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Objectives: The type of ligamentous tear and the degree of knee laxity have important guiding significance for the diagnosis and management of anterior cruciate ligament (ACL) tears. Instrumental measurement is necessary for ACL tears since physical examination and magnetic resonance imaging (MRI) cannot provide an objective and quantitative assessment of knee laxity. This study aimed to compare the application of a novel knee arthrometer and simultaneous stress radiography in differentiating between complete and partial acute ACL tears, and further assess the correlation between the two measurements. Methods: A total of 106 patients with complete acute ACL tears and 52 patients with partial acute ACL tears were included in the study. Preoperative arthrometry and simultaneous stress radiography were performed using the Ligs arthrometer at 90, 120, and 150 N to assess side‐to‐side difference (SSD) in anterior knee laxity. The optimal threshold was determined using the receiver operating characteristic (ROC) curve. The area under the ROC curve (AUC) was used to assess the diagnostic value of the measurement. Pearson's correlation coefficient was used to assess the correlation between the two measurements. Results: The optimal differential SSD thresholds in the Ligs arthrometer were 2.7 mm at 90 N, 3.8 mm at 120 N, and 4.6 mm at 150 N. Similarly, the optimal differential SSD thresholds in simultaneous stress radiography were 3.8 mm at 90 N, 5.1 mm at 120 N, and 5.6 mm at 150 N. The AUC analysis revealed that the Ligs arthrometer was fairly informative at 90 N (AUC = 0.851), 120 N (AUC = 0.878), and 150 N (AUC = 0.884), and simultaneous stress radiography was highly informative at 90 N (AUC = 0.910), 120 N (AUC = 0.925), and 150 N (AUC = 0.948). Moreover, the AUC of the combined measurements was 0.914 at 90 N, 0.931 at 120 N, and 0.951 at 150 N. A significantly strong correlation was found between the two measurements at 90 N (r = 0.743, p < 0.001), 120 N (r = 0.802, p < 0.001), and 150 N (r = 0.823, p < 0.001). Conclusions: The Ligs arthrometer and simultaneous stress radiography proved to be valid diagnostic tools to differentiate between complete and partial acute ACL tears, with a strong correlation between the two measurements in SSD values. Compared with single instrumental measurement, the combination of the two measurements can further improve the diagnostic value in this regard. [ABSTRACT FROM AUTHOR]

The optimal surgical intervention for lateral patellar instability remains a topic of controversy despite satisfactory clinical outcomes and low re‐dislocation rates reported in numerous studies following medial patellofemoral ligament reconstruction (MPFLR) with and without tibial tubercle transfer (TTT). The purpose of this systematic review and meta‐analysis is to investigate the hypothesis that combining MPFLR with TTT provides reduced complication rates and improved clinical outcomes to isolated MPFLR in patients with lateral patellar instability. We conducted a comprehensive systematic review and meta‐analysis of comparative trials involving MPFLR with and without TTT, sourcing data from PubMed, the Cochrane Library, Embase, and Web of Science. The primary clinical outcomes analyzed included the Kujala score, the Lysholm score, complication rates, and the Caton–Deschamps index (CDI). Random or fixed effects were used for the meta‐analysis. Postoperatively, there were no significant differences observed in the Kujala and Lysholm scores between MPFLR and MPFLR + TTT (p = 0.053). At the final follow‐up, the CDI had decreased 0.015 (95% CI −0.044, 0.013; p = 0.289) points in the MPFLR group, with no statistical significance. In contrast, the MPFLR + TTT group demonstrated a significant decrease of 0.207 (95% CI −0.240, −0.174; p = 0.000) points in CDI. Notably, the complication rate was higher in the MPFLR + TTT group compared to the MPFLR‐only group (RR = 2.472; 95% CI 1.638, 3.731; p = 0.000). Both MPFLR and MPFLR + TTT procedures yield significant improvements in the Kujala and Lysholm scores. However, the MPFLR + TTT approach results in an apparent improvement in CDI and corrects patellar maltracking, particularly in cases involving high tibial tuberosity‐trochlear groove (TT‐TG) (>20 mm) or patella alta (CDI > 1.2), while MPFLR alone cannot. It is essential to consider the higher complication rate of MPFLR + TTT, which suggests that MPFLR alone may be sufficient for patients without high TT‐TG or patella alta. [ABSTRACT FROM AUTHOR]

Objective: The tibial tubercle‐trochlear groove (TT‐TG) distance is now routinely utilized to help determine whether a realignment procedure is necessary for patients with patellar instability. The tibial tubercle‐posterior cruciate ligament (TT‐PCL) distance has been explored as an alternative measurement. The aim of this study is to compare the reliability of TT‐TG and TT‐PCL; to explore whether there is a relationship between the TT‐PCL and the TT‐TG distance; to determine whether there is a relationship between the TT‐TG and TT‐PCL distances and knee rotation; and to compare the abilities of the TT‐PCL distance and the TT‐TG distance with predicted patellar instability. Method: This systematic review was performed in accordance with PRISMA guidelines. Three databases, PubMed, EMBASE, and Cochrane Central Register of Controlled Trials, were searched from inception to September 2021 to identify clinical studies comparing TT‐TG and TT‐PCL distances to patellar instability. Data on patient baseline characteristics, TT‐TG and TT‐PCL distances, inter‐observer reliability, and area under the receiver‐operating characteristic curve (AUC) were recorded. The methodological quality of the studies was assessed using the quality assessment form recommended by the Agency for Healthcare Research and Quality (AHRQ). Result: Twenty studies were included in the final analysis, comprising 2330 knees from 2260 patients. The current study showed that TT‐TG and TT‐PCL have similar observer reliability. The inter‐ and intra‐observer reliability of TT‐TG ranged from 0.807 to 0.98 and 0.553 to 0.99, respectively. The inter‐ and intra‐observer reliability of TT‐PCL ranged from 0.553 to 0.99 and 0.88 to 0.981, respectively. Six studies compared the AUC for predicting patellar instability and showed that TT‐TG had better predictive performance than TT‐PCL. Three studies reported a correlation between TT‐TG and knee rotation, but no such relationship was found for TT‐PCL. Eight studies reported a weak or moderate correlation between TT‐TG and TT‐PCL. Conclusion: TT‐TG and TT‐PCL have similar inter‐ and intra‐rater reliability (as measured by ICC), but TT‐TG has greater discriminatory power to predict patellar instability than TT‐PCL (as measured by AUC values and odds ratio). However, considering trochlear dysplasia and individual variations, future studies need to find more accurate and individualized methods to predict patellar instability. [ABSTRACT FROM AUTHOR]

Objective: Hyaluronic acid (HA) intra‐articular injection after arthroscopic knee surgery has been widely applied but its efficacy and safety remain controversial. The aim of this systematic review is to analyze the efficacy and safety of HA intra‐articular injection after arthroscopic knee surgery, and to compare the efficacy of HA with different molecular weights. Methods: We conducted a systematic literature search in PubMed, Embase, Google scholar and the Cochrane library from inception to 16 September 2022 for English‐written articles, in order to identify randomized controlled trials that evaluated the clinical efficacy and/or safety of HA intra‐articular injection after arthroscopic knee surgery. Then we meta‐analyzed the outcomes of patients given intra‐articular HA injections postoperatively and control patients. We also evaluated the influence of HA with different molecular weights. In every calculation, sensitive analysis was performed. The visual analogue scale (VAS) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and adverse events were selected as the primary outcome measurements, while Lysholm, International Knee Documentation Committee (IKDC) and Tegner score were selected as the secondary outcome measurements. Publication bias of every outcome was evaluated using egger test. Results: Fifteen studies involving 951 knees were included and 12 of them were used to performed the meta‐analysis. The results showed no significant difference between the HA group and control group according to VAS, whether assessed at less (P = 0.90) or more than 6 months (P = 0.55). Besides, there were no statistical differences between the HA group and control group according to subgroup analysis (Ps = 0.77, 0.91 and 0.81 in anterior cruciate ligament reconstruction, meniscectomy and overall groups, respectively). Compared to control group, the overall effect of WOMAC score showed no significant differences (P = 0.25), nor did in two subgroups (P = 0.37 and P = 0.22). Outcomes measured by Lysholm (P = 0.13), IKDC (P = 0.86) and Tegner (P = 0.42) scores showed no significant differences, either. The analysis of the risk of adverse events indicated no increase in HA groups (P = 0.06). We found no significant differences between high‐ and low‐molecular‐weight HA at 6 (P = 0.96) or 12 months (P = 0.93) postoperatively. Two studies failed to pass the sensitive analysis and the reasons were discussed detailly and acceptable publication bias was observed. Conclusions: Although HA injection after arthroscopic knee surgery is safe, the available evidence does not support its efficacy in pain relief and functional recovery. Therefore, the application of HA injection after arthroscopic knee surgery is not recommended. [ABSTRACT FROM AUTHOR]

Objective: Musculoskeletal pain is having growing impacts worldwide with clinical challenge in pain management. The purpose of the present study is to investigate the preferences of orthopedic surgeons of China for using medicine in musculoskeletal pain. Methods: A questionnaire was developed, including the following domains, personal information, medication preference for pain treatment, and perceptions of topical medicine. Ten participants were selected to confirm the consistency of questionnaire. A cross‐sectional survey was conducted in orthopedic physicians with different specialties in different regions of China via the online survey platform. The participants' survey results were analyzed one‐way and multi‐way using chi‐square test and logistic regression. Results: The pre‐survey analysis results of 10 randomly selected investigators were a mean weighted kappa coefficient of 0.76 (range 0.61–0.89), which indicated the substantial consistency of the present questionnaire. A total of 1099 orthopedic surgeons (mean age, 41.67 ± 8.31 years) responded to our survey, most of whom were male (90.72%), and most of whom worked in level III hospitals (63.24%) and trained in modern medicine (71.43%). Most surgeons who participated in the survey had used topical analgesics in their clinical work (95.81%), and most preferred to use topical analgesics (39.50%) or a combination of oral analgesics (28.87%). Primary reasons for preferring topical analgesics were as follows: less adverse reactions (68.01%); ease of use (60.90%); and not interfering with other oral medications (49.60%). The preference for prescribing topical analgesics increased with the education level of the respondent, where statistically significant differences were seen (P < 0.05). In addition, the level of the respondent's hospital, type of hospital, the respondent's profession, and their participation in surgical work influenced their preferences for topical analgesics (P < 0.05). Conclusion: Orthopedic surgeons across China have different medication preferences in the treatment of musculoskeletal pain. The educational background of the physician largely influences the preference when selecting medications. To better improve the treatment of musculoskeletal pain, there is a need to improve the overall medical education of practitioners and to disseminate clinical practice guidelines. [ABSTRACT FROM AUTHOR]

Purpose. The purpose of this study was to compare the accuracy and clinical outcomes of the medial open wedge high tibial osteotomy (MOWHTO) using a three-dimensional (3D-) printed patient-specific instrumentation (PSI) with that of conventional surgical techniques. Methods. A prospective comparative study which included 18 patients who underwent MOWHTO using 3D-printed PSI technique (3D-printed group) and 19 patients with conventional technique was conducted from Jan 2019 to Dec 2019. After the preoperative planning, 3D-printed PSI (cutting guide model) was used in MOWHTO for 3D-printed group, while freehand osteotomies were adopted in the conventional group. The accuracy of MOWHTO for each method was compared using the radiological index obtained preoperatively and postoperatively, including mechanical femorotibial angle (mFTA) and medial mechanical proximal tibial angle (mMPTA), and correction error. Regular clinical outcomes were also compared between the 2 groups. Results. The correction errors in the 3D-printed group were significantly lower than the conventional group (mFTA, 0.2 ° ± 0.6 ° vs. 1.2 ° ± 1.4 ° , P = 0.004) (mMPTA, 0.1 ° ± 0.4 ° vs. 2.2 ° ± 1.8 ° , P < 0.00001). There was a significantly shorter duration (P < 0.00001) and lower radiation exposures (P < 0.00001) for the osteotomy procedure in the 3D-printed group than in the conventional group. There were significantly higher subjective IKDC scores (P = 0.009) and Lysholm scores (P = 0.03) in the 3D-printed group at the 3-month follow-up, but not significantly different at other time points. Fewer complications occurred in the 3D-printed group. Conclusions. With the assistance of the 3D-printed patient-specific cutting guide model, a safe and feasible MOWHTO can be conducted with superior accuracy than the conventional technique. [ABSTRACT FROM AUTHOR]

Objective. To conduct a meta-analysis of randomized controlled trials (RCTs) to compare knee arthroplasty with patient-specific instrumentation (PSI) with the conventional instrumentation (CI). Methods. RCTs were selected in PubMed and Embase from 2012 to 2018. Key data extracted included malalignment of mechanical axis, blood loss, surgical time, Oxford Knee Score (OKS), Knee Society Score (KSS), length of stay, and complications. Subgroup analysis was also performed regarding different PSI systems and different image processing methods. Results. 29 RCTs with 2487 knees were eligible for the meta-analysis. Results showed that PSI did not improve the alignment of the mechanical axis compared with CI, but MRI-based PSI and Visionaire-specific PSI decrease the risk of malalignment significantly (P = 0.04 and P = 0.003 , respectively). PSI reduced operative time (P = 0.03) and blood loss (P = 0.002) and improve the KSS (P = 0.02) compared with CI, but for CT-based PSI, the difference of operative time becomes insignificant. PSI showed no significant difference with CI regarding risk of complication, length of stay in hospital, and functional outcomes of OKS. Conclusion. PSI reduced the blood loss and improved KSS. MRI-based PSI reduced operative time and risk of malalignment of mechanical axis compared with CT-based PSI. Moreover, Visionaire-specific PSI achieves better alignment result of the mechanical axis than other systems. [ABSTRACT FROM AUTHOR]

Porous asphalt mixture is a type of asphalt mixture with good drainage. However, it has poor tensile strength performance and durability. Chopped basalt fibers (CBF) have been proved to be an effective additive to improve the mechanical and fatigue performance of asphalt mixtures, but little attention has been paid on porous asphalt mixture. This paper examined the effect of chopped basalt fibers with different lengths (nonfiber, 3 mm, 6 mm, 9 mm, and 12 mm) and contents (3% and 4%) on the performance of the porous asphalt mixture. A series of tests were conducted to figure out the optimum fiber length and content, including draindown test, cantabro abrasion test, freeze-thaw split tensile test, wheel tracking test, low-temperature cracking resistance test, and four-point bending beam test. Thereafter, indirect tensile tests at different temperatures were conducted to investigate the tensile strength properties of porous asphalt mixtures with optimum fiber length and content. Besides, the macroscopic and microscopic morphology of fracture sections of the samples after indirect tensile tests were studied by using a single-lens reflex (SLR) camera and scanning electron microscopy (SEM) so as to further explore the reinforced mechanism of chopped basalt fibers. The results show that the addition of chopped basalt fibers can generally improve the performance of porous asphalt mixture since chopped basalt fibers form a three-dimensional network structure in the porous asphalt mixture. [ABSTRACT FROM AUTHOR]

This study aimed to culture and characterize mesenchymal stem cells derived from meniscal debris. Cells in meniscal debris from patients with meniscal injury were isolated by enzymatic digestion, cultured in vitro to the third passage, and analyzed by light microscopy to observe morphology and growth. Third-passage cultures were also analyzed for immunophenotype and ability to differentiate into osteogenic, adipogenic, and chondrogenic lineages. After 4-5 days in culture, cells showed a long fusiform shape and adhered to the plastic walls. After 10–12 days, cell clusters and colonies were observed. Third-passage cells showed uniform morphology and good proliferation. They expressed CD44, CD90, and CD105 but were negative for CD34 and CD45. Cultures induced to differentiate via osteogenesis became positive for Alizarin Red staining as well as alkaline phosphatase activity. Cultures induced to undergo adipogenesis were positive for Oil Red O staining. Cultures induced to undergo chondrogenesis were positive for staining with Toluidine Blue, Alcian Blue, and type II collagen immunohistochemistry, indicating cartilage-specific matrix. These results indicate that the cells we cultured from meniscal debris are mesenchymal stem cells capable of differentiating along three lineages. These stem cells may be valuable source for meniscal regeneration. [ABSTRACT FROM AUTHOR]

Suppression of neo-angiogenesis is a clinically used anti-tumor strategy with new targets such as angiopoietin-2 (Ang2) being proposed. However, the functions of Ang2 in vascular remodeling, inflammation and tumor growth are not consistent. We examined effect of depletion of host Ang2 on liver colony formation using Ang2 deficient ( Ang2−/−) mice. Surprisingly, the metastatic colonies formed in Ang2−/− mice were larger than those in the wild type. These colonies had greater vascular density with more pericyte coverage than the vessels in liver colonies in the wild type. Liver VEGF concentration in both genotypes was equivalent, and thus, the differences appeared VEGF independent. However, after colony formation, the serum concentration of granulocyte-colony stimulating factor (G-CSF) and CXCL1 in Ang2−/− mice was 12 and 6 times greater than after colony formation in wild type. Increase of these two cytokines was associated with two times greater numbers of neutrophils recruited to the liver. Two times more Tie2+/CD11b+/CD31− cells were present in the tumors in Ang2−/− than in the wild type livers. These results suggest that the depletion of host Ang2 induced compensatory VEGF-independent angiogenic mechanisms and thus enhanced liver metastatic colony growth and colony vascularity. They further indicate organotypic differences in response to tumor metastasis. In contrast, Ang2 deficiency inhibited tumor growth during metastatic colony formation in the lung, consistent with the reports of decreased pulmonary seeding of tumor cells after pharmacological inhibition of Ang2. Further studies are thus required to assess the effects of pharmacological Ang2 blockade for cancer patients particularly in the liver. [ABSTRACT FROM AUTHOR]

Abstract Background: Recent molecular studies suggest that mammals and Drosophila utilize similar components to generate circadian (≈ 24 h) rhythms. The first identified circadian clock gene, the period (per ) gene, is indispensable for behavioural rhythms in Drosophila and is represented in mammals by three orthologues, the relative roles of which are not known. In this study, we investigated the functional conservation of per by introducing the mouse mPer1 and mPer2 genes, driven by the Drosophila timeless (tim ) promoter, into Drosophila melanogaster . Results: Behavioural assays showed that both mPer constructs restored rhythms in per 01 flies that are otherwise arrhythmic due to a lack of endogenous per protein (PER). However, the rhythms restored by mPer2 were generally stronger and differed in periodicity from those restored by mPer1 . In rhythmic transgenic flies, mPER proteins were expressed in lateral neurones and/or many cells in optic lobe. In addition, cell culture experiments indicated that the Drosophila PER partner, TIM, can form a complex with each of these two mammalian proteins. Conclusions: This study demonstrates that both mPer1 and mPer2 can function as clock components, and has implications for a functional analysis of the different per genes. [ABSTRACT FROM AUTHOR]