To explore the early efficacy of muscle energy technique in reverse total shoulder arthroplasty (RTSA).

The patients after RTSA with intact deltoid muscle and no axillary nerve or brachial plexus injury were enrolled, while the patients with incision site infection were excluded. Twenty-eight patients who underwent RTSA in Guangzhou Red Cross Hospital from October 2021 to December 2024 were randomly divided into the observation group (14 cases) and the control group (14 cases). Both groups received conventional rehabilitation treatment, while the observation group was additionally treated with muscle energy technique. The American Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) score of the patients were statistically analyzed at the first day, two and six weeks after surgery. Independent sample t test was used for data analysis.

On the first day after surgery, there was no statistically significant difference in the baseline ASES and UCLA scores between the two groups (P>0.05), indicating that the baseline data of the two groups were comparable. Two weeks after surgery, ASES score was 41.4±5.3 in the observation group while 38.1±6.1 in the control group, no statistically significant difference was observed (P>0.05). The UCLA score of the observation group was 18.3±2.4, which was significantly higher than 15.9±2.4 of the control group (t=2.670, P<0.05). Six weeks after surgery, the ASES score was 51.4±6.1 and UCLA score was 26.4±2.8 in the observation group, which were higher than 46.7±5.9 and 23.8±3.1 in the control group with statistically significant differences (ASES: t=2.110, UCLA: t=2.320, all P<0.05).

The use of muscle energy technique in the early stage of RTSA can achieve good clinical results.

Exploring the clinical characteristics of humeral lateral condyle fracture combined with elbow dislocation in children and the guiding value of classification based on the relative width of fracture fragments for diagnosis and treatment.

A retrospective analysis was performed on the clinical data of 19 patients with lateral humeral condyle fractures (LHCF) complicated by elbow dislocation admitted to the Department of Orthopedics, Children’s Hospital of Soochow University, from August 2021 to October 2024. Inclusion criteria: age <16 years, imaging-confirmed diagnosis, and complete follow-up records. Exclusion criteria: open fractures, severe multiple trauma, pathological fractures, and a history of prior elbow deformity or surgery. Patients were divided into two groups based on the ratio of the fracture fragment’s transverse diameter to the width of the lateral humeral condyle. The structural instability (SI) group (n=14) consisted of cases with a mean relative width >50%, while the ligamentous instability (LI) group (n=5) consisted of cases with a mean relative width <20%. Independent samples t tests, Mann-Whitney U tests, and Fisher’s exact tests were utilized to compare the differences between the two groups in terms of baseline characteristics, dislocation mechanisms, imaging features, treatment priorities, and clinical outcomes.

There were no statistically significant differences between the two groups in terms of gender, age, injury side, time from injury to hospitalization, neurovascular injury, and length of hospital stay (all P>0.05). Significant differences in imaging characteristics were observed between the two groups: fractures in the SI group involved the epiphyseal plate and articular surface, while fractures in the LI group were confined to the metaphysis or the lateral aspect of the epiphyseal plate, with the articular surface remaining intact. Treatment strategies also differed between the groups: all patients in the SI group underwent surgery to restore articular anatomy and bony stability, including four cases of closed reduction and 10 cases of open reduction, with four cases supplemented by elbow arthrography. In the LI group, three patients with small fracture fragments, minimal displacement, and stable joints received conservative treatment, while two patients with radial collateral ligament injuries underwent surgical ligament repair. No statistically significant difference in postoperative Mayo score and Hospital for Special Surgery (HSS) score was found between the two groups (all P>0.05), and both achieved 100.0% excellent and good rate. None of the patients experienced complications such as nonunion, delayed union, avascular necrosis of the distal humerus, or elbow deformity.

The SI/LI classification, based on the average relative width of fracture fragments, effectively distinguishes between two primary injury patterns: structural instability and ligamentous instability. This classification offers significant guiding value for radiologic assessment and the selection of targeted treatment strategies. All the patients included in this study achieved excellent clinical outcomes following the specific interventions tailored to their respective injury patterns.

To investigate the clinical efficacy of absorbable screws combined with quadratus femoris muscle pedicle bone flap transplantation in the treatment of osteonecrosis of the femoral head (ONFH).

A retrospective analysis was performed on 54 patients with ONFH. The patients with ARCO stage Ⅱ or ⅢA, and aged from 16 to 55 years were included. The patients with surgery history at involved side hip, severe osteoporosis or infections were excluded. The treatment group (n=20) underwent absorbable screw fixation combined with quadratus femoris bone flap transplantation; the control group (n=34) received traditional bone flap implantation. Continuous variables were described as

The treatment group presented longer operative time (1.42±0.21) h and more blood loss (95.70±10.20) ml than the control group (75.40±8.60) ml (t=13.251, 8.076, both P<0.001). Femoral head recovery rate was 80.0% in the treatment group which was higher than 52.9% in the control group (χ²=3.954, P<0.05). Necrosis rate was 5.0% in the treatment group which was lower than 29.4% in the control group (χ²=4.626, P<0.05). Harris excellent-good rate was 85.0% in the treatment group which was higher than 58.8% in the control group (χ²=4.105, P<0.05). Digital subtraction angiography showed higher microcirculation reconstruction rate in the treatment group than the control group (72.5% vs 43.9%) (χ²=4.378, P<0.05 ). The overall Harris hip function recovery rate was also higher in the treatment group (χ²=4.105, P<0.05).

This combined technique is effective for ONFH, yielding satisfactory improvement in femoral head blood supply and hip function.

To monitor the impact of extracorporeal shock wave therapy on the blood supply and microcirculation of the femoral head in patients with early-to-mid-stage osteonecrosis of the femoral head (ONFH) using musculoskeletal ultrasound and T2-weighted MRI for verification, so as to provide clinical data for the treatment of ONFH with shock waves.

Sixty patients diagnosed with osteonecrosis of the femoral head (ONFH) (ARCO stageⅠto Ⅲ A) in Shock Wave Therapy Center of Ningxia Hui Autonomous Region People’s Hospital were randomly divided into the medication treatment group (medication group) and the shockwave treatment group (shockwave group) using a computer-generated block randomization scheme. Inclusion criteria: patients diagnosed with ONFH, Association Research Circulation Osseous (ARCO) stages Ⅰto Ⅲ A (collapse <2 mm). Exclusion criteria: abnormal coagulation function, thrombosis in the treatment area, severe cognitive impairment, severe arrhythmia, pregnancy, local infection, etc. VAS score was assessed before treatment, after shockwave treatment (within one week), and at three, six and nine months after treatment to analyze inter-group differences and observe treatment efficacy. Musculoskeletal ultrasound examinations were performed in the shockwave group before and after treatment to record data such as blood flow resistance index (RI), vascular filling, and peak systolic velocity (PSV) of the medial and lateral circumflex femoral arteries, lateral femoral ascending branch, transverse branch, and descending branch on the affected side. MRI was used to verify the regression of edema and changes in the necrotic zone, confirming the treatment outcome. Shapiro-Wilk test was performed to evaluate normality. Measurement data were described as

There was no statistically significant difference in baseline data between the two groups before treatment (all P>0.05). Both the shockwave group and the conventional medication group showed significant pain relief after treatment. Although the onset of action in the shockwave group was slower, it had a longer duration of efficacy. The analgesic effect of the shockwave group was significantly better than that of the medication group in the later stages. Six and nine months after treatment, VAS scores in the shockwave group (2.7±1.2, 3.0±1.3) were lower than those in the medication group (4.0±1.1, 4.6±1.3), with statistically significant differences (t=4.12, 4.68, both P<0.05). Three and six months after treatment, musculoskeletal ultrasound examination of the five arteries related to the femoral head showed increased flow velocity and decreased vascular resistance, indicating a significant increase in blood flow in the femoral head of patients treated with shockwaves. Musculoskeletal ultrasound at three and six months after treatment in the shockwave treatment group showed a significant increase in PSV of the medial circumflex femoral artery, lateral circumflex femoral artery, and their branches compared to before treatment (all P<0.01), with a significant decrease in RI (all P<0.05), indicating improved blood flow. MRI T2-weighted imaging in six and 12 months after treatment showed reduced edema zone signals, with no significant changes in the hypointense zone, suggesting improvement in venous stasis or no significant increase in the necrotic area of the femoral head after shockwave treatment.

Extracorporeal shock wave therapy has significant therapeutic effects on patients with ONFH in ARCO stagesⅠ, Ⅱ, and some cases of stage Ⅲ A. The pain relief effect is superior to or at least comparable to that of the drug treatment group. Shock wave therapy can effectively improve the blood supply of the femoral head, increasing blood flow velocity and reducing vascular resistance in all five relevant vessels. MRI suggests that extracorporeal shock wave therapy stabilizes the condition of patients with ONFH in ARCO stagesⅠand Ⅱ, delaying the need for surgical intervention. Shock wave therapy for the femoral head in ARCO stagesⅠand Ⅱ has demonstrated good clinical outcomes and is worth promoting.

To evaluate the corrective effect of direct anterior approach total hip arthroplasty (DAA-THA) on leg length discrepancy (LLD) and pelvic obliquity (PO) in patients with developmental dysplasia of the hip (DDH), and to analyze the factors influencing improvement.

A retrospective analysis was conducted on 111 patients with DDH of Crowe typeⅠ-Ⅳ who underwent unilateral DAA-THA in Nanjing Drum Tower Hospital between January 2018 and June 2024. Inclusion criteria: radiologically confirmed DDH, primary unilateral DAA-THA, and complete imaging data. Patients with hip or lumbar surgery history, severe trauma, or other conditions affecting pelvic or lower limb alignment were excluded. The cohort included patients aged 42-84 years with a body mass index (BMI) of 18.7 to 34.0 kg/m²; 50 cases were left-sided (45.0%) and 61 were right-sided (55.0%). According to Crowe classification, 89 cases were type Ⅰ (80.2%), 15 cases of type Ⅱ (13.5%), five cases of type Ⅲ (4.5%), and two cases of type Ⅳ (1.8%). LLD, PO, and sacro-femoral-pubic (SFP) angle were measured on standardized anteroposterior pelvic radiographs. Data before and after operation were compared, and subgroup analyses were performed according to Crowe classification. Statistical analyses included paired t test, Mann-Whitney U test, and multivariate linear regression.

All the patients were followed for 2.0 (0, 6.0) months. The mean age was (60±11) years, and mean body mass index (BMI) was (25±5) kg/m². Median disease duration was 84 (36, 120) months. After surgery, LLD decreased from 9.0 (5.3, 17.3) mm to 7.9 (3.6, 12.8) mm (Z=−3.874, P<0.001). PO decreased from 2.5 (1.7, 4.2)° to 2.3 (1.2, 4.2)° (Z=−2.294, P=0.022). The SFP angle increased from 62.0 (58.0, 64.9)° to 67.2 (63.1, 71.8)° (Z=−8.358, P<0.001). In subgroup analysis, the LLD change was 4.25 (−2.93, 8.70) mm in the patients of Crowe typeⅠ-Ⅱ and 11.73 (3.31, 29.60) mm in the patients of Crowe type Ⅲ-Ⅳ, while PO change was 0.40 (−1.00, 1.80)° in Crowe typeⅠ-Ⅱ and 1.90 (0.10, 2.70)° in Crowe type Ⅲ-Ⅳ, none of the difference was statistically significant (U=231.0, 263.0, both P>0.05). Multivariate regression showed that preoperative LLD was an independent predictor of LLD correction [β=0.867, 95% confidence interval (CI) (0.723, 1.010), P<0.001]. In the PO model, intraoperative blood loss [β=−0.104, 95% CI (−0.198, −0.010), P=0.030] and BMI [β=0.156, 95% CI (0.046, 0.266), P=0.006] were significant predictors. In the SFP model, preoperative SFP angle (β=−0.241, 95% CI (−0.428, 0.055), P=0.012) and Crowe classification [β=0.296, 95% CI (0.110, 0.481), P=0.002] were independently associated with improvement.

DAA-THA effectively improves LLD and sagittal pelvic alignment in DDH. However, correction of PO shows a improvement trend with no statistically significant difference. DDH of Crowe type Ⅲ-Ⅳ demonstrates greater improvement in SFP angle compared with Crowe typeⅠ-Ⅱ. Preoperative LLD is the primary predictor of LLD correction, while PO correction is influenced by preoperative PO, BMI, and intraoperative blood loss. SFP angle improvement is associated with preoperative SFP angle and Crowe classification. DAA-THA provides favorable short-term radiographic outcomes, but further large-scale studies with longer follow-up are required to confirm long-term efficacy.

To explore the application effect of three dimensional (3D) printed custom osteotomy guide combined with 3D animation guidance in total knee arthroplasty (TKA) for diabetic patients, and to evaluate its impact on postoperative motor function and clinical efficacy.

A prospective randomized controlled trial was conducted. Inclusion criteria: diabetes duration more than five years; knee osteoarthritis of Kellgren-Lawrence grade Ⅲ to Ⅳ; age from 50 to 75 years, body mass index (BMI) 20 to 30 kg/m²; glycated hemoglobin (HbA1c) ≤8.5%. Exclusion criteria: severe vital organs dysfunction; periarticular infection of the knee joint; history of knee surgery or joint deformity; psychiatric disorders or cognitive impairment; allergy to 3D printing materials. A total of 180 diabetic patients with end-stage knee osteoarthritis who met the inclusion criteria were enrolled. They were divided into the observation group (90 cases) and the control group (90 cases) by random number table. The control group underwent TKA using traditional metal osteotomy guides, while the observation group received TKA with 3D-printed custom osteotomy guides combined with 3D animation-assisted surgery and rehabilitation guidance. The two groups were compared by t test, repeated measurement analysis of variance or chi square test in terms of surgery-related indicators (operation time, intraoperative blood loss, incision length, incidence of complications), imaging indicators such as hip-knee-ankle angle (HKA) deviation, differences between prosthetic angles and preoperative planning, knee range of motion (ROM), walking and balance function, and pain visual analogue scale (VAS), Knee Society score (KSS), blood glucose fluctuation.

Regarding the discrepancy between prosthesis angles and preoperative planning, the observation group exhibited significantly lower deviations from preoperative planning in the femoral-tibial angle (FTA), femoral flexion-extension angle (FFE), tibial lateral condylar angle (LTC), and femoral lateral condylar angle (LFC) compared to the control group, with statistically significant intergroup differences (t=5.495,6.524,7.631,4.842, all P<0.01). Knee joint ROM comparison at different time points showed that ROM in both groups exhibited an upward trend over time at one week, one month, and three months after surgery, with statistically significant temporal effects (F=428.615, P<0.001). ROM in the observation group was significantly higher than that in the control group at all the time points, with statistically significant intergroup effects (F=106.932, P<0.001). There was an interaction effect between group and time, with the observation group demonstrating superior ROM improvement (P<0.001). Three months after surgery, the observation group achieved longer distances on the six-minute walk test (6MWT) and shorter durations on the timed standing-up-walking test (TUGT) compared to the control group, with statistically significant intergroup differences (t=11.567,10.892, all P<0.001). The Berg balance scale (BBS) score in the observation group was significantly better than that in the control group (Z=-4.826, P<0.001).

Three dimensional-printed custom osteotomy guide combined with 3D animation guidance can improve the surgical accuracy of TKA in diabetic patients, reduce trauma and complications, promote postoperative motor function recovery, and enhance clinical efficacy, providing an optimized "surgery-rehabilitation" integrated solution for this population.

To investigate the differences in CT and MRI indicators between patients with knee osteoarthritis (KOA).

From April 2024 to September 2025, a total of 46 patients diagnosed with KOA and history of knee pain, aged from 40 to 80 years at the First Affiliated Hospital of Guangzhou Medical University were enrolled as the research subjects.The patients with knee infection, severe vital organs diseases, hemoragic tendency, etc. were excluded. According to the visual analogue scale (VAS) score, the patients were divided into two groups: the high-score group (VAS scoreequal or over three, n=23) and the low-score group (VAS scoreless than three, n=23). The Western Ontario and McMaster Universities osteoarthritis index (WOMAC) scores, as well as CT and MRI imaging indicators, were compared between the two groups using independent samples t test or Mann-Whitney U test, as appropriate.

The high-score group showed significantly higher scores in pain, stiffness, functional activity, and total WOMAC score than the low-score group (Z=-6.213, -4.550, -6.067, -6.066, all P<0.01). CT image findings: when the knee joint was flexed at 50 degrees, there was a significant difference in the patellar tilt angle (PTA) between the high-score group and the low-score group (Z=-2.169, P<0.05). MRI findings: the high-score group had higher scores than the low-score group in the following aspects: the percentage of cartilage defects in the corresponding area, the percentage of full-thickness cartilage defects in the corresponding area, osteophytes, meniscal signal abnormalities, and periarticular soft tissue signs (Z=-2.256, -2.070, -1.975, -3.238, -2.220, all P<0.05).

Patients in the high pain score group have significantly more severe knee joint dysfunction than those in the low pain score group. Meanwhile, imaging findings indicate that the level of pain score is associated with the narrowing of PTA when the knee joint is flexed at 50 degrees, as well as the severity of articular cartilage damage, osteophytes, meniscal degeneration, and periarticular soft tissue lesions.

To construct a differential diagnosis model for musculoskeletal ultrasound (MSUS)signs in patients with gouty arthritis (GA) and rheumatoid arthritis (RA).

A total of 180 patients from the Department of Rheumatology and Immunology of Xuzhou First People’s Hospital between January 2020 and May 2025 were selected. Inclusion criteria: age between 18 and 75 years old; present with typical symptoms of arthritis such as joint pain and swelling; Patients can cooperate to complete musculoskeletal ultrasound examination. Exclusion criteria: complicated with other types of arthritis, such as infectious arthritis, reactive arthritis, etc.; severe functional disorders of important organs like heart, liver, and kidney; pregnant or lactating women. Based on diagnostic results, they were divided into the GA group (n=92) and the RA group (n=88). High-frequency musculoskeletal ultrasound was used to detect synovial thickness, blood flow signals, bone erosion, the double-contour sign, and tophi. Differences in ultrasound findings between the two groups were compared by independent t test. Multivariate logistic regression and receiver operating characteristic (ROC) curve analysis were employed to evaluate the differential diagnostic performance of the ultrasound signs.

There were statistically significant differences between the two groups in terms of age (t=2.916), gender (χ²=17.370), body mass index (BMI) ( t=5.427), knee joint (χ²=4.447), toe joint involvement rate (χ²=13.310), wrist joint (χ²=11.117), shoulder joint involvement rate (χ²=5.692), double-track sign (χ²=59.732), punctate hyperechoic area (χ²=34.567), positive rate of gout stones (χ²=46.075), bone erosion depth (t=6.640), synovial hyperplasia (t=8.586), joint cavity effusion (t=9.164), blood flow signal over level two (χ²=17.759), and cartilage destruction (χ²=10.940) ( all P<0.05). Multivariate logistic regression analysis revealed that bone erosion [odds ratio (OR)=7.655, β=2.035], joint cavity effusion (OR=6.323, β=1.844), blood flow signal (OR=4.791, β=1.567), gender (OR=7.202, β=1.974), and BMI (OR=0.684, β=-0.38) (all P<0.05) were independent influencing factors for GA and RA. Additionally, ROC results demonstrated that the combined model of double-track sign, punctate hyperechoic, and tophus in GA differentiation had an area under the curve (AUC) of 0.921, with sensitivity of 82.4% and specificity of 94.3%. For RA differentiation, the combined model of bone erosion and joint cavity effusion had an AUC of 0.882, with sensitivity of 78.4% and specificity of 87.0%. The combined diagnostic models exhibited good diagnostic efficacy.

Musculoskeletal ultrasound signs are valuable in the differentiation between GA and RA, and the combination of characteristic signs such as double-track sign and gout stone can improve the diagnostic efficacy of GA, while bone erosion and joint cavity effusion are significant in the differentiation of RA.

To explore the mechanism of synovial macrophage-derived hepcidin and iron exporter protein (FPN1) in chondrocyte ferroptosis of knee osteoarthritis (KOA).

Animal experiment: 24 SD rats of six to eight weeks old were selected and randomly divided using a random number tableinto the sham operation group (the sham group) and the modified-Hult surgery (M-Hult) group (the surgical group), 12 rats in each group. The sham group only incised the joint capsule, while the M-Hult group established a model of KOA. After the model was successful, enzyme linked immunosorbent assay (ELISA) was used to detect the changes in hepcidin expression in rat serum. Micro-CT was employed to observe the morphological and structural changes of the rat knee joints. Hematoxylin-eosin (HE) staining, toluidine blue staining and safranin O/fast green violet staining were used to observe the morphological changes of the knee joint cartilage tissue. Immunohistochemistry was used to detect the expression of hepcidin, matrix metalloproteinase (MMP3) and type Ⅱ collagen (Col2a1) in the knee joint synovium of rats. Immunofluorescence technique was used to detect the expression of glutathione peroxidase 4 (GPX4) and nuclear factor erythroid 2-related factor 2 (NRF2) in the knee joint cartilage. Cell experiment: RAW264.7 cells were treated with interleukin ( IL)-6 to investigate the optimal time and concentration for IL-6 to induce the secretion of hepcidin by macrophages; the supernatant obtained after IL-6 intervention on RAW264.7 cells was used to intervene chondrocytes, and the expression of FPN1 in chondrocytes was observed; the chondrocytes were divided into blank control group, model group (hepcidin treated), and positive control group (erastin treated). The changes in chondrocytes were directly observed, the effect of hepcidin in macrophages on FPN1 in chondrocytes was detected by western blot, the expression of redox-related factor reactive oxygen species (ROS) was detected by immunofluorescence technology, and the oxidative-reductive indicators were detected using glutathione/glutathione disulfide (GSH/GSSG), MDA, and SOD kits. Single factor variance analysis and t test were performed for data analysis.

Compared with the sham group, the knee osteoarthritis model rats in the surgical group showed significant pathological changes in their knees: micro-CT revealed that the joint space in the model group narrowed, bone spurs formed, and the bone volume fraction (t=5.069, P<0.001), trabecular number (t=4.225, P<0.05), and thickness (t=5.879, P<0.001) significantly decreased, while the trabecular separation (t=2.691, P<0.01) increased, and the bone microstructure was severely damaged. Compared with the sham group, the osteoarthritis score in the surgical group was significantly elevated (t=7.778, P<0.001). Cartilage tissue staining revealed disorganized layers, sparse cell arrangement, and matrix fissure formation. Meanwhile, the expression of Col2a1 decreased (t=4.931, P<0.001), the expression of MMP3 upregulated (t=17.35, P<0.001), and a substantial loss of proteoglycans was observed. In the serum and synovial tissue of the model group rats, the expression of hepcidin significantly increased, while the expression of the iron export protein FPN1 in the cartilage tissue significantly down regulated (t=10.67, P<0.001). The expression levels of the ferroptosis core inhibitor GPX4 (t=15.93, P<0.001) and the antioxidant transcription factor NRF2 (t=14.26, P<0.001) in cartilage tissue were significantly decreased. Cell experiments demonstrated that 10 μg/L IL-6 could efficiently induce high expression of hepcidin in RAW264.7 cells, and its 10% conditioned medium could significantly inhibit the expression of FPN1 in chondrocytes. After hepcidin intervenes with chondrocytes, ROS accumulation occurs, the GSH/GSSG ratio decreases (F=395.1, P<0.001), the expression level of MDA increases (F=181.7, P<0.001), and the activity of SOD decreases (F=1160, P<0.001).

Hepcidin derived from synovial macrophages inhibits the function of FPN1 in chondrocytes, which triggers iron accumulation in chondrocytes, thereby activating the oxidative stress-lipid peroxidation pathway, and ultimately inducing ferroptosis of chondrocytes in KOA.

Osteoarthritis (OA) is the most common chronic degenerative joint disease in clinical practice. Its core characteristics include progressive degradation of articular cartilage, abnormal remodeling of subchondral bone, and synovial inflammation; to date, there remains no curative treatment. Autophagy, as a core degradation mechanism for maintaining intracellular homeostasis, plays a crucial role in the pathogenesis and progression of OA due to its functional dysregulation. It exhibits dynamic, phasic, and bidirectional regulatory characteristics throughout the OA process, and abnormalities in its activity directly affect the survival status of chondrocytes. This article systematically reviewed the multilevel interactive regulatory network of autophagy in OA, focusing on the mTOR-centered signaling pathway, key molecular nodes such as forkhead box O (FoxO)/silent mating type information regulation 2 homolog (SIRT)/hypoxia inducible factor (HIF), as well as the epigenetic regulatory roles of non-coding RNAs and exosome-mediated intercellular communication mechanisms, thereby providing a systematic theoretical basis for precision-targeted autophagy-based therapies for OA.

Articular cartilage has limited capacity for self-repair, making cartilage regeneration a persistent challenge in orthopaedics. Platelet-rich plasma (PRP), derived from autologous blood and rich in growth factors, is simple to prepare and well tolerated, and has become an active area of cartilage repair research. PRP improves the repair microenvironment and supports cartilage regeneration by regulating chondrocyte apoptosis and autophagy, easing inflammation, and balancing angiogenesis. As an adjunct to arthroscopic surgery, it can be delivered by intraoperative or postoperative injection or via biomaterial scaffolds, helping to improve repair quality, relieve pain, and restore joint function. Its clinical use is still limited by unsettled questions over injection protocols, preparation standardization, and individualized treatment. This review outlined the mechanisms by which PRP promotes cartilage repair, examines its use alongside arthroscopic surgery and the supporting evidence, weighs current controversies, and considers its combination with stem cells, exosomes, and tissue engineering, aiming to inform cartilage repair in clinical practice.

Joint arthroplasty is the main treatment for end-stage joint disease. China’s population is aging and osteoarthritis is becoming more common. As a result, the number of arthroplasty procedures continues to grow. National volume-based procurement has substantially increased the use of domestic implants. China, however, has not yet conducted a unified nationwide arthroplasty cohort study. It therefore lacks the real-world data needed to assess implant quality and to detect revision risk early. This shortfall makes it harder to improve care, strengthen insurance oversight, and advance the domestic device industry. Experience from cohort studies in other countries shows that a unified national arthroplasty registry can identify revision risk early, lower medical costs, and improve quality of care. China has now completed a unified national medical insurance platform. Its data cover nearly the entire population, span long periods, reach a large scale, and link directly to payment policy. Together these features provide a strong basis for arthroplasty cohort research. This article reviewed the current state of arthroplasty cohort studies in China and abroad. It analyzed the feasibility, value, and limitations of building a Chinese arthroplasty cohort from full-process medical insurance data. It then offered recommendations for standardizing data, refining outcome measures, and improving follow-up. The aim is to inform better clinical care, stronger regulation of high-value implants, and the growth of China’s domestic medical device industry.

Anterior cruciate ligament (ACL) injury is a common soft tissue injury of the knee joint, often caused by non-contact or contact violence. Currently, arthroscopic ACL reconstruction is considered the gold standard for treating this injury. Various surgical techniques are available for ACL reconstruction, and postoperative recovery is influenced by multiple factors, including the preservation of the ACL remnant, graft selection, fixation methods, single-bundle versus double-bundle reconstruction, and femoral tunnel drilling technique. Therefore, this article provided a systematic review of the anatomical characteristics of the ACL, traditional and emerging diagnostic methods for ACL injury (such as high-resolution MRI, ultrasound, artificial intelligence-assisted diagnosis, and biomarkers), as well as aspects related to remnant management during reconstruction, graft selection and fixation, single-versus double-bundle reconstruction, femoral tunnel drilling techniques, and combined reconstruction of the anterolateral ligament.

Based on the concept of knee preservation, periarticular knee osteotomy is a commonly used, safe, and effective knee-preserving procedure in clinical practice. It corrects osseous deformities (extra-articular deformities) through osteotomy and modifies the mechanical axis of lower extremity load transmission.Therefore, periarticular knee osteotomy not only preserves the normal anatomical structures but also effectively relieves pain, maintains knee function, restores partial working ability of patients, and delays the progression of knee osteoarthritis (KOA). Periarticular knee osteotomy mainly corrects varus and valgus deformities of the knee joint, aiming to redistribute the load across the knee compartments. At present, there are various types of periarticular knee osteotomies, each with its own advantages and corresponding indications. This article reviewed relevant studies on different osteotomy techniques in clinical practice, summarizes the characteristics, indications, advantages, and disadvantages of common procedures, so as to provide guidance for clinical treatment.

To analyze the characteristics of patients with osteonecrosis of the femoral head (ONFH) who achieved long-term success with conservative treatment and to summarize clinical experience in the conservative management of ONFH.

A retrospective analysis was conducted on patients with ONFH who received conservative treatment at the First Affiliated Hospital of Guangzhou University of Chinese Medicine from October 2009 to October 2024, with a continuous follow-up of more than five years. The Association Research Circulation Osseous (ARCO) stage, Japanese Investigation Committee (JIC) classification, and percentage of femoral head involvement were recorded and descriptively analyzed. According to the imaging outcomes, the cases were classified into three types: long-term stable type, medial collapse type, and subchondral fracture repair type.

A total of 16 patients were included, with a follow-up duration of 8 (7, 12) years. Among them, 10 cases were classified as long-term stable type, five as medial collapse type, and one as subchondral fracture repair type. In the long-term stable group, one patient with JIC type C1 had mild femoral head involvement, three patients had severe involvement but with lesions located medially (JIC type A), and the remaining six patients had mild or moderate involvement with JIC type A or B. All the five medial collapse cases had severe femoral head involvement, and four of them exhibited a "collapse-arrest-repair" process. The single subchondral fracture repair case was JIC type C1 with moderate femoral head involvement and preserved lateral cortex; the subchondral fracture line disappeared within eight years.

JIC types A and B are the most suitable candidates for conservative treatment, generally achieving long-term stability. Even when collapse occurs due to a large necrotic area, it tends to be self-limiting or even repair, with a favorable prognosis. For patients with JIC type C1, if the percentage of femoral head involvement is mild or moderate and the lateral cortex is preserved, long-term stability or even healing of subchondral fracture is still possible. However, identification is more difficult. It is recommended to combine quantitative assessments such as the preserved angle of the lateral wall or the China-Japan Friendship Hospital (CJFH) classification.

To investigate the clinical outcomes of arthroscopic anatomical repair of the posterolateral bundle (PLB) of the anterior cruciate ligament (ACL) combined with cosmetic portal suturing for the treatment of mild anterior knee instability.

Twenty-one patients with mild anterior knee instability underwent arthroscopic anatomical repair of the PLB of ACL. Cosmetic suturing was simultaneously performed for the anteromedial and anterolateral portals. The patients underwent a standard rehabilitation protocol and were followed up for one to six months after surgery. Knee stability was evaluated by Lachman test, anterior drawer test (ADT), and pivot-shift test. MRI findings, and functional assessments—including the International Knee Documentation Committee (IKDC) subjective evaluation form, Lysholm knee scoring scale, and Tegner activity score—were compared between the data before surgery and data during the follow-up. Incision healing and complications were also recorded. The data were analysed by repeated variation analysis and rank sum test.

Among the 21 patients, 19 achieved full range of knee motion eight weeks after surgery, while two experienced restricted knee flexion at 90°. Knee stability: compared with preoperative grade Ⅱ positive Lachman tests, all the patients demonstrated negative Lachman tests postoperatively. The ADT and pivot-shift test remained negative. Postoperative MRI revealed uniform and continuous ACL signals across two consecutive slices, indicating significantly improved ligament tension. Functional assessment: IKDC, Lysholm, and Tegner scores after surgery were significantly higher than the preoperative values (F=55.99, 105.84, Z=37.86, all P<0.001). Incision healing: no infections or other adverse events occurred in any of the patients. One patient with a scar diathesis developed scar induration, hyperpigmentation, and localized pain during extreme knee flexion. The remaining patients achieved excellent incision healing.

Arthroscopic anatomical repair of the ACL PLB combined with cosmetic portal suturing for mild anterior knee instability can effectively minimize incision-related irritation and facilitate the early rehabilitation of knee function. Long-term outcomes warrant a further follow-up observation.