surgery (all P<0.001). At the final follow up, all prostheses were well fixed without loosening or migration. Radiolucent lines <two millimeters at the bone cement interface were observed in 23 cases (eight in the shallow defect group and 15 in the deep defect group), with no progressive widening during follow up and no cases of subsidence or osteolysis. TFA [(166.1±5.5)° vs (166.9±5.6)°] showed no statistically significant difference between groups before surgery (P>0.05). Compared with the data before surgery, TFA values were significantly improved in both groups after surgery (t=-8.229, -7.132, both P<0.001), with no statistically significant difference between two groups (P>0.05). Equivalence testing demonstrated that the postoperative clinical outcomes and correction of lower limb alignment were equivalent between the two groups.

The screw cement technique is a viable option for reconstructing non contained posteromedial tibial plateau defects in KBD patients undergoing TKA. It effectively restores knee biomechanical performance, provides reliable fixation in the short term, and is cost effective, making it particularly suitable for widespread application in the impoverished KBD affected population.

To explore the differences and roles of fibular morphology in patients with knee osteoarthritis of different severity levels, as well as in knee osteoarthritis with various deformities.

A retrospective analysis was conducted on patients who visited the Dali Bai Autonomous Prefecture People’s Hospital from January 2021 to October 2023. Inclusion criteria: patients aged ≥18 years, with standard standing full-length radiographs of the lower extremities and diagnosis of knee osteoarthritis. Exclusion criteria: history of lower limb trauma or surgery, lower limb skeletal dysplasia or bone diseases. A total of 269 patients (447 knees) were finally included, comprising 75 males and 194 females, with age ranging from 18 to 86 years. The Kellgren-Lawrence (K-L) grading system was used to assess the radiological severity of knee osteoarthritis. Radiological measurement indicators included: hip-knee-ankle angle, total fibular curvature, proximal fibular curvature, distal fibular curvature, fibular-tibial distance, and tibiolfibular interosseous space area. Univariate analysis was first performed to evaluate the differences in fibular morphological indicators in the occurrence and progression of knee osteoarthritis, followed by logistic analysis to determine the role of each fibular morphological indicator in the occurrence and progression of knee osteoarthritis.

With the increase in K-L grading, no significant differences were observed in overall total fibular curvature, proximal fibular curvature, distal fibular curvature, fibular-tibial distance, and tibiolfibular interosseous space area among the groups (P>0.05). The proximal fibular curvature and distal fibular curvature in the varus knee osteoarthritis group were both greater than those in the valgus knee osteoarthritis group, with statistically significant differences (t=1.985, -3.642, both P<0.05), while overall total fibular curvature, fibular-tibial distance, and tibiolfibular interosseous space area showed no significant differences among the groups (all P>0.05). Binary logistic regression analysis indicated that differences in proximal fibular curvature [odds ratio (OR)=1.312, 95% confidence interval (CI) (1.071, 1.607) , P=0.009] and distal fibular curvature (OR=0.712, 95% CI (0.589, 0.861), P<0.001) were statistically significant.

This study found no statistically significant differences in fibular morphological imaging parameters between groups of different severity of knee osteoarthritis. However, differences were observed in the proximal and distal fibular curvatures between varus and valgus knee osteoarthritis. Proximal fibular curvature may be a risk factor for knee osteoarthritis in varus deformity, Distal fibular curvature may also be a protective factor for varus deformity knee osteoarthritis.

To investigate the effects of modified Shenling Baizhu powder on succinate-induced mitochondrial oxidative stress injury in osteoarthritis (OA) chondrocytes and its potential downstream mechanisms.

The effects of different concentrations of diethyl succinate (DS) and medicated serum containing modified Shenling Baizhu powder on chondrocyte viability were assessed using the cell counting kit-8 (CCK-8) assay, followed by Dunnett’s test. Subsequently, an OA-like chondrocyte model was established by lipopolysaccharide (LPS) stimulation. The cells were divided into the control group, LPS group, DS group, and DS+JWSLBZS group (DS plus 5% medicated serum containing modified Shenling Baizhu powder). Extracellular matrix changes were evaluated by toluidine blue and alcian blue staining, and the expression levels of type II collagen (COL2) and matrix metalloproteinase (MMP)13 were detected by immunofluorescence. Oxidative stress was assessed by measuring reactive oxygen species (ROS) levels and superoxide dismutase (SOD) activity, with all pairwise comparisons among groups performed using Tukey’s multiple-comparison test. Mitochondrial ultrastructure was examined by transmission electron microscopy. Transcriptome sequencing was performed to identify differentially expressed genes and potential target genes of modified Shenling Baizhu powder, followed by gene ontology (GO), Kyoto encyclopedia of genes and genomes (KEGG), and gene set enrichment analysis (GSEA).

The CCK-8 assay showed that DS inhibited chondrocyte viability in a dose-dependent manner, with a half-maximal inhibitory concentration (IC₅₀) of 15.5 mmol/L. Cell viability decreased when the concentration of medicated serum reached 10% (q=3.47, P<0.05). Therefore, 10 mmol/L DS and 5% medicated serum were selected for subsequent experiments. Compared with the control group, the LPS and DS groups showed weaker extracellular matrix staining, decreased COL2 expression, and increased MMP13 expression; these abnormalities were improved in the DS+JWSLBZS group compared with the DS group. Compared with the control group, the LPS and DS groups showed increased ROS levels and decreased SOD activity, accompanied by mitochondrial swelling, reduced cristae, and other structural abnormalities. Tukey’s multiple-comparison test for SOD activity showed significant differences between the LPS and CON groups (q=28.88, P<0.001) and between the DS and control groups (q=18.71, P<0.001). Following intervention with medicated serum, these indices showed an improving trend, and mitochondrial structural damage was alleviated. Transcriptomic analysis identified 138 differentially expressed genes shared by the LPS and DS groups, which were enriched in pathways including nuclear factor-κB (NF-κB) signaling. Further directional screening showed that the “abnormally upregulated–intervention downregulated” gene set was mainly enriched in mitogen-activated protein kinase (MAPK) signaling and transient receptor potential (TRP) channel-related signaling axes, whereas the “abnormally down regulated–intervention up regulated” gene set was mainly enriched in matrix homeostasis-related pathways, including transforming growth factor-β (TGF-β) signaling. The GSEA results were consistent with these enrichment patterns.

Succinate accumulation may induce a metabolically imbalanced phenotype in chondrocytes characterized by reduced matrix synthesis and enhanced matrix degradation, accompanied by increased oxidative stress and mitochondrial ultrastructural damage. Modified Shenling Baizhu powder may alleviate succinate accumulation-induced mitochondrial oxidative stress injury by regulating MAPK signaling and related networks.

The central nervous system plays a critical role in motor control and functional recovery, and the regulation of neural plasticity is of great importance throughout the rehabilitation of sports injuries. In recent years, advances in neuroimaging and non-invasive brain stimulation have made central nervous system assessment and neuromodulation a frontier area in sports injury rehabilitation research. This review summarized recent advances in the application of these techniques to sports injury rehabilitation. At the assessment level, functional magnetic resonance imaging, electroencephalography, functional near-infrared spectroscopy, and transcranial magnetic stimulation can dynamically monitor brain functional activity and reveal the patterns and characteristics of brain network reorganization throughout the occurrence of sports injuries and subsequent rehabilitation interventions. At the modulation level, transcranial magnetic stimulation, transcranial direct current stimulation, transcranial alternating current stimulation, and temporal interference stimulation promote motor function recovery by selectively modulating neuronal excitability. These techniques have distinct strengths and limitations in terms of spatial and temporal resolution, applicability to motor tasks, stimulation depth, and reproducibility. Given the complementary value of multimodal signals, the increasing maturity of real-time feedback technologies, and considerable interindividual variability in neural responses, future research should focus on feedback-based rehabilitation integrating central and peripheral information, as well as precision neuromodulation combining artificial intelligence with individualized anatomical and functional characteristics.

Osteoarthritis (OA) is currently the most common type of arthritis, and ultrasound-guided treatment for OA is an important therapeutic approach. Ultrasound-guided intra-articular drug injections and radiofrequency ablation of the affected areas can effectively relieve chronic joint pain in patients with OA. At the same time, targeted therapy for OA using drug-loaded nanoparticles offers unique therapeutic advantages. Among these, biomimetic nanoparticles combine superior targeting capabilities with ultrasonic imaging capabilities, allowing for ultrasonic visualization to monitor the targeting process and the extent of drug release within the biomimetic nanoparticle carriers. This article reviewed conventional treatments for OA—such as ultrasound-guided intra-articular drug injections and radiofrequency ablation—as well as advances in nanotargeted therapy under visual monitoring, covering three types of carriers: metal nanoparticles, polymer nanoparticles, and biomimetic nanoparticles. The aim is to provide additional therapeutic insights for future clinical research on ultrasound-guided nanotargeted therapy for OA and to offer more comprehensive treatment options for clinical practice.

Anterior Cruciate Ligament (ACL) injury is a common sports-related injury. Although arthroscopic ACL reconstruction (ACLR) is the standard treatment, the success of the surgery is highly dependent on the precise placement of bone tunnels, with technical errors being one of the primary causes of surgical failure. To address the precision challenges of traditional surgery, robot-assisted surgery has been introduced into clinical practice as an emerging technology, aiming to reduce human error by enhancing operational accuracy and reproducibility. This review elaborated on the current status, existing problems and future research directions of robot-assisted ACLR. Current research reveals a core "precision-outcome" paradox: although studies ranging from cadaveric models to multicenter clinical trials have consistently confirmed that robotic systems achieve significantly higher precision in bone tunnel creation than traditional manual methods, this technical advantage has not translated into superior clinical functional outcomes or knee stability for patients in short- to mid-term follow-up. This phenomenon may stem from the combined influence of multiple factors, including the biological healing of the graft, the quality of postoperative rehabilitation, patient-specific variables, and the insensitivity of existing clinical assessment tools. These factors may play a more critical role in determining the final outcome than marginal improvements in precision. Furthermore, the widespread adoption of robotic technology is still hindered by practical issues such as high equipment costs, longer surgical times, and a lack of haptic feedback. Looking ahead, the future direction for robot-assisted ACLR is to evolve from a tool merely pursuing precision into a "smarter" clinical partner. Through the deep integration of artificial intelligence (AI), augmented reality (AR), and comprehensive management of the entire process including postoperative rehabilitation, it may ultimately bridge the gap between technical precision and clinical efficacy, delivering long-term, tangible benefits to patients.

To explore the predictive effect of nadroparin calcium combined with Xingqi Quyu decoction on lower extremity deep venous thrombosis (DVT) in patients with artificial femoral head replacement.

A total of 106 patients with femoral neck fractures who underwent artificial femoral head replacement at Shunde Hospital, Guangzhou University of Chinese Medicine from January 2022 to June 2024 were selected and they were divided into the observation group and the control group according to the random number table method. The control group was given nadroparin calcium to prevent DVT, while the observation group received additional Xingqi Quyu decoction on top of the control group’s treatment to prevent DVT. An independent sample t test was used to compare the differences in TCM syndrome scores, swelling degree of the affected limb, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), platelet count and bone density between the two groups before treatment and on the seventh day after treatment. Chi square test or Fisher’s exact probability test was used to compare the adverse reaction rates between the two groups.

Seven days after surgery, the observation group had significantly lower scores of symptoms such as limb swelling, pain, ecchymosis and pale complexion than the control group (t=3.421, 3.070, 2.934, 3.646, all P<0.0125). The degree of lower limb swelling and the overall incidence of DVT seven days after surgery were both lower in the observation group than those in the control group (t=3.728, χ²=3.975, both P<0.05). PT, APTT, TT and FIB in the observation group at seven days after surgery were significantly lower compared to the control group (t=61.583, 5.245, 21.321, 30.104, all P<0.0125). After treatment, the observation group showed a significantly higherplatelet count than the control group (t=2.930, P<0.05).

The combination of nadroparin calcium and Xingqi Quyu decoction can effectively alleviate the affected limb swelling and pain after surgery, and prevent the DVT after artificial femoral head replacement.

To evaluate the clinical efficacy and safety of arthroscopic treatment for refractory insertional Achilles tendinopathy.

A retrospective study of 36 patients with refractory insertional Achilles tendinopathy admitted to Shenzhen Pingle Orthopaedic Hospital (Shenzhen Pingshan District Hospital of Traditional Chinese Medicine) between January 2021 and January 2024. All the patients underwent arthroscopic osteophyte debridement and Achilles tendon release. Surgical duration, intraoperative blood loss, postoperative weight-bearing time, and complications were recorded. Clinical outcomes were assessed using the visual analog scale (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Measurement data were described as mean±standard deviation. The paired-samples ttest was used for within-group comparison between preoperative and postoperative data. Categorical data were presented as cases. The difference was considered statistically significant when P<0.05.

All 36 patients were followed up with an average follow-up time of (6.7±2.0) months. No complications such as infection or Achilles tendon rupture were observed. After operation, VAS score was 2.3±1.1 which was lower than the score 6.3±1.4 before operation; the AOFAS score was 76.2±5.8 which was higher than 92.1±5.9 before operation; the differences were statistically significant (t=15.683, 36.796, both P<0.05).

Arthroscopic treatment for refractory insertional Achilles tendinopathy exhibits positive effects and excellent recovery rate, good postoperative outcomes and minor adverse events, which is certainly worthy of clinical recommendation.