Despite the growing clinical relevance of obesity in the context of multiligament knee injuries, there remains a paucity of data evaluating patient-reported outcomes in this population. To compare clinical and functional outcomes, including postoperative patient-reported outcome measures (PROMs) and complication/revision rates, of multiligament knee reconstruction (MLKR) in individuals with a body mass index (BMI) >30 kg/m2 versus <30 kg/m2 at a minimum 2-year follow-up. Case series; Level of evidence, 4. A retrospective review was performed to identify all patients who underwent MLKR between 2001 and 2022 at a single institution. Patients with a BMI >30 kg/m2 were propensity-matched to patients with a BMI <30 kg/m2 on a 1:1 basis by age, sex, laterality, and Schenck classification (knee dislocation). Medical records were reviewed for patient characteristics, time to surgery, year of surgery, number and type of ligament interventions, graft choice, single versus staged reconstruction, and concomitant injuries. Postoperative clinical examination findings and PROMs for each cohort, including visual analog scale score, Tegner activity scale score, Lysholm score, and International Knee Documentation Committee (IKDC) subjective score, were analyzed and compared. Postoperative complication and revision rates were evaluated and compared. Of 158 patients, 79 patients with a BMI <30 kg/m2 (mean age, 31.0 ± 11.5 years; mean BMI, 25.8 ± 3.0 kg/m2) were matched to 79 patients with a BMI >30 kg/m2 (mean age, 32.8 ± 9.5 years; mean BMI, 37.1 ± 5.8 kg/m2). There were no significant differences between cohorts regarding age, sex, laterality, and Schenck classification (P≥ .100); however, patients in the BMI >30 kg/m2 group had greater numbers of posterior cruciate ligament reconstruction. The mean follow-up was 7.5 ± 4.8 years for the BMI <30 kg/m2 cohort and 7.2 ± 4.8 years for the BMI >30 kg/m2 cohort (P = .229). Patients with a lower BMI (<30 kg/m2) had significantly better postoperative mean IKDC (79.3 ± 18.7 vs 67.9 ± 21.2; P = .004), Lysholm (85.1 ± 17.1 vs 75.7 ± 21.0; P = .007), and Tegner (5.1 ± 2.0 vs 4.4 ± 1.7; P = .041) scores. The BMI >30 kg/m2 group also had significantly more postoperative complications (P = .028). However, there was no significant difference between the 2 cohorts in terms of reoperation rate or conversion to total knee arthroplasty (P≥ .189). Patients who undergo MLKR and have a BMI >30 kg/m2 demonstrate significantly decreased postoperative PROMs when compared to patients with a BMI <30 kg/m2. Increasing BMI significantly increased the incidence of complication rates after MLKR.

Posterior cruciate ligament (PCL) avulsion fractures from the tibial insertion are rare but clinically notable injuries that can compromise knee stability if not treated effectively. Arthroscopic approaches have increasingly replaced open surgery for such injuries due to their less invasive nature and lower risk of postoperative issues. This retrospective case series evaluates the clinical and radiological outcomes of 16 patients treated with a single suture tape pullout approach for PCL tibial avulsion fractures. The average age of the patients was 29.6 years, and all were treated within 3 weeks of injury. Functional assessment was conducted using Lysholm and International Knee Documentation Committee (IKDC) scores, and fracture healing was monitored with computed tomography. At a mean follow-up of 16.8 months, the Lysholm score improved from 48.2 to 91.7, and the IKDC score improved from 38.5 to 86.3, both with statistically notable P values ( P < 0.001). All patients obtained radiological union within 12 weeks. No major postoperative issues or fixation failures occurred. The dual-tunnel suture tape pullout approach offers excellent stability, facilitates early rehabilitation, and offers high union rates with minimal postoperative issues.

The purpose of this study was to compare radiographic and clinical outcomes between patients undergoing distal femoral osteotomy (DFO) with intraoperative hinge fracture treated with percutaneous compression screw fixation and those without hinge fracture. This retrospective case-control study included patients undergoing DFO for coronal plane deformity correction between January 2019 and May 2023, with minimum 2-year follow-up. Patients sustaining a hinge fracture treated with percutaneous compression screw fixation constituted the case group; patients without hinge fracture served as unmatched controls. Radiographic parameters-including coronal correction (ΔHKA: change in hip-knee-ankle angle), alignment maintenance and radiographic union-and patient-reported outcome measures (Knee Injury and Osteoarthritis Outcome Score, Lysholm score, Simple Knee Value, UCLA Activity Score, NRS pain score) were assessed pre and postoperatively. Statistical significance was set at p < 0.05. Of 130 patients screened, 67 were included: 21 in the hinge fracture group and 46 controls. Mean age was 41.8 ± 13.9 years, 75% were male and mean BMI was 26.8 ± 4.5 kg/m2. Baseline demographics were comparable except for osteoarthritis grade, which was more advanced in the hinge fracture group (p = 0.015). Mean follow-up was 3.5 ± 1.1 years. Coronal correction did not differ between groups (Δhip-knee-ankle angle: 7.2 ± 3.1° vs. 8.1 ± 3.8°; p = 0.486), and alignment maintenance was comparable. All osteotomies achieved radiographic union. Patient reported outcome measures improved significantly in both groups with no between-group differences at final follow-up (Lysholm: 78.3 ± 21.6 vs. 72.7 ± 26.2; p = 0.481). Progressive weight-bearing initiated at 3 weeks was not associated with loss of correction or delayed union. DFO-associated hinge fractures treated with percutaneous compression screw fixation were not associated with inferior radiographic or clinical outcomes compared with patients without hinge fracture. Progressive weight-bearing from 3 weeks was safe, supporting this technique as a reliable intraoperative management strategy. Level III, retrospective comparative cohort.

Residual Midbody Meniscal Widths >13 mm Immediately After Surgery Decreased Faster and Had Greater Complication Rates in Discoid Lateral Menisci Treated With Saucerization and Repair.

Increased Medial Posterior Tibial Slope Is Associated With Worse Patient-Reported Outcomes After Bicruciate Ligament Reconstruction.

The impact of preoperative rehabilitation on bone mineral density (BMD) and tendon-bone healing in anterior cruciate ligament reconstruction (ACLR) patients is unknown. A total of 53 ACL rupture patients were randomized into 2 groups (Control Group [CON, n = 27] and Exercise rehabilitation group [ER, n = 26]). The CON received conventional treatment, and the ER group received 6-week exercise on this basis. Subsequently, both groups underwent ACLR. At baseline, after 3, 6 and 12 months post-ACLR, the knee BMD, magnetic resonance imaging, and physical function were measured. The BMD of lateral femur condyle (LFC) in ER group was higher than CON group at 3 and 6 months post-ACLR (p = 0.004, 0.01). The signal/noise quotient (SNQ) of proximal and distal segments in ER group were lower than CON group at 6 and 12 months post-ACLR (p = 0.02, 0.03). The medial femoral condyle cartilage thickness in ER group was begun thicker than CON group at 3 months post-ACLR (p = 0.04). At 6 months post-ACLR, the relative peak torque of the quads and hamstrings, the balance composite score, the Lysholm and IKDC scores in the ER group were better than CON group (Quads p = 0.02; Hamstrings p = 0.01; balance p < 0.001; Lysholm p < 0.001; IKDC p < 0.001). The difference value of BMD from baseline to 3 months post-ACLR in medial femoral condyles (MFC) exhibited positive correlations with 6 and 12 months post-ACLR within distal autograft SNQ (p = 0.025; 0.011). ACLR patients who undergo preoperative rehabilitation can effectively delay the decline of BMD in the LFC, enhance the tendon-bone healing, improve the knee articular cartilage thickness and advance the physical function. The less the early BMD of MFC loss in early postoperative, the better the later tendon-bone healing within or near the tibial tunnel. PRS, NCT05924178. Registered 28 May 2023, www. gov.

Eight-year clinical and radiographic outcomes after meniscal repair augmented with autologous synovial mesenchymal stem cell transplantation: A long-term follow-up case series.

Anterior cruciate ligament (ACL) rupture frequently occurs alongside meniscal injury, together altering the intra-articular environment. While ACL injury triggers an inflammatory cascade within synovial fluid, meniscal injury may intensify these responses, contributing to joint degeneration. However, little is known about how combined ACL and meniscal injuries shape the synovial inflammatory milieu or whether these profiles influence long-term outcomes. The purpose was to characterize synovial fluid inflammatory phenotypes at the time of ACL reconstruction with concomitant meniscal injury and assess their association with patient-reported outcome measures (PROMs) and clinically meaningful improvement. It was hypothesized that (1) distinct inflammatory phenotypes would exist, (2) these phenotypes would correlate with symptom severity and recovery, and (3) individual biomarkers' effects on outcomes would vary by phenotype. Cohort study; Level of evidence, 3. Patients undergoing arthroscopic ACL reconstruction with concomitant meniscal injury were prospectively enrolled between July 2011 and January 2024. Synovial fluid was aspirated before incision, and the concentrations of 10 biomarkers were quantified. Unsupervised k-means clustering identified high- and low-inflammation phenotypes. PROMs were collected preoperatively on the day of surgery (baseline) and at long-term follow-up. Linear regression assessed biomarker associations with PROMs, with interaction models evaluating effect modification by inflammation phenotype. Minimal clinically important difference (MCID) achievement thresholds were calculated using a distribution-based approach (0.5 × baseline SD) and compared between clusters. A total of 97 patients were stratified into high-inflammation (n = 66) and low-inflammation (n = 31) clusters. Patient and surgical characteristics were similar, but the high-inflammation cluster demonstrated significantly worse baseline pain and function (all P≤ .008). At a mean follow-up of 8.2 ± 2.5 years, postoperative PROMs were similar, but the high-inflammation cluster experienced greater improvements in VAS pain (-13.5 vs 3.1; P = .008) and Lysholm (28.6 vs 8.9; P = .002) scores. Monocyte chemoattractant protein-1 (MCP-1) demonstrated strong, phenotype-dependent associations with PROMs, and patients with high inflammation were more likely to achieve the MCID for VAS pain score (57.6% vs 17.6%; P < .05). Synovial fluid biomarker profiles at the time of ACL reconstruction with concomitant meniscal injury identified distinct inflammatory phenotypes associated with baseline symptom severity and differential patterns of clinical improvement. Although long-term PROMs were similar between groups, phenotype-dependent biomarker associations, particularly involving MCP-1, suggest that the biological context of recovery differs across inflammatory profiles.

To investigate knee biomechanical characteristics and kinesiophobia levels across different body mass index (BMI) categories in patients following tibial plateau fracture surgery, and to examine the mediating role of kinesiophobia in the relationship between BMI and knee biomechanical outcomes. A cross-sectional controlled study was conducted. Sixty postoperative tibial plateau fracture patients were stratified into Group A (obese, BMI ≥ 28kg/m2), Group B (overweight, BMI 24.0-27.9kg/m2), and Group C (normal weight, BMI 18.5-23.9kg/m2), with 20 patients per group, alongside 20 healthy controls (Group D). Kinesiophobia and knee function were assessed using the Tampa Scale for Kinesiophobia-17 (TSK-17) and the Lysholm Knee Scoring Scale, respectively. A three-dimensional motion capture system synchronized with a force platform was used to collect spatiotemporal gait parameters and knee kinematic and kinetic data. Between- and within-group bilateral limb differences were analyzed, and correlation analysis, multiple linear regression, and bootstrap mediation analysis were performed to examine the mediating effect of kinesiophobia. Between-group comparisons revealed that Lysholm scores progressively decreased (Group A: 73.80 ± 4.74; Group B: 77.95 ± 2.86; Group C: 81.65 ± 3.63), whereas TSK-17 scores progressively increased (Group A: 57.00 ± 3.88; Group B: 51.40 ± 3.44; Group C: 46.70 ± 4.66) with increasing BMI (P < 0.01). On the affected side, cadence (Group A: 60.90 ± 12.56; Group D: 105.90 ± 4.61 steps/min), gait velocity (Group A: 0.58 ± 0.19; Group D: 1.08 ± 0.06m/s), and sagittal plane range of motion (Group A: 47.46° ± 9.46°; Group D: 67.23° ± 2.82°) progressively decreased, whereas sagittal plane moments progressively increased (Group A: 680.35 ± 130.98; Group D: 225.13 ± 85.78 N·m) across BMI groups (P < 0.01). Within-group comparisons demonstrated that sagittal plane range of motion on the affected side was significantly smaller than that on the unaffected side, and that joint moments were significantly greater on the affected side across all three patient groups (P < 0.05); however, no significant bilateral differences were observed in the control group. Mediation analysis indicated that kinesiophobia partially mediated the relationship between BMI and gait velocity on the unaffected side (indirect effect = - 0.01; 95% CI [- 0.03, - 0.00]) as well as between BMI and sagittal plane moments on the affected side (indirect effect = 7.45; 95% CI [0.43, 18.56]), with mediation proportions of 48.4% and 27.5%, respectively. Patients with postoperative tibial plateau fractures and higher BMI exhibited significantly worse knee function, greater kinesiophobia, and compromised biomechanical characteristics, including slower gait, reduced sagittal plane range of motion, and elevated knee joint moments. Kinesiophobia partially mediated the adverse effects of elevated BMI on gait velocity and sagittal plane moments. Clinical rehabilitation programs should incorporate BMI-stratified individualized interventions integrating weight management with targeted psychological support to reduce kinesiophobia. Chinese Clinical Trial Registry ChiCTR2500101020. Registered on 18/04/2025.

To explore short-term efficacy of technique of single-bundle anterior cruciate ligament (ACL) reconstruction combined with residual end repair and suturing under arthroscopic. From February 2020 to February 2024, clinical data of 62 patients with ACL injury who underwent single-bundle residual preservation reconstruction were retrospective analyzed, including 36 males and 26 females;aged from 16 to 58 years old with an average of (35.7±11.0) years old;patients were divided into two groups based on classification of tibial residual end of ACL observed during arthroscopic. In control group (Sherman type Ⅲ/ Ⅳ), there were 32 patients, including 20 males and 12 females;aged from 17 to 58 years old with an average of (34.88±11.40) years old;treated with single-bundle hamstring tendon reconstruction using residual tibial portion of ACL, and the retained residual part formed a sleeve-like covering for the reconstructed ligament. In observation group (Sherman typeⅠ/Ⅱ), there were 30 patients, included 16 males and 14 females;aged from 16 to 55 years old with an average of (36.53±10.57) years old;during the reconstruction of hamstring tendon single bundle, ACL stump was repaired and sutured to lateral wall of intercondylar fossa of femur to restore the tension of tibial ACL stump tissue. The occurrence of postoperative complications were observed;the stability of knee joint was evaluated by pivot shift test, Lachman test, and KT-1000 bilateral knee anterior laxity difference at 9 months after operation;knee joint function was assessed by International Knee Documentation Committee (IKDC) score and Lysholm score. All patients were followed up from 9 to 12 months with an average of (10.5±1.6) months. In control group, 1 patient was developed Cyclops syndrome without further surgery;1 patient was suffered from longitudinal tear of medial meniscus, which was cured after the modified Lemaire anterior-lateral ligament reinforcement surgery and meniscus repair;and there were not corresponding complications in observation group. There was no statistically significant difference in positive rates between two groups of axial displacement tests (P>0.05);the positive rate of Lachman test in control group (10/32) was higher than that in observation group (3/30), and the difference was statistically significant (P<0.05);at 9 months after operation, anterior laxity of both knees of KT-1000 device in control group (1.71±1.02) mm was greater than that in observation group (1.22±0.81) mm, and the difference was statistically significant (P<0.05). At 9 months after operation, IKDC score of control group was (88.21±6.50) points, which was lower than that of observation group (93.10±4.71) points, and the difference was statistically significant (P<0.05);Lysholm score of control group was (92.11±4.32) points, which was lower than that of observation group (96.42±3.13) points, and the difference was also statistically significant (P<0.05). The combined ACL single-bundle reconstruction and residual stump repair technique significantly improves early stability of knee joint and enhances knee joint function after operation, achieving better clinical outcomes. It is particularly suitable for Sherman typeⅠ/Ⅱpatients with good residual stump quality on tibia side of ACL. This technique restores tension of natural ACL tissue, providing an optimized treatment method for ACL reconstruction. However, the surgical difficulty and benefit-risk ratio need to be balanced due to obstruction of ACL residual stump field of view.

To compare radiographic valgus stability, patient-reported outcome measures (PROMs), and complication and failure rates between patients treated with isolated repair of Stener-like medial collateral ligament (MCL) lesions and those who received repair with augmentation. We hypothesised that repair with augmentation would result in superior radiographic stability and improved clinical outcomes. A retrospective cohort study was performed on consecutive patients aged ≥18 years who underwent surgical treatment for distal MCL avulsion injuries with pes anserinus interposition between January 2015 and December 2022 at a single institution, with a minimum follow-up of 24 months. Surgical treatment consisted of isolated repair or repair with biological augmentation using autograft or allograft tissue. Functional outcomes were assessed using Lysholm and Knee Osteoarthritis Outcome Score (KOOS) scores. Radiographic valgus stability was evaluated using stress radiographs obtained at 3 months post-operatively. Twenty-nine patients were included, of whom 19 (65.5%) underwent isolated repair and 10 (34.5%) underwent repair with augmentation. Eighteen patients (62.1%) had multiligament injuries, and the mean time from injury to surgery was 33.1 ± 17.8 days. Both groups showed a significant reduction in medial joint gapping on valgus stress radiographs, with no differences between techniques (p = 0.985). The mean Lysholm score for the entire cohort was 89.3 ± 15.4, with no significant differences between groups (p = 0.940). Similarly, no differences were observed in any KOOS subscale. Seven complications (24.1%) were recorded, most commonly post-operative stiffness requiring arthroscopic lysis of adhesions. Complication rates were comparable between groups (p = 0.664). One failure occurred in the isolated repair group, requiring MCL reconstruction. Surgical treatment of Stener-like MCL lesions provides good radiographic and functional outcomes at mid-term follow-up. Repair with augmentation does not result in superior outcomes compared with isolated repair, suggesting that anatomic repair alone may be sufficient in most cases. Level III, retrospective cohort study.

To compare clinical and functional outcomes after primary anterior cruciate ligament reconstruction (ACLR) using quadriceps tendon (QT) autografts versus bone-patellar tendon-bone (BPTB) and, separately, QT versus hamstring tendon (HT) autografts, to inform evidence-based graft selection. We performed a Cochrane-guided systematic review and meta-analysis. Searches of PubMed, Scopus, Cochrane Library, SPORTDiscus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and major trial registries through November 2025 identified randomized controlled trials (RCTs) comparing QT with HT or BPTB in adults undergoing primary ACLR. Random-effects models (REML) were used to pool mean differences/standardized mean differences and risk ratios. Heterogeneity was quantified using I2 and Q statistics. Sensitivity analyses (leave-one-out) and the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach were applied. When pooling was infeasible, a structured narrative synthesis was provided. Fifteen RCTs (2014-2025) were included. Objective anterior stability (KT-1000) showed no significant difference between QT and HT at 12 or 24 months and no significant difference between QT and BPTB at 12 months. Patient-reported outcomes (International Knee Documentation Committee, Lysholm, Knee Injury and Osteoarthritis Outcome Score [KOOS], Tegner) were largely equivalent at 12-24 months. After resolving inconsistencies due to non-exchangeable constructs/comparators, a small 12-month KOOS signal favoured QT, while 24-month effects remained null. Graft failure rates were comparable for QT versus HT and QT versus BPTB. Donor-site morbidity was substantially lower with QT versus BPTB; QT versus HT showed no significant difference. Pivot-shift favoured QT, but not significantly; postoperative stiffness did not differ. Overall certainty was mostly moderate (downgrades for imprecision and occasional indirectness); donor-site morbidity versus BPTB reached high certainty. Across randomized evidence up to 24 months, QT provides stability and patient-reported outcomes comparable to HT and BPTB, with clearly lower donor-site morbidity compared to BPTB and no excess failure compared to HT. QT is an evidence-supported alternative for primary ACLR; longer, adequately powered, construct-specific RCTs are needed for guideline-level certainty. Level I, systematic review of Level I randomized controlled studies.

No Difference in Functional Outcomes and Stability but Lesser Tunnel Widening With Tibial Suspensory Fixation Compared With Interference Screw in Hamstring Autograft Anterior Cruciate Ligament Reconstruction: A Systematic Review.

In revision anterior cruciate ligament reconstruction (R-ACLR), adding a lateral extra-articular procedure (LEAP) reduces graft failure and postoperative laxity. Iliotibial band (ITB)-based techniques may avoid patellar tendon harvesting morbidity, but evidence in adults, particularly in revision cases, remains limited. We compared clinical outcomes at ≥2 years after R-ACLR using a modified ITB-allograft (ITB-AG) technique versus bone-patellar tendon-bone with lateral extra-articular tenodesis (BPTB-LET). It was hypothesized that no difference in retear rates between techniques would be found. A retrospective analysis of prospectively collected data was performed on consecutive adult patients (≥18 years) undergoing R-ACLR between 2018 and 2023. Patients were included if they received ITB-AG or BPTB-LET R-ACLR, if surgery occurred within 24 months of graft failure and follow-up was ≥2 years. Exclusions were multiligament injury, concomitant osteotomy or refusal to participate. Primary outcome was graft retear, and secondary outcomes were International Knee Documentation Committee (IKDC) subjective score, Lysholm score, complications, side-to-side anterior laxity and pivot-shift grade. Comparisons between groups were performed using Student's t test or Mann-Whitney U test for continuous variables and chi-square or Fisher exact test for categorical variables, with statistical significance set at p < 0.05. One hundred ninety-five patients were analysed (BPTB-LET, n = 105; ITB-AG, n = 90). Groups were similar at baseline; follow-up was 38 ± 9 months for BPTB-LET and 34 ± 7 months for ITB-AG (p = 0.0005). Meniscal tears and repairs were more frequent with ITB-AG; graft diameter was slightly smaller with ITB-AG (8.8 ± 0.7 mm for ITB-AG vs. 9.3 ± 0.5 mm for BPTB-LET; p = 0.0001). Retear rates were not different (5.7% BPTB-LET vs. 4.4% ITB-AG; p = 0.7551). IKDC was higher with ITB-AG (90.7 ± 10.8 vs. 88.3 ± 10.1; p = 0.0026); 97% (BPTB-LET) and 93% (ITB-AG) achieved the IKDC Patient Acceptable Symptom State (p = 0.3073). Lysholm was higher with ITB-AG (94.6 ± 10.8 vs. 90.8 ± 9.0; p < 0.00001). A negative pivot-shift was found in 98.9% (ITB-AG) versus 66.7% (BPTB-LET) (p < 0.00001), while KT-1000 anterior laxity did not differ significantly (p = 0.1164). Complication rates were similar (4.7% vs. 5.5%; p = 1). At midterm follow-up, a modified ITB-AG technique provided comparable graft survival to BPTB-LET, with similarly low complication rates. Patient-reported outcome measures were statistically higher and a greater proportion of patients demonstrated a negative pivot-shift test in the ITB-AG group, although the clinical relevance of these differences remains uncertain. Level III.

Osteoarthritis (OA) is a chronic disease characterized by the degeneration of articular cartilage and secondary hyperosteogeny, typically located in weight-bearing joints. This study was undertaken to assess the expression profile, the diagnostic value, and the molecular mechanism of miR-584-5p in OA. Quantitative real-time polymerase chain reaction (qRT-PCR) was performed to detect the expression levels of miR-584-5p and hypoxia-inducible factor-1A (HIF1A) in serum samples from OA patients and healthy controls. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic efficacy of miR-584-5p for OA. Pearson correlation analysis was applied to explore the correlations between miR-584-5p expression and clinical scores (Lysholm, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analogue Scale (VAS) as well as HIF1A expression. In vitro, human chondrogenic HC-A cells were induced with interleukin-1β (IL-1β) to establish an OA cell model. Cell counting kit-8 (CCK-8) assay and flow cytometry were used to assess chondrocyte proliferation and apoptosis, respectively. Enzyme-linked immunosorbent assay (ELISA) kits were employed to quantify the secretion levels of inflammatory factors including interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and IL-1β. Dual-luciferase reporter assay was conducted to verify the direct targeting relationship between miR-584-5p and HIF1A. miR-584-5p was significantly downregulated in OA patients, and its expression level decreased progressively with the increase of Kellgren-Lawrence (K-L) grade. ROC curve analysis confirmed that miR-584-5p had a high diagnostic value for OA with an area under the curve (AUC) of 0.897, a sensitivity of 80.2% and a specificity of 86.2%. Pearson correlation analysis showed that miR-584-5p expression was positively correlated with Lysholm scores and negatively correlated with WOMAC and VAS scores in OA patients. In the IL-1β-induced HC-A cell model, miR-584-5p mimic significantly promoted chondrocyte proliferation, inhibited cell apoptosis, and reduced the secretion of IL-6, TNF-α and IL-1β. Additionally, miR-584-5p mimic downregulated the mRNA expression of extracellular matrix (ECM)-degrading enzymes including matrix metalloproteinase 13 (MMP13) and a disintegrin and metalloproteinase with thrombospondin motifs 5 (ADAMTS5), while upregulated the expression of ECM synthesis-related molecules including aggrecan (ACAN) and collagen type II alpha 1 chain (COL2A1). Notably, all these protective effects of miR-584-5p mimic were abrogated by transfection with HIF1A overexpression plasmid (oe-HIF1A). miR-584-5p is a potential novel diagnostic biomarker for OA with high sensitivity and specificity, and its expression level can reflect the clinical severity of OA. Mechanistically, miR-584-5p alleviates IL-1β-induced chondrocyte injury, inflammatory response and ECM metabolic imbalance in OA by directly targeting and inhibiting HIF1A.

Background: Anterior knee pain (AKP) is a frequent complaint after tibial intramedullary nailing (IMN), and the choice of entry approach may contribute to its occurrence. This trial compared the lateral parapatellar semi-extended (LPP) approach versus the midline transpatellar splitting (MLTP) approach for IMN of closed diaphyseal tibial fractures, focusing on AKP and knee function. Methods: In this single-blinded randomized controlled trial, 50 adults with acute closed AO/OTA 42 tibial shaft fractures were allocated 1:1 to IMN performed through either the LPP or MLTP approach. Follow-up assessments were performed at 3 and 6 months after surgery. Primary outcomes were AKP during weight-bearing, quantified using a visual analog scale (VAS), and knee function measured by the Lysholm Knee Score. Results: LPP achieved higher Lysholm scores at 3 months (82.36 ± 5.2 vs. 75.76 ± 6.1; P < 0.001) and 6 months (87.32 ± 4.8 vs. 84.20 ± 5.4; P = 0.024), indicating superior early functional recovery. VAS AKP was lower with LPP at 3 months (2.40 ± 0.9 vs. 3.60 ± 1.2; P = 0.001), but similar by 6 months (1.80 ± 0.7 vs. 1.96 ± 0.8; P = 0.122), suggesting the benefit is mainly early. Operative time favored LPP (62.1 ± 8.7 vs. 68.4 ± 10.2 min; P = 0.02) with fewer fluoroscopy shots (29.2 ± 5.4 vs. 38.5 ± 6.1; P < 0.001). All fractures united; time to union was comparable (16.8 ± 2.4 vs. 16.2 ± 2.1 weeks; P = 0.41). Complications were minor in both groups. Conclusions: LPP semi-extended tibial IMN was associated with lower early AKP, better early knee function, and improved operative efficiency without compromising union during 6-month follow-up. A Longer follow-up is required to determine whether anterior knee pain and functional outcomes converge over time.

Ramp lesions, tears involving the peripheral attachment of the posterior horn of the medial meniscus, significantly impact knee stability and function, particularly in association with anterior cruciate ligament injuries. However, evidence regarding optimal treatment strategies remains inconclusive. This systematic review and meta-analysis aimed to evaluate and compare the clinical efficacy of various treatment modalities for ramp lesions. A comprehensive systematic search was conducted across major electronic databases, including PubMed, Scopus, and Web of Science, up to June 2025. Studies were included based on predefined eligibility criteria. Data extraction was performed and meta-analytic synthesis was conducted using random-effects models. A total of 17 studies met inclusion criteria. The pooled mean difference demonstrated significant improvements in both IKDC (MD=28.5 points; 95% CI: 27.9-29.2) and Lysholm scores (MD=28.5 points; 95% CI: 27.9-29.2). Subgroup analyses revealed notable effectiveness for AIR compared to CM and PM, with statistically significant subgroup differences (p<0.05). The overall treatment success rate was 87% (95% CI: 83-92%). Across techniques, patient-reported outcomes improved markedly (IKDC fixed-effect pooled Mean Difference [MD] 28.8 points, 95% CI 28.2-29.4; random-effects overall effect significant; I²=98%). In anterior vs posterior all-inside subgroups, IKDC showed no robust between-approach difference on the random-effects test (χ²=0.51, p=.48), with a small fixed-effect difference (χ²=4.34, p=.04). Lysholm scores also improved substantially (fixed-effect pooled MD 28.0 points, 95% CI 27.3-28.7), and the between-approach difference was significant, favoring the posterior subgroup on the fixed-effect model. The pooled clinical success proportion was 90% without a significant difference between approaches (p=.10). The findings indicate that surgical interventions, particularly All-inside repair has effectively improved knee function and patient-reported outcomes following ramp lesions compared to conservative management and partial meniscectomy. However, no significant difference was detected between anterior and posterior all-inside repair techniques.

Attachment-sparing anterior cruciate ligament reconstruction (ACLR) is gaining acceptance over the use of free grafts because of reported early graft ligamentization in both animals and humans. However, the literature regarding clinical outcomes and the correlation of early graft healing is unclear. Tibial attachment-sparing hamstring graft (AS) results in earlier graft maturation, which correlates with a better clinical outcome than a free hamstring graft (FG). Randomized controlled trial; Level of evidence, 1. A total of 56 patients were randomly assigned to 2 groups at the commencement of the study. Of these patients, 25 (AS group) underwent ACLR using the attachment-sparing technique, while 25 patients (FG group) underwent ACLR using the free hamstring graft technique. Prospective sequential magnetic resonance imaging (MRI) evaluations were performed at 3, 6, and 9 months to document graft maturation, characteristics, orientation, and tunnel dilation. Clinical evaluation was done at 3, 6, 9, and 12 months to document Lysholm, International Knee Documentation Committee (IKDC), and Tegner scores and anterior tibial translation (ATT) by KT-2000 arthrometer, by independent observers. The overall follow-up rate was 78% (19 cases and 20 controls of 25 in each group). MRI Figueroa scores demonstrated significant differences between the AS and FG groups, with the AS group showing consistently higher scores at all timelines. The earliest noticed graft maturation in the case group was at 3 months (26.3% had Figueroa score 4), compared to 6 months for the controls. In the AS group, all participants attained a Figueroa score of 5 at the final assessment, whereas only 10% of the FG group achieved that. The AS group maintained nearly the same graft diameters, but the FG group showed increased diameter (graft swelling) at all follow-up time points. A significant increase in tibial tunnel diameter over time was observed in both groups, with a greater increase in the AS group. A significant improvement was observed in Lysholm score, IKDC score, and ATT in both groups. Tibial attachment-sparing hamstring grafts result in earlier and complete graft maturation on MRI as compared to free hamstring grafts for ACLR. Clinical Trials Registry - India (CTRI/2022/10/046620).

Comparison of Peroneus Longus and Hamstring Autografts in ACL Reconstruction: Graft Diameter and Donor-Site Morbidity Analysis.

Medial meniscus posterior root tear with concomitant focal cartilage lesion may be successfully treated with pullout repair combined with additional bone marrow stimulation