Bone is innervated by nerves that have important roles in signaling bone pain, regulating bone homeostasis and remodeling, control of bone vasculature and hematopoiesis. However, a detailed knowledge of how nerves influence bone function is lacking, which has contributed to significant challenges for clinicians in successfully managing bone disease. In this study, we used tissue clearing and light-sheet microscopy to visualize and explore the 3D distribution of nerves in human bone with a view to better understand how nerves are distributed throughout different parts of the small bones of the hand. Human hand bones were obtained from patients undergoing excision due to advanced osteoarthritis. Bones were fixed and cleared using an optimized solvent-based clearing protocol. Nerves in the bone were immunolabeled using an antibody directed against a pan-neuronal marker (protein gene product 9.5). Samples were imaged using light-sheet microscopy (Ultramicroscope Blaze, Miltenyi Biotec). Three-dimensional visualization and analyses were performed with Imaris (Bitplane). There is extensive innervation of the small bones of the human hand. Immunolabeled nerves followed blood vessels into each bone via nutrient foramina and branched extensively within trabecular bone and marrow cavity spaces. Many axons had a typical corkscrew morphology associated with the innervation of the vasculature, and many terminated as free nerve endings, including in osteochondral channels beneath articular surfaces. Nerve entry points and their distribution through each of the different bones varied. There was evidence of a greater density of innervation in areas where cartilage had degenerated, relative to those where cartilage was intact. This is the first detailed 3D visualization of the neuroanatomical distribution of nerves in intact human bone. This approach to visualizing nerves in bone will be useful in informing the rational design of approaches to the management of a variety of skeletal pathologies, including pain management for osteoarthritis of the hand joints.

Articular surface conformity is a critical factor influencing the biomechanics of knee prostheses, yet its impact on the biomechanics of rotation-hinged knee (RHK) prostheses and their tibial fixation remains unclear. In this study, a rotational platform tibial insert model of RHK prostheses with varying coronal and sagittal conformities is established. Finite element analysis was performed under ISO boundary conditions to investigate the effects of articular surface conformity on the biomechanics of the RHK prosthesis and tibial fixation. The study revealed that when the coronal conformity decreased from 0.83 to 0.33, the maximum Mises stress in the tibia and the maximum contact pressure in the insert increased by 10.78% and 52.62%, respectively, while the maximum shear stress in the bone cement decreased by 10.17%. When sagittal conformity decreased from 0.88 to 0.47, the maximum Mises stress in the tibia and maximum contact pressure in the insert increased by 5.62% and 14.31%, respectively, while Mises stress at the hinge-rotation axis and bone cement shear stress decreased by 62.53% and 29.46%, respectively. A reduction in conformity decreased the contact area. Sagittal conformity has a lesser impact on insert contact pressure compared to coronal conformity, but a more significant impact on bone cement shear stress, and reducing sagittal conformity could effectively reduce the Mises stress at the hinge-rotation axis. The coronal conformity of the RHK prosthesis on the rotational platform more effectively regulates contact mechanics, reducing sagittal conformity facilitates lowering hinge-rotation axis Mises stress and bone cement shear stress without significantly increasing contact pressure, thereby mitigating risks of prosthesis failure such as dislocation, fracture, and loosening.

We describe a minimally invasive percutaneous technique incorporating articular surface reaming for distal interphalangeal joint arthrodesis and report its clinical outcomes in ten patients. All patients achieved bone union at 6 weeks. Pain and functional scores improved at the 2-year follow-up.

Patellar Facet Maturation and Trochlear Depth in the Early Pediatric Age Group: A 3D Laser Scanning Analysis of Developmental Interplay.

Abstract Micro-computed tomography enables high-resolution, three-dimensional, non-destructive visualization of bone microarchitecture in small preclinical animal models. It is widely applied to assess mineralized tissues in joints, making it a valuable tool for monitoring disease progression. Murine models are particularly prevalent in joint research due to their cost-effectiveness and disease tunability. Established guidelines for murine bone microstructure assessment by Bouxsein et al. (Journal of Bone and Mineral Research, 25: 1468-1486) standardize morphometric analysis and facilitate cross-studies comparisons. However, these recommendations were developed for trabecular and cortical bone in long bones and may not fully address the unique characteristics of mineralized tissues within joints. This review focuses on murine studies and aims to: (i) examine reported methodologies for volume of interest selection; (ii) outline commonly evaluated parameters; and (iii) propose adaptations to expand existing guidelines for quantitative analysis of the osteochondral unit. In the absence of specific guidelines for osteochondral unit analysis, reported volumes of interest vary considerably, influenced by anatomical differences across strains, sexes, ages, and disease stages. Many studies target the subchondral bone plate; however, the spatial resolution of desktop microCT is insufficient to distinguish subchondral bone plate from calcified cartilage, hence, they are measured as one entity. To enhance reproducibility and comparability, we recommend standardized volumes of interest that include all mineralized tissues from the articular surface to the growth plate. Given structural differences between subchondral bone plate and subchondral trabecular bone, a consistent method for defining their boundary is strongly recommended. Data should be reported using robust, easily implementable metrics such as volume and thickness, with additional parameters (e.g., porosity, mineral density) included as appropriate. Commonly used metrics such as subchondral bone plate thickness and volume should continue to be used. When subchondral bone plate and calcified cartilage cannot be distinguished, we recommend using subchondral mineralized plate nomenclature.

Autologous osteoperiosteal transplantation (AOPT) from the iliac crest has been proposed as a potential treatment for large osteochondral lesions of the talus (OLTs). This single-arm study aims to prospectively evaluate the clinical, radiological, and arthroscopic outcomes of AOPT from the iliac crest in patients with large cystic OLTs. This is a prospective single-arm study. We evaluated 42 patients who underwent AOPT from the iliac crest for OLTs. The mean follow-up was 32.5months. Clinical outcomes were assessed using the Visual Analog Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) scores, and Tegner activity scores. Radiologic outcomes were evaluated via X-ray, CT, and MRI. Arthroscopy was performed on a subset of patients for second-look evaluation. Significant clinical improvements were observed, with VAS scores decreasing from 4.36 ± 1.76 to 0.45 ± 0.63, AOFAS scores increasing from 75.38 ± 13.52 to 95.33 ± 4.81, and Tegner scores increasing from 2.00 ± 0.99 to 4.10 ± 1.10. Postoperative imaging revealed the resolution of subchondral radiolucency, improvement of articular surface protrusion or collapse, graft integration with surrounding bone, and a reduction in marrow oedema. Follow-up arthroscopy demonstrated significant lesion repair, with cartilage-like tissue integrated into the talus. No complications, including infections or donor-site morbidity, were observed. AOPT from the iliac crest is associated with favourable short- to mid-term clinical, radiological, and arthroscopic outcomes, with no complications observed in this series. These findings provide prospective evidence supporting the potential of AOPT from the iliac crest as a treatment option for large talar osteochondral defects.

BackgroundPolyethylene wear is a mode of failure of any joint replacement, including total ankle arthroplasty (TAA). This study aims to quantify the type and severity of polyethylene damage from retrieved TAA prostheses. We hypothesized that polyethylene wear will be more extensive in TAAs that underwent revision (polyethylene and tibial and/or talar component) rather than reoperation (polyethylene exchange alone), and that wear would vary between implants based on extent of constraint.MethodsThis is a retrospective study of TAA patients (2007-2021) who underwent revision or reoperation following primary TAA with a symmetric bicondylar (SB) implant with more constraint (n = 25, Inbone II/Infinity) or an asymmetric bicondylar (AB) implant with less constraint (n = 30, Salto Talaris). Retrieved polyethylene inserts were examined microscopically to characterize wear patterns according to a standardized protocol. Two independent raters graded articular and backside surfaces in quadrants for 7 damage modes. We assessed associations between polyethylene wear pattern and severity with implant type, revision, and reoperation.ResultsFifty-five TAAs underwent revision (n = 28) or reoperation (n = 27). The SB cohort had significantly greater overall polyethylene damage severity for one rater (P = .007), and greater damage severity in the medial anterior articular region (P = .019) than the AB for both raters. Revision TAAs had significantly greater overall damage severity than reoperations (P ≤ .036), with significantly greater damage severity in multiple articular-sided regions (P ≤ .048). Scratching (P ≤ .030) and pitting (P < .001) were also significantly greater in revision TAAsConclusionTotal ankle arthroplasties with primary SB implants exhibited greater overall polyethylene damage severity than AB implants. Thus, surgeons may want to consider polyethylene type when selecting an implant. In addition, revision was associated with greater polyethylene damage than reoperation. Clinical Relevance. This may suggest polyethylene damage severity increases with increased constraint. Furthermore, polyethylene damage severity is linked to TAA failure, indicating a more severe intraarticular process involving the polyethylene.

To explore regional and depth-dependent associations between subchondral bone metabolic activity and adjacent cartilage composition in individuals with mild-to-moderate hip osteoarthritis using simultaneous [18F]-sodium fluoride (NaF) positron emission tomography (PET) and quantitative magnetic resonance (MR) imaging. In this exploratory cross-sectional study, 14 participants (28 hips) underwent [18F]-NaF PET/MR imaging. Subchondral bone metabolic activity was quantified using standardized uptake values (SUV); cartilage composition was assessed using T1ρ and T2 relaxation times. PET/MR images were registered to a reference space allowing regional cartilage and adjacent bone analysis across subregions and depths (4-16 mm from the articular surface). Linear mixed-effects models adjusted for age were used to explore regional differences and cartilage-bone relationships with false discovery rate (FDR) correction. Higher T1ρ and T2 relaxation times were observed in the overall femoral cartilage compared with the acetabular cartilage, whereas higher SUV was observed in the acetabulum than in the femur. Within the femur, elevated SUV was observed in the femoral neck. No cartilage-bone relationships remained statistically significant after FDR correction. Exploratory analyses without the FDR correction suggested positive and negative regression coefficients between cartilage relaxation times and adjacent femoral bone SUV in the posterior and anterior femoral head regions. The magnitude and direction of these coefficients were consistent across increasing bone depths. This preliminary study presents an exploratory framework for assessing region and depth-specific interactions between subchondral bone metabolic activity and cartilage composition in the hip. The observed patterns are hypothesis-generating and warrant confirmation in larger, longitudinal studies.

Surgical treatment of shoulder instability with glenoid bone loss using a distal tibial allograft has achieved success, with the bone graft placed parallel, flush, or recessed to the articular surface, but questions remain about optimal graft positioning. Given evidence that glenoid concavity and congruence influence stability, we hypothesized that angled bone blocks better restore native concavity and biomechanics compared to flat graft placement. Controlled laboratory study. A total of 9 cadaveric shoulders were dissected, separating rotator cuff muscles from the capsule. Native glenoid dimensions were measured with a digitizer. A 20% anterior bone defect was created and then reconstructed with a distal tibial allograft (bone graft). There were 4 conditions tested: intact, defect, flat bone block, and angled bone block (30°). Using a testing machine, the humeral head was translated anteriorly 10 mm, and distraction and contact forces were recorded. Mean peak distraction forces were as follows: 48.28 ± 8.06 N (intact), 33.99 ± 10.54 N (defect; 70.4% of intact), 41.83 ± 9.07 N (flat; 89.6% of intact), and 45.64 ± 9.03 N (angled; 98.5% of intact). Humeral head contact with the graft occurred in 100.0% of angled trials versus 70.0% of flat trials. Mean glenohumeral contact forces were as follows: 71.81 ± 16.42 N (intact), 31.39 ± 16.60 N (defect), 46.91 ± 4.12 N (flat), and 62.17 ± 9.26 N (angled). One-way analysis of variance showed a significant effect of construct type on both contact and distraction forces (P < .001). Pairwise comparisons showed significant differences in distraction forces between intact and defect conditions and between defect and angled bone block conditions. Comparisons also demonstrated significant differences in contact forces between intact and defect, intact and flat bone block, defect and flat bone block, defect and angled bone block, and flat bone block and angled bone block conditions. No significant difference was observed between the intact shoulder and angled bone block repair. Angled bone blocks more closely restored native glenoid concavity and were biomechanically superior to flat bone blocks in re-establishing stability and centering the humeral head after glenoid bone loss. This study provides a quantitative comparison between different bony glenoid augmentation methods.

Concurrent joint contact in anterior cruciate ligament injury induces cartilage micro-injury and subchondral bone sclerosis, resulting in knee osteoarthritis.

Intramedullary nailing (IMN) for proximal humerus fractures is commonly performed through an anterolateral approach. A percutaneous approach through the Neviaser portal has been shown to be an alternative to avoid cuff tendon insertion violation and be used for a third-generation IMN. The aim of the present cadaver study was to confirm whether the Neviaser approach was reproducible to reach the optimal nail entry point, at the top of the humeral head, passing through the muscular portion of the supraspinatus and to evaluate the risk of biceps and neurovascular bundle damage. This was a basic science surgical technique study with sixteen preserved frozen shoulders from 11 donors (8 females, 3 males) used. All surgical procedures were performed using the third-generation AEQUALIS™ IM Nail. Dissection of each specimen was then performed. The nail entry point through the soft-tissue layer was assessed, determining whether the device was inserted through the supraspinatus muscular or tendinous part. A manual caliper with a precision of 0.1 mm was then used to measure the distances of the device to different anatomic structures. The nails were inserted through the muscular part in all specimens still having a rotator cuff (RC). The mean distances from the nail entry point to the myotendinous junction and RC footprint were 4 mm (range, 2-6 mm) and 39 mm (range, 36-42 mm), respectively. The distances from the lower tuberosity (LT) head screw and most lateral greater tuberosity (GT) head screw to the long head of the biceps (LHB) groove were 9 mm (range, 8-11 mm) and 15 mm (range, 14-17 mm), respectively. The distance of LT head screw to the anterior circumflex pedicle and the lateral cord of the brachial plexus was 15 mm (range 14-17 mm) and 41 mm (range 32-45 mm), respectively. The distance of the highest distal screw and the lowest proximal screw to the axillary nerve was respectively 32 mm (range, 28-40 mm) and 23 mm (range, 21-25 mm). The nail entry point was entirely within the humeral articular surface and at the bone-cartilage junction in 14 and 2 specimens respectively. This study demonstrated that a third-generation IMN might be inserted via the Neviaser portal. This approach is safe and allows the insertion of the device through the RC muscular part with a reproducible access to the hinge point and with no risk of neurovascular injury. IV; Anatomy study; Cadaver Dissection.

This study aimed to (1) assess changes in subchondral bone density distribution across patellofemoral (PF) joint before and after medial closing wedge-distal femoral varus osteotomy (MCW-DFVO) and (2) determine correlation between PF alignment and changes in bone density distribution. This retrospective study enroled patients who underwent MCW-DFVO for symptomatic isolated lateral compartment osteoarthritis (OA), spontaneous osteonecrosis of the knee and lateral femoral condyle cartilage injury with valgus alignment from 2016 to 2022. Clinical and radiological assessments were conducted preoperatively and at the final follow-up. The final follow-up referred to the last documented visit at which outcome measures were available. The radiological quadriceps angle (rQ angle) was measured using computed tomography (CT). The distribution of subchondral bone density on trochlear and patella was examined using CT osteoabsorptiometry. The lateral ratio was calculated as the proportion of high-density areas (HDAs) in the lateral compartments relative to the total HDAs across compartments of trochlea and patella. The paired Student's t test and Pearson's correlation analysis were used to test for significance (p = 0.05). Seventeen knees (17 patients; mean age, 48 years) were included. Following MCW-DFVO, the mean postoperative Lysholm score significantly improved at the final follow-up (mean, 29.2 months; range, 14-65 months). The mean lateral ratio of the trochlea and patella notably declined from 69% to 50% and 69% to 56%, respectively (p = 0.004 and p = 0.041). Changes in trochlear lateral ratio were significantly correlated with changes in the hip-knee-ankle angle, mechanical axis, rQ angle and lateral shift ratio (p = 0.027, p = 0.031, p = 0.024 and p = 0.008, respectively). MCW-DFVO induced a redistribution of HDA from lateral to medial PF articular surface. Moreover, degree of PF alignment correction post-MCW-DFVO was linked to shifts in HDA distribution. MCW-DFVO alters PF joint stress distribution by reducing lateral compartment loading, supporting its use in valgus knees with PF mal-tracking or overload. Level IV, case series.

Synovial fluid protects cartilage against fatigue failure in cyclical compression.

High-grade fracture of the posterolateral tibial plateau (PLTP) has been reported to increase bone loss, which in turn is associated with residual rotational instability and impaired function after anterior cruciate ligament (ACL) reconstruction. To investigate whether high-grade impaction fracture in PLTP is associated with the rate of return to sports (RTS) after ACL reconstruction (ACLR). Cohort study; Level of evidence, 3. This study retrospectively analyzed data from patients with complete ACL tears between December 2018 and June 2022. Inclusion criteria included primary ACLR with autologous hamstring reconstruction, standard preoperative magnetic resonance imaging (MRI) evaluation, and at least 2 years of postoperative follow-up. In contrast to bone contusions, a high-grade impaction fracture in PLTP is defined as subchondral or cortical bone displacement in this area involving the articular surface. Based on whether or not there were high-grade impaction fractures seen on the preoperative MRI, patients were divided into 2 groups: high-grade fracture and control group. Patients were followed up after surgery to assess their level of RTS, Tegner score, Lysholm score, and recovery time. The chi-square test was used to compare the differences in the RTS rate between the 2 groups. Among 190 patients, 34 patients (17.9%) were in the high-grade group, while 156 patients (82.1%) were in the control group. Among the main outcomes, the high-grade fracture knee group performed worse in return to any sport (Tegner score ≥5) (71% vs 88.9%; P = .002) and level 1/2 (cutting) sports (26.5% vs 46.2%; P = .035), while there was no significant difference in return to strenuous sports (Tegner score ≥6) (48.4% in the high-grade group and 62.7% in the control group; P = .136) and return to play (2.9% in the high-grade group and 10.3% in the control group; P = .317). In the later follow-up period of survival analysis, the rate of recovery of any sport was slower in the high-grade fracture group (hazard ratio, 0.22; 95% CI, 0.07-0.72; P = .0118). The results of this study showed that high-grade impaction fracture of PLTP was associated with the rate of RTS after ACLR, mainly in the rate of return to any sport and level 1/2 (cutting) sports. Accordingly, the rehabilitation strategies and priorities for such patients should be adjusted to compensate for the impact.

Background: The stability of the distal radioulnar joint (DRUJ) relies heavily on the osseous congruity of the ulnar (sigmoid) notch. Morphometric variations, particularly anterior-posterior asymmetry, significantly influence joint mechanics and implant design. This study aimed to evaluate the detailed morphometric parameters of the distal radius, specifically analyzing the dimensional asymmetry between the anterior and posterior aspects of the ulnar notch. Materials and Methods: A morphometric study was conducted on 54 dry adult human radii (27 right and 27 left) free of pathology. Using a digital Vernier caliper (0.01-mm precision), measurements were obtained for the anterior and posterior lengths of the ulnar notch, notch width, radial styloid length, and the dimensions of the inferior articular facet. Statistical analysis was performed using paired and independent t -tests. Results: The analysis revealed significant anteroposterior asymmetry. The posterior (dorsal) length of the ulnar notch was consistently greater than the anterior (volar) length. On the right, the mean posterior length (0.77 ± 0.18 cm) significantly exceeded the anterior length (0.46 ± 0.14 cm; P &lt; 0.001). Left-sided specimens showed a similar pattern (0.58 vs. 0.45 cm). Conversely, the inferior articular facet was wider at its anterior margin. The mean radial styloid length was 1.16 cm (right) and 1.12 cm (left). Conclusion: The ulnar notch extends significantly further dorsally than volarly, likely to accommodate the dorsal radioulnar ligament and increase articular surface area. In contrast, the radiocarpal facet is wider anteriorly. These morphometric norms are critical for preoperative planning, radiographic interpretation, and designing anatomical plates that restore DRUJ congruity.

This study evaluated a novel implant for proximal interphalangeal (PIP) joint arthroplasty that we designed according to the principles of a logarithmic spiral. The design addresses the limitations of current implants that poorly replicate natural finger kinematics. Finite element analysis and cadaver studies, including biomechanical and kinematic analyses, were conducted. Results showed that our implant had consistent sliding displacement, maintained consistent articular surface spacing, and was able to achieve a flexion arc greater than 90°, all while maintaining consistent contact throughout joint motion. In both simulation and cadaveric models, our implant demonstrates improved biomechanics by better replicating anatomical finger joint motion through its logarithmic spiral design that can potentially improve clinical outcomes for patients undergoing PIP joint arthroplasty.

Posterior Horn Meniscus Centroid Position Is Altered Soon After Noncontact ACL Injury in Males and Females.

Aim: to evaluate the nature of ultrasound changes in some structures of the knee joints among patients seeking outpatient medical care. Using the example of a clinical case to demonstrate the importance of differential diagnosis of diseases of the knee joints with vascular pathology of the lower extremities. Material and methods. 380 volunteers aged 18 to 86 years were examined. SonoAce R7 diagnostic equipment was used. The results were entered into spreadsheets, followed by grouping and statistical analysis using MS Excel, IBM SPSS Statistics 20, and plotting distribution using StatSoft Statistica 10. Results. The average age of the participants diagnosed with Baker’s cysts was 57.9±9.1 years: 56.5±8.5 years for men and 58.3±9.2 years for women. The signs of osteoarthritis, including sharpened articular surface edges and prominent osteophytes, were detected in 67.3% (256) of cases. These manifestations were detected in 56.1% of men and 75.9% of women. Synovitis was observed in 22.1% (84) cases, 24.4% for men and 20.4% for women. Baker’s cysts were diagnosed in 23.7% (90) cases, 12.2% for men and 32.4% for women. Similar dynamics in the development of structural changes in the knee joints were noted, regardless of the patient’s gender. Conclusion. Determining the etiology of pathological changes and assessing their role in the development of associated symptoms and potential complications allows for more effective diagnosis and treatment, as well as the selection of optimal patient management strategies.

High-resolution peripheral quantitative computed tomography (HR-pQCT) combined with micro-finite element (μFE) analysis enables noninvasive assessment of bone mechanics. While widely used at the distal radius and tibia, knee modeling is challenging due to complex geometry, large model sizes, and the need for physiologically relevant boundary conditions. Standardization and reproducibility are critical for interpreting mechanical predictions. HR-pQCT images were collected from one participant with recent anterior cruciate ligament (ACL) injury for boundary condition testing and 28 healthy volunteers for reproducibility. Patient-specific μFE models incorporated anatomically shaped or rectangular simulated-polymethyl methacrylate (PMMA) support layers with variable stiffness (1500-3000 MPa) and extrusion lengths (1-7 mm). Sensitivity analyses quantified the influence of layer geometry, stiffness, and length on strain energy density (SED). Reproducibility of repeated tibial scans was assessed using root-mean-square percentage coefficient of variation (RMS %CV) and intraclass correlation coefficients (ICCs). μFE knee models contained hundreds of millions of degrees-of-freedom, with solution times of 3.6-16.4 h for anatomically shaped layers and 4.1-20.1 h for rectangular layers (32 cores). Support layer stiffness had the greatest effect on tibial SED, whereas geometry and length had minimal influence. Reproducibility across tibial scans ranged from 5.5% to 18.4% RMS %CV, with ICCs of 0.72-0.94; peri-articular trabecular regions 5-7.5 mm below the articular surface were most stable. Standardized HR-pQCT-based μFE knee modeling is essential for reproducibility. An anatomically shaped, 3-mm extruded PMMA-like support layer with ∼2500 MPa stiffness provides stable, computationally efficient load distribution and will facilitate comparability in future longitudinal knee studies.

To evaluate impact of needle-knife dissection of popliteus muscle on stress distribution of knee joint by establishing finite element models of knee joint before and after needle-knife intervention. CT data from a patient (male, 42 years old, weighted 82 kg, the course of disease ranged from 15 months, left side, K-L gradeⅡ)with early-stage knee osteoarthritis (KOA) were used to construct a finite element model of knee joint by using Mimics 21.0, Geomagic 2021, SolidWorks 2021, and Ansys 2021R1. The distal tibia was fixed with complete constraints to simulate single-leg standing. A vertical downward force of 500 N was applied to the proximal femur, and 200 N upward force parallel to Q-angle was applied to quadriceps tendon. The knee joint was simulated at 30° and 90° flexion angles to compare stress distribution and magnitude changes in meniscus, femoral cartilage, and patellar cartilage before and after acupotomy intervention. At 30° of knee flexion, the peak surface stresses of femoral cartilage, patellar cartilage, and meniscus in intervention group decreased by 5.910 MPa (31.23%), 0.441 MPa (2.05%), and 6.216 MPa(26.38%), respectively, compared with non-intervention group. At 90° of knee flexion, the corresponding decreases were 1.999 MPa (7.10%), 2.736 MPa (6.49%), and 4.671 MPa (10.51%), respectively. After acupotomy release, the area of stress distribution increased, and abnormal stress concentration was alleviated. Acupotomy release of popliteus muscle effectively improves stress distribution on tibiofemoral and patellofemoral joint surfaces, reduces peak stress on articular surfaces, and promotes more uniform stress distribution, thereby providing a therapeutic approach for early-stage knee osteoarthritis.