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Background The application of artificial intelligence (AI) in medical education and patient interaction is rapidly growing. Large language models (LLMs) such as GPT-3.5, GPT-4, Google Gemini, and Claude 3 Opus have shown potential in providing relevant medical information. This study aims to evaluate and compare the performance of these LLMs in answering frequently asked questions (FAQs) about Total Knee Arthroplasty (TKA), with a specific focus on the impact of role-playing prompts. Methods Four leading LLMs—GPT-3.5, GPT-4, Google Gemini, and Claude 3 Opus—were evaluated using ten standardized patient inquiries related to TKA. Each model produced two distinct responses per question: one generated under zero-shot prompting (question-only), and one under role-playing prompting (instructed to simulate an experienced orthopaedic surgeon). Four orthopaedic surgeons evaluated responses for accuracy and comprehensiveness on a 5-point Likert scale, along with a binary measure for acceptability. Statistical analyses (Wilcoxon rank sum and Chi-squared tests; P  < 0.05) were conducted to compare model performance. Results ChatGPT-4 with role-playing prompts achieved the highest scores for accuracy (3.73), comprehensiveness (4.05), and acceptability (77.5%), followed closely by ChatGPT-3.5 with role-playing prompts (3.70, 3.85, 72.5%, respectively). Google Gemini and Claude 3 Opus demonstrated lower performance across all metrics. In between-model comparisons based on zero-shot prompting, ChatGPT-4 achieved significantly higher scores of both accuracy and comprehensiveness relative to Google Gemini ( P  = 0.031 and P  = 0.009, respectively) and Claude 3 Opus ( P  = 0.019 and P  = 0.002), and demonstrated higher acceptability than Claude 3 Opus ( P  = 0.006). Within-model comparisons showed role-playing significantly improved all metrics for ChatGPT-3.5 ( P  < 0.05) and acceptability for ChatGPT-4 ( P  = 0.033). No significant prompting effects were observed for Gemini or Claude. Conclusions This study demonstrates that role-playing prompts significantly enhance the performance of LLMs, particularly for ChatGPT-3.5 and ChatGPT-4, in answering FAQs related to TKA. ChatGPT-4, with role-playing prompts, showed superior performance in terms of accuracy, comprehensiveness, and acceptability. Despite occasional inaccuracies, LLMs hold promise for improving patient education and clinical decision-making in orthopaedic practice. Clinical trial number Not applicable.

Background We investigated whether double-bundle (DB) anterior cruciate ligament (ACL) reconstruction (ACLR) combined with anterolateral ligament reconstruction (ALLR) improved clinical and radiological outcomes in patients at high risk of ACL failure. The primary outcome was graft failure, and secondary outcomes included knee stability and patient-reported outcome measures (PROMs). Patients and methods Fifty-two patients who underwent DB ACLR combined with ALLR were included in this retrospective cohort study. Preoperative risk factors, including femorotibial angle (FTA), lateral tibial slope (LTS), medial tibial slope (MTS), and meniscal tears, were assessed using X-ray and magnetic resonance imaging (MRI). The grade of post-operative pivot shift, Lysholm score, and Tegner activity score were used to assess clinical outcomes. The minimum follow up duration was 2 years. Results The cohort (mean age, 26.1 ± 9.4 years; 51.9% male) had a mean follow-up duration of 28.9 ± 3.4 months. Preoperatively, 57.8% had lateral meniscus (LM) tears, and 61.0% had a grade 2–3 pivot shift. Postoperatively, no graft failures or revision cases occurred during follow-up. Approximately 90.4% of the patients exhibited a negative pivot shift ( p  < 0.001), with Lysholm and Tegner activity scores of 92.5 ± 6.1 and 5.1 ± 2.0. The medial meniscus (MM) tear group had a significantly smaller FTA than the intact group ( p  = 0.043). No significant differences in PROMs were found between the LM tear and intact LM groups or between the high and low MTS or LTS groups (p = n.s.). Conclusion DB ACLR combined with ALLR had satisfactory clinical outcomes in patients at high risk of ACL failure, with no graft failures observed during a mean follow-up duration of 2.4 years. The technique effectively reduced the postoperative pivot shift, regardless of preoperative risk factors. Study design Level IV, retrospective therapeutic case-series. Trail registration ethical approval number, 202300134B0; ethical committee, the Institutional Review Board of Chang Gung Medical Foundation.

Background Anterior cruciate ligament (ACL) graft failure is influenced by factors such as meniscal tears and tibial plateau slope. Combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction has reduced failure rates; however, its efficacy in high-risk patients remains unclear. This study hypothesized that combined ACL and ALL reconstruction would yield similar clinical outcomes in patients with varying risks of ACL failure. Patients and methods A total of 76 patients who underwent primary single-bundle ACL reconstruction combined with ALL reconstruction between June 2018 and June 2021 were included. The medial tibial slope (MTS), lateral tibial slope (LTS), and anterior tibial translation (ATT) were measured using magnetic resonance imaging and plain radiography of the knee joint. The meniscal lesions were assessed during surgery. Preoperative clinical assessments and final follow-up were conducted using patient-reported outcome measurements (PROMs), including the International Knee Documentation Committee (IKDC) evaluation, Lysholm knee scoring scale, and Tegner Activity scale. PROMs were collected at least two years postoperatively. Results The average follow-up was 32.5 ± 7.4 months. There were no significant differences in postoperative IKDC score, Lysholm score, or Tegner activity score between patients with or without medial meniscus injury ( p  = 0.155, 0.914, and 0.042, respectively), with or without lateral meniscus injury ( p  = 0.737, 0.569, and 0.942, respectively), medial tibial slope > 12° or ≤ 12° ( p  = 0.290, 0.496, and 0.988, respectively), or lateral tibial slope > 7.4° or ≤ 7.4° ( p  = 0.213, 0.625, and 0.922, respectively). No significant correlations were found between anterior tibial translation and postoperative IKDC ( R  = -0.058, p  = 0.365), Lysholm ( R  = -0.017, p  = 0.459), or Tegner activity scores ( R  = -0.147, p  = 0.189). Conclusion Our study demonstrates that single-bundle ACL reconstruction combined with ALL reconstruction provides reliable and comparable clinical outcomes in patients with high-risk factors for ACL graft failure, such as increased tibial slope or meniscal injury. Our results suggest that the indications for ALL reconstruction may be expanded to include patients with a high tibial slope or meniscal injury, because these factors have been shown to contribute to increased rotational instability and high rates of ACL graft failure. Future prospective randomized controlled trials with large patient cohorts and long follow-up periods are needed to validate these findings and establish clear guidelines for patient selection and surgical decision-making. Level of evidence Level 3.

Background Single-bundle (SB) anterior cruciate ligament reconstruction (ACLR), double-bundle (DB) ACLR, and DB ACLR combined with anterolateral ligament reconstruction (DB ACLR and ALLR) have been developed to address ACL tears. We hypothesized that these three techniques provide satisfactory results for patients with ACL tears, with the DB ACL and ALLR group having more lateral knee discomfort. Methods 167 patients were retrospectively divided into three groups: SB ACLR, DB ACLR, and DB ACLR and ALLR. Postoperative evaluations were conducted via telephone interviews and in-person consultations using the Tegner and Lysholm scores. Results The mean follow-up time was 27.7 ± 4.4 months in the SB ACLR group, 25.5 ± 3.2 months in the DB ACLR group, and 28.1 ± 3.6 months in the DB ACLR and ALLR group ( P  = 0.044). For Lysholm score, the DB ACLR and ALLR group ( n  = 55) was 92.3 ± 7.0, the DB ACLR group ( n  = 21) was 92.4 ± 6.6, and the SB ACLR group ( n  = 91) was 92.5 ± 10.2 ( P  = 0.995). For the Tegner score, the DB ACLR and ALLR group was 4.5 ± 2.2, the DB ACLR group was 5.0 ± 1.6, and the SB ACLR group was 4.4 ± 1.7 ( P  = 0.378). In the DB ACLR and ALLR group, 10 of the 55 (18.2%) patients exhibited symptoms in the lateral knee. Conclusions SB ACLR, DB ACLR, and DB ACLR and ALLR with suture tape augmentation procedures yielded comparable clinical functional scores. While lateral knee symptoms were observed in patients receiving DB ACLR and ALLR with suture tape augmentation, these symptoms did not significantly influence the functional outcome.

Conventionally, efficiency is indirectly estimated through a respiratory gas analyser (oxygen, carbon dioxide), which is a complex and rather costly calculation method that is difficult to perform in many situations. Therefore, the present study proposed a modified definition of efficiency, called the efficiency factor (EF) (i.e., the ratio of work to the corresponding exercise intensity), and evaluated the relation between the EF and maximal oxygen uptake ( V ˙ O 2 max ), as well as compared the prediction models established based on the EF. The heart rate (maximal heart rate: 186 ± 6 beats min −1 ), rating of perceived exertion (19 ± 1), and V ˙ O 2 max (39.0 ± 7.1 mL kg −1  min −1 ) of 150 healthy men (age: 20 ± 2 years; height: 175.0 ± 6.0 cm; weight: 73.6 ± 10.7 kg; body mass index [BMI]: 24.0 ± 3.0 kg m −2 ; percent body fat [PBF]: 17.0 ± 5.7%) were measured during the cardiopulmonary exercise test (CPET). Through multiple linear regression analysis, we established the BMI model using age and BMI as parameters. Additionally, we created the PBF model HRR utilizing weight, PBF, and heart rate reserve (HRR) and developed PBF model EF6 and PBF model EF7 by incorporating EF6 from the exercise stage 6 and EF7 from the exercise stage 7 during the CPET, respectively. EF6 (r = 0.32, p  = 0.001) and EF7 (r = 0.31, p  = 0.002) were significantly related to V ˙ O 2 max . Among the models, the PBF model EF6 showed the highest accuracy, which could explain 62.6% of the variance in the V ˙ O 2 max at with a standard error of estimate (SEE) of 4.39 mL kg −1  min −1 (%SEE = 11.25%, p  < 0.001). These results indicated that the EF is a significant predictor of V ˙ O 2 max , and compared to the other models, the PBF model EF6 is the best model for estimating V ˙ O 2 max .

Intermittent training (IT) has been shown to enhance athletic performance by improving aerobic and anaerobic capacities, neuromuscular efficiency, and recovery key factors for judokas given the intermittent nature of judo combat. This study investigated the effects of a six-week judo-specific intermittent training program on body composition (body mass (BM); percent body fat (PBF); skeletal muscle mass (SMM)), grip strength, lower-limb impulse (countermovement jump, (CMJ)) (relative force peak (RFP)), relative force peak (RFP), reactive strength index-modified (RSImod), jump height (JH), time to takeoff (TTT)), and specialized performance (special judo fitness test, (SJFT)) (SJFT series A, SJFT series B, SJFT series C, SJFT total number of throws, SJFT post-exercise heart rate, SJFT one-minute post-exercise heart rate), with two primary objectives: (1) incorporating uchikomi + ippon seoi-nage (Tori group) as part of the training intervention and (2) examining the impact of serving as sparring partners through mae-ukemi (Uke group) on performance outcomes. Thirty male judo athletes (all black belt) were randomly assigned to the Tori (169.90 ± 6.17 cm in stature, 76.67 ± 18.2 kg in mass, 20.64 ± 3.07 years of age and 13.10 ± 2.88 years of experience), Uke (72.36 ± 6.32 cm in stature, 77.28 ± 19.4 kg in mass, 21.73 ± 6.15 years of age and 11.90 ± 1.79 years of experience), and control group (CON) (167.18 ± 4.16 cm in stature, 76.77 ± 13.7 kg in mass, 21.55 ± 5.30 years of age, and 12.00 ± 2.40 years of experience) ( n  = 10 per group). The intermittent training sessions were held twice weekly (Tuesday and Thursday) at 2:00 PM, with a 24-hour recovery between sessions. Participants were paired by body weight (≤10% difference). Training included two blocks of six 20-second sets, with 20-second passive rest intervals, totaling 8 minutes per session. The results showed a significant time effect ( p  < 0.01) in the special judo fitness index, along with a time × group interaction ( F  = 5.44; p  = 0.01; η 2  = 0.28). Post hoc comparisons revealed that the Tori group’s improvement was significantly greater than that of the other two groups (Tori: p  < 0.01; Uke: p  = 0.58; CON: p  = 0.78). For CMJ parameters (RFP, JH, RSImod), although a significant time effect was observed, no interaction effects were found for any parameter. In terms of body composition and grip strength, neither a time effect nor an interaction effect was present. Additionally, the Uke group, while serving as sparring partners, had no negative impact on any variables examined in this study. Judo-specific intermittent training can significantly enhance SJFT, making it an effective training method. While CMJ parameters showed a time effect, intermittent training alone may not fully improve lower-limb impulse. Additionally, during sport-specific intermittent training, serving as a sparring partner does not negatively impact performance, allowing safe integration into training programs.

There is currently no consensus on the optimal placement of the tibial tunnel for double-bundle posterior cruciate ligament (PCL) reconstruction. The purpose of this study was to compare the clinical and radiologic outcomes of double-bundle PCL reconstruction utilizing anatomic versus low tibial tunnels. We conducted a retrospective cohort study involving patients who underwent double-bundle PCL reconstruction between Jan 2019 and Jan 2022, with a minimum follow-up of 2 years (n = 36). Based on the tibial tunnel position on postoperative computed tomography, patients were categorized into two groups: anatomic placement (group A; n = 18) and low tunnel placement (group L; n = 18). We compared the range of motion, stability test, complications, and side-to-side differences in tibial posterior translation using kneeling stress radiography between the two groups. There were no significant differences between the groups regarding clinical outcomes or complication rates. No significant differences in the posterior drawer test and side-to-side difference on kneeling stress radiography (2.5 ± 1.2 mm in group A vs. 3.7 ± 2.0 mm in group L; p = 0.346). In conclusion, the main findings of this study indicate that both anatomic tunnel and low tibial tunnel placements in double-bundle PCL reconstruction demonstrated comparable and satisfactory clinical and radiologic outcomes, with similar overall complication rates at the 2-year follow-up.

Background To investigate the radiologic and prognostic outcomes after using arthroscopic-assisted reduction and internal fixation (ARIF) in complex tibial plateau fractures with mid- to long-term follow-up. Methods This retrospective study reviewed complex tibial plateau fractures that underwent ARIF from 1999 to 2019. Radiologic outcomes, including tibial plateau angle (TPA), posterior slope angle (PSA), Kellgren–Lawrence classification and Rasmussen radiologic assessment, were measured and evaluated. The prognosis and complications were assessed by the Rasmussen clinical assessment with a minimum follow-up of 2 years. Results Ninety-two consecutive patients (mean age: 46.9 years) with a mean follow-up of 74.8 months (24–180) were included in our series. Using AO classification, there were 20 type C1 fractures, 21 type C2 fractures, and 51 type C3 fractures. All the fractures achieved solid union. TPA was maintained well on average at the last follow-up and showed no significant difference compared to postoperatively ( p  = 0.208). In the sagittal plane, the mean PSA increased from 9.3 ± 2.9° to 9.6 ± 3.1° ( p  = 0.092). A statistically significant increase in PSA was also noted in the C3 group ( p  = 0.044). Superficial or deep infection was noted in 4 cases (4.3%), and total knee arthroplasty (TKA) was performed in 2 cases (2.2%) due to grade 4 osteoarthritis (OA). Ninety (97.8%) and 89 (96.7%) patients had good or excellent results in the Rasmussen radiologic assessment and Rasmussen clinical assessment, respectively. Conclusions The complex tibial plateau fracture could be treated successfully using arthroscopy-assisted reduction and internal fixation. Most patients achieve excellent and good clinical outcomes with low complication rates. In our experience, a higher incidence of increased slope was noted, especially in type C3 fractures. Reduction of the posterior fragment should be done cautiously during the operation. Levels of evidence Level III.

Background There are many adhesion barrier materials, cross-linked or non-cross-linked hyaluronic acid (HA), used during surgeries. Purpose This study investigates the efficacy of cross-linked and non-cross-linked HA in preventing Achilles tendon adhesions. We hypothesized that non-cross-linked HA may be more effective than cross-linked HA in preventing Achilles tendon adhesions following injury and repair. Methods Twenty male Sprague Dawley rats, totaling 40 legs, underwent Achilles tendon transection and repair. Following the surgery, they were treated simultaneously with cross-linked and non-cross-linked HA formulations. The rats were divided into four groups: a positive control group, a group treated with BMC non-cross-linked HA gel, a group treated with DEFEHERE cross-linked HA gel, and a group treated with ANIKA cross-linked HA gel. Four weeks after surgery, macroscopic evaluation of peritendinous adhesion and histological analysis were conducted to assess the effectiveness of the treatments. Results Non-cross-linked BMC HA demonstrated superior efficacy in preventing tendon adhesions compared to cross-linked HA and control groups. Histological analysis confirmed reduced adhesion severity in the non-cross-linked HA group ( P  < 0.05). The findings support the potential of non-cross-linked HA as a treatment to inhibit tendon adhesions. Further research, including clinical trials, is warranted to validate these results in human subjects. Conclusions Non-cross-linked BMC HA had significantly lower tendon adhesions parameters and better healing scores in histological analysis than cross-linked HA and control group did. Non-cross-linked HA holds promise as a potential treatment to inhibit the formation of such adhesions.

This case report describes a new approach to segmental meniscal reconstruction using a peroneal longus autograft in a patient with recurrent traumatic medial meniscus tear and anterior cruciate ligament reconstruction (ACLR) failure. While allograft meniscal transplantation is the preferred method for treating meniscal deficiency, its high cost and various legal regulations have limited its widespread use. Autologous tendon grafts have been proposed as a substitute for allograft meniscus transplantation, but their initial results were poor, leading to little progress in this area. However, recent animal experiments and clinical studies have demonstrated promising results in using autologous tendon grafts for meniscal transplantation, including improvements in pain and quality of life for patients. Further research is needed to evaluate the effectiveness of segmental meniscal reconstruction using autologous tendon grafts, but it could potentially lead to more accessible and cost-effective treatment options for patients with meniscal deficiency.