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Purpose To compare the outcomes of anterior cruciate ligament (ACL) reconstruction with those of combined ACL and anterolateral ligament (ALL) reconstruction in ACL-deficient knees. The objective of this study was to improve knowledge regarding the treatment of ACL-deficient knees with combined ACL and ALL reconstruction. Combined ACL and ALL reconstruction has been hypothesized to result in better clinical and functional outcomes than isolated ACL reconstruction (ACLR). Methods One-hundred and seven adult male athletes with ACL tears and high-grade pivot shifts were randomized into two groups. Those in group A ( n  = 54) underwent ACLR, while those in group B ( n  = 53) underwent combined ACL and ALL reconstruction. The median age was 26 (18–40) and 24 (18–33) years in groups A and B, respectively, and the median follow-up was 60 (55–65) months. Physical examination findings, instrumented knee laxity tested using a KT-1000 arthrometer, and International Knee Documentation Committee Scale (IKDC) scores were used to evaluate the outcomes. Results One-hundred and two patients were available for follow-up: 52 in group A and 50 in group B. Postoperatively, the pivot shift was normal in 43 (82.7%) and 48 (96%) patients in groups A and B, respectively ( p  < 0.001). The median instrumented knee laxity was 2.5 ± 0.7 (1.2–6.1) mm in patients in group A and 1.2 ± 0.7 (1.2–3.2) mm in patients in group B ( p  < 0.001). Additionally, 44 (84.6%) patients in group A had normal IKDC scores and 3 (5.8%) had nearly normal scores, while 48 (96.0%) patients in group B had normal IKDC scores and 2 (4%) had nearly normal scores ( p  < 0.001). Conclusion Combined ACL and ALL reconstruction, compared with isolated ACLR resulted in favourable clinical and functional outcomes, as demonstrated by decreased rotational instability and instrumented knee laxity, a lower graft rupture rate and better postoperative IKDC scores. Level of evidence 1.

Purpose The acromioclavicular ligament complex (ACLC) is the primary stabilizer against horizontal translation with the superior ACLC providing the main contribution. The purpose of this study was to evaluate the specific regional contributions in the superior half of ACLC, where the surgeon can easily access and repair or reconstruct, for posterior translational and rotational stability. Methods The superior half of ACLC was divided into three regions; Region A (0°–60°): an anterior 1/3 region of the superior half of ACLC, Region B (60°–120°): a superior 1/3 region of the superior half of ACLC, and Region C (120°–180°): a posterior 1/3 region of the superior half of ACLC. Fifteen fresh-frozen cadaveric shoulders were used. Biomechanical testing was performed to evaluate the resistance force against passive posterior translation (10 mm) and the resistance torque against passive posterior rotation (20°) during the following the four conditions. (1) Stability was tested on all specimens in their intact condition ( n  = 15). (2) The ACLC was dissected and stability was tested ( n  = 15). (3) Specimens were randomly divided into three groups by regions of suturing. Stability was tested after suturing Region A, Region B, or Region C ( n  = 5 per group). (4) Stability was tested after suturing additional regions: Region A + B (0°–120°), Region B + C (60°–180°), or Region A + C (0°–60°, 120°–180°, n  = 5 per group). Results The translational force increased after suturing Region A when compared with dissected ACLC ( P  = 0.025). The force after suturing Region A + B was significantly higher compared to the dissected ACLC ( P  < 0.001). The rotational torque increased after suturing Region A or Region B compared with dissected ACLC ( P  = 0.020, P  = 0.045, respectively). The torque after suturing the Region A + C was significantly higher compared to the dissected ACLC ( P  < 0.001). Conclusion The combined Region A + B contributed more to posterior translational stability than Region B + C or Region A + C. In contrast, combined Region A + C contributed more to posterior rotational stability than Region A + B or Region B + C. Based on these findings, surgical techniques restoring the entire superior ACLC are recommended to address both posterior translational and rotational stability of the AC joint.

The coracoacromial ligament (CAL) connects the acromion and coracoid process of the scapula. This study aimed to explore the correlation between CAL degeneration and shoulder pathology, specifically focusing on the efficacy of acromioplasty in treating shoulder impingement in patients with varying degrees of CAL degeneration. 49 patients diagnosed with bursal-side partial rotator cuff tear were assessed for CAL degeneration and categorized into three grades. They were then randomized into acromioplasty and non-acromioplasty groups to compare the outcomes. Acromiohumeral distance (AHD) and fatty infiltration was evaluated on imaging examinations. American Shoulder and Elbow Score (ASES) and Visual Analogue Scale (VAS) was recorded to evaluate the shoulder function before and two years after surgery. Grade III CAL patients demonstrated significantly reduced AHD and increased VAS scores compared to Grades I and II. Post-acromioplasty, Grade III patients showed a statistically significant improvement in ASES scores compared to the non-acromioplasty group. The study indicates that CAL degeneration is a significant indicator of shoulder impingement. Notably, acromioplasty significantly improves shoulder function in patients with severe CAL degeneration, suggesting its potential as a targeted treatment in managing shoulder impingement.

To observe and compare the curative effect of a locking plate plus titanium cable under the Guide device and clavicular hook plate in the treatment of Neer type II distal clavicle fractures. A prospective cohort study was conducted to analyse the clinical data of 36 patients with distal clavicle fractures from January 2016 to January 2019. The results were analysed. According to the random number method, the patients were divided into two groups: the titanium cable group (fixed with a titanium cable in combination with a locking plate) and hook plate group (fixed with a clavicular hook plate only). Under the guidance of a special device (for which a patent was obtained), in the titanium cable group, the coracoclavicular ligament was fixed with tension reduction, and then the distal clavicular fracture was fixed with a locking plate. In the hook plate group, the distal clavicle fracture was fixed with a hook plate. The incision length, operation time, bleeding volume and VAS score before, 1 week after and 1 year after the operation were compared between the two groups. The effect of the operation was evaluated by the Constant-Murley score before and 1 year after the operation. X-ray films were taken 2 days, 3 months, half a year and 1 year after the operation to observe the reduction and healing of fractures. At the same time, complications were recorded. The amount of bleeding was the same in the two groups. The operation time in the hook plate group was relatively short, and the difference was statistically significant (P < 0.05). The VAS score in the titanium cable group was significantly lower than that in the hook plate group one year after the operation. The Constant-Murley score in the titanium cable group and hook plate group was significantly higher 1 year after the operation. The number of postoperative complications in the titanium cable group was significantly lower than that in the hook plate group. The treatment of Neer type II distal clavicle fractures with a titanium cable plus a locking plate has a good curative effect, few complications and good postoperative recovery and thus is worth popularizing.

BACKGROUND: Ultrasound-guided transverse carpal ligament (TCL) needle release has been demonstrated to be an effective treatment for carpal tunnel syndrome (CTS). However, no existing evidence has investigated the comparative efficacy of different release approaches. OBJECTIVE: To compare the efficacy of ultrasound-guided TCL needle release via different approaches for patients with mild to moderate CTS over a 12-month follow-up. STUDY DESIGN: A prospective, randomized, controlled trial. SETTING: Outpatient clinic at a university hospital. METHODS: Sixty-four patients with mild to moderate CTS (> 3 months’ duration) were randomly assigned to either the long-axis group (one session of ultrasound-guided corticosteroid injection plus long-axis TCL needle release) or the short-axis group (one session of ultrasound-guided corticosteroid injection plus short-axis TCL needle release) in a one-to-one ratio. The primary outcomes were the symptom severity scale (SSS) and functional severity scale (FSS) scores of the Boston Carpal Tunnel Questionnaire (BCTQ). The secondary outcomes were electrophysiological studies, including distal motor latency (DML) and sensory nerve conduction velocity (SNCV), cross-sectional area (CSA) of the median nerve (MN), and patient-reported successful clinical response. Assessments were performed before treatment and at one, 3, 6, and 12 months after treatment. RESULTS: A total of 60 patients (30 per group) completed the trial. Compared to the baseline, both groups exhibited improvement in SSS, FSS, SNCV, DML, and CSA at all follow-up time points, with statistical differences for SSS, FSS, and SNCV at 3, 6, and 12 months (P < 0.05), DML at 6 and 12 months (P < 0.05), and CSA at each follow-up time point (P < 0.05). Compared to the short-axis group, the long-axis group exhibited more improvement in SSS and FSS at all follow-up time points, with statistical differences at 3, 6, and 12 months (P < 0.05), and in SNCV and DML at 6 and 12 months (P < 0.05). Although the long-axis patients exhibited more improvement in their wrists’ CSAs, the intergroup differences were nonsignificant at all follow-up time points (P > 0.05). Four patients in the short-axis group experienced recurrent symptoms and underwent surgery at 12 months, whereas no recurrence was observed in the long-axis group. LIMITATIONS: A relevant future trial with a longer follow-up period than this one used is still necessary. CONCLUSIONS: Ultrasound-guided TCL needle release via the long-axis approach appears to be more effective than the short-axis approach for treating mild to moderate CTS. KEY WORDS: Carpal tunnel syndrome, transverse carpal ligament, needle release, 12-month efficacy, corticosteroid, comparison, ultrasound, different approaches

Objective To investigate the efficacy of Endobutton plate combined with high-strength suture Nice knot fixation in the treatment of distal clavicular fractures with coracoclavicular ligament injuries. Methods A retrospective analysis was performed on 43 patients who sustained distal clavicular fractures along with injuries to the coracoclavicular ligament. These patients were treated between January 2017 and December 2023. The fractures were classified according to the fixation method: high-strength Nice knot suture fixation (experimental group, n  = 23) and acromioclavicular Kirschner wire fixation (control group, n  = 20). The basic information of the two groups of patients, including age, gender, cause of injury, fracture classification, hospitalization duration, fracture healing time and complications, was collected and analyzed. The increase rate of coracoclavicular space on the affected side was collected and analyzed. The pain level of the affected shoulder was assessed using the visual analog scale (VAS). The shoulder joint function was assessed using the American Shoulder and Elbow Surgeons (ASES) scores and Constant-Murley scores before and after surgery. Results No significant differences were observed in the general demographic data, including age, gender, injury etiology, Craig classification, and hospitalization duration between the two groups ( p  > 0.05). Both groups were followed for a period ranging from 12 to 33 months, with an average follow-up of 20.53 ± 5.16 months. The bone healing time in the experimental group was significantly shorter than in the control group (12.82 ± 1.12 weeks vs. 17.25 ± 1.71 weeks, p  < 0.05). At the final follow-up, The increase rate of coracoclavicular space was (9.25 ± 2.53) % in the experimental group and (8.10 ± 2.53) % in the control group, which was not significantly different ( p  > 0.05). Both groups demonstrated significant improvements in VAS scores, Constant-Murley scores, and ASES scores post-operatively compared to pre-operative values ( p  < 0.05 ). One month after surgery, the Constant-Murley and ASES scores were significantly superior in the experimental group compared to the control group ( p  < 0.05). However, no statistical difference was observed three months post-surgery or during the final follow-up ( p  > 0.05). The control group reported one case of infection related to the Kirschner wire and one case of Kirschner wire displacement postoperatively. Conversely, no significant complications were reported in the experimental group. Conclusion In the management of distal clavicle fractures accompanied by coracoclavicular ligament injuries, particularly oblique fractures or those with butterfly-shaped fragments, the application of a high-strength Nice knot suture in conjunction with Endobutton plate fixation can effectively stabilize the fracture site. This approach not only mitigates complications associated with Kirschner wire fixation but also enhances fracture healing, leading to favorable postoperative outcomes.

The purpose of this study is to evaluate the efficiency of local platelet-rich plasma (PRP) injection as an adjuvant treatment after carpal ligament release. We conducted a prospective randomized, triple-blinded, controlled trial. Fifty participants with mild to extreme carpal tunnel syndrome (CTS) were randomly assigned either to the PRP ( n  = 25) or the platelet-poor plasma (PPP, n  = 25) group. After performing open surgical release of the carpal ligament, the inside of the carpal tunnel was irrigated with 3 mL of PRP or PPP according to each participant’s group allocation. The primary outcome was hand grip strength (HGS). Secondary outcomes were the time taken off work after surgery (in days) and scores on the Wong–Baker Faces Scale , Boston Carpal Tunnel Questionnaire , and Southampton Wound Assessment Scale . We evaluated patients before treatment and at 6-weeks. As expected, the pain levels, symptom severity, and functional status improved in all the patients after surgery. However, intragroup analysis revealed that only the participants in the PRP group had regained their pre-operative HGS levels at 6-weeks follow-up. These findings indicate that PRP is an effective adjuvant treatment in patients with mild to severe CTS who require surgery.

IntroductionArthroscopic-assisted medial patellofemoral ligament reconstruction (MPFLR) is a common surgical procedure for patellar dislocation. We present the protocol of a randomised controlled clinical trial to compare postoperative pain, knee function and quality of life outcomes of MPFL reconstruction using the non-absorbable surgical sutures (FiberWire) and semitendinosus tendon.Methods and analysisThis single-blind, randomised controlled trial enrolled patients with patellar dislocation who were undergoing inpatient surgery at the Department of Orthopedics, Xiangya Hospital, Central South University. Participants were randomly allocated to either the experimental or the control group using a random number table method, with an equal number of 15 subjects in each group. The experimental group was treated with a FiberWire for the MPFLR, whereas the control group received reconstruction using the semitendinosus tendon. A standardised postoperative rehabilitation protocol was implemented for both groups. All subjects will be evaluated for imaging, pain, knee function and quality of life at five time points: preoperatively and at 1 month, 3 months, 6 months and 12 months postoperatively. MRI scans will be performed preoperatively and at 12 months postoperatively to assess changes in patellar tilt angles and congruence angles. Pain assessment is performed using the Visual Analogue Scale (VAS). Knee function will be assessed using the Kujala score, Lysholm score and International Knee Documentation Committee (IKDC) knee function score. Quality of life was assessed using the 12-Item Short Form Survey scale.Ethics and disseminationThe trial was approved by the Medical Ethics Committee of Xiangya Hospital of Central South University on 26 October 2021 (ethics number: 202110478) and registered in the China Clinical Trials Registry on 15 March 2022. Data will be published in peer-reviewed journals and presented at national and international conferences.Trial registration numberChiCTR2200057574.

Purpose Rising expectations in functional performance of total knee joints are inciting further improvement of knee arthroplasty implants. From a patient-centred view, bicruciate-retaining models provide a more natural feeling knee. However, there is no evidence of functional advantage for these implants. The aim of this study was to evaluate balance ability as a measure of proprioception in patients with a bicruciate-retaining total knee arthroplasty. Methods A prospective, controlled trial was conducted to compare balance ability in 60 patients after arthroplasty of the knee for osteoarthritis. We compared patients with a bicruciate-retaining knee arthroplasty (BCR group) to a control group of patients with a medial unicompartmental knee arthroplasty (UKA group) and another control group of patients with a posterior stabilized total knee arthroplasty (PS group). The patient population comprised 30 women (50.0 %) and 30 men in three cohorts of 20 each. The mean age was 62.1 ± 8.0 years (range 43–78). Patients were evaluated preoperatively and 9 months post-operatively. The evaluation included clinical, radiological, and balance testing—a single-leg stance with eyes closed compared to eyes open. The difference in area of sway between eyes closed and eyes open represents static balance ability after knee arthroplasty. Results Perioperative data showed that there was no intra-operative fracture of the intercondylar eminence. There was a decreased post-operative knee extension 9 months post-operative in the BCR group, which was not clinically relevant in any case. We recorded a lower difference in the area of sway between eyes closed and eyes open (Δ A (ec–eo) ) for the BCR group ( p  = 0.01) and the UKA group ( p  = 0.04) compared to the PS group. Conclusions This study found superior static balance ability after preservation of both cruciate ligaments in arthroplasty of the knee, indicating superior proprioceptive function. Hence, BCR implants could provide improved functional properties. Superior proprioceptive function of bicruciate-retaining implants can be an important factor in implant selection. Further prospective, randomized studies to investigate kinematics and long-term survivorship of bicruciate-retaining implants are needed. Level of evidence II.

Purpose To assess whether the use of an articulated external fixator provides improvements in the mobility, stability and subjective function of patients undergoing ligament reconstruction. Methods Thirty-three patients with sub-acute and chronic knee dislocation were subjected to multi-ligament reconstruction surgery. These patients were randomly allocated to two groups for immobilization after reconstruction: group 0—control (18 patients), with rigid knee bracing, and group 1—articulated external fixator (15 patients). The stability of the reconstructed ligaments was assessed after at least 14 months (26.6-month average) postoperatively by physical examination. Deficit of extension and flexion was measured in relation to the unaffected contralateral knee, and the Lysholm knee scoring scale questionnaire was applied. Results There was no difference in the assessment of joint stability between the groups. In group 1, patients showed less flexion deficit (4.8° ± 5.4° vs. 18.2° ± 14.8°, p  < 0.05), and the percentage of patients with a flexion deficit of 5° or less were higher compared with group 0 (64 vs. 18 %, p  < 0.05). There was no difference between groups in relation to extension loss. Group 1 also presented better Lysholm scores, with 73 % of patients rated as excellent or good compared with 35 % in group 0 ( p  < 0.05). Conclusions Compared with the control rehabilitation protocol with rigid knee bracing in extension, the use of an articulated external fixator in the treatment of chronic multi-ligament-injured knees provided the same ligament stability, better final range of motion and improved Lysholm score. Patients presenting with chronic multi-ligament instability should be considered for articulated external fixation to supplement reconstruction procedures. Level of evidence Randomized controlled trial, Level I.