Background: Posterior cruciate ligament (PCL) injury is a relatively common musculoskeletal condition. However, there is currently a lack of consensus on decision-making, treatment and postoperative management for such injuries. Objectives: To use the modified Delphi method to reach expert consensus on the management of PCL injury. Methods: A literature search of PubMed, Cochrane Library, Embase, and Web of Science for articles up to 17 October 2024, to support the development of recommendation statements. An Expert Panel of 90 experienced clinicians from orthopedics and sports medicine participated in a two-round Delphi process. Each statement was evaluated in two parts: the first part assessed content appropriateness (score of 7–9 indicating appropriateness and 4–6 indicating possible appropriateness), while the second part assessed agreement (score of 5–9 indicating agreement). Results: The panel members developed 11 statements using the Delphi process, addressing the following topics: (1) clinical decision-making, (2) treatment, and (3) postoperative management about PCL injuries. The final consensus was reached on 11 statements and we eventually translated these statements into a corresponding table of expert recommendations. Conclusion: Consensus was reached on 11 statements regarding three aspects of PCL injury management. These findings provide a foundation for developing evidence-based guidelines that can enhance clinical decision-making, improve treatment strategies, and optimize postoperative care for patients with PCL injuries.

Chronic rotator cuff tears are debilitating diseases which significantly affect patients’ quality of life and pose substantial financial burden to the society. The intraoperative reparability of injured tendon and postoperative probability of tendon retear are highly associated with the quality of torn muscles, specifically, the severity of muscle atrophy and fatty infiltration. Animal models that reproduce the characteristic muscle pathology after rotator cuff injury have been developed and used to provide insight into the underlying biology and pathophysiology. In this review, we briefly summarize the current information obtained from preclinical animal studies regarding the degenerative change of cuff muscle subsequent to tendon release and/or suprascapular nerve denervation. Importantly, we focus on the potential translational therapeutic targets or agents for the prevention or reversal of muscle atrophy and fatty infiltration. While further studies are warranted to assess the safety and efficacy of novel therapies derived from these preclinical animal research, we believe that their clinical translation for the treatment of rotator cuff disorders is on the horizon. Novel therapeutic strategies described in this review from preclinical animal studies hold a great translational potential for preventing or reversing rotator cuff muscle pathology, while further assessments on their safety and efficacy are warranted.

Objective: Popliteal artery injury is a rare but serious complication of arthroscopic knee surgery. The absence of comprehensive data and standardized guidelines underscores the urgent need for further investigation. This study examines the incidence, risk factors, management strategies, and long‐term outcomes of popliteal artery injury in the context of arthroscopic knee procedures.Methods: We conducted a retrospective cohort study utilizing data from 21 medical institutions in Hunan Province, China, from January 2018 to December 2022. We identified patients who underwent arthroscopic knee surgery and complained of postsurgical popliteal artery injury. Patients were followed up for 43.1 ± 13.23 months (ranging from 22 to 58 months). The primary outcome was joint function, which was evaluated by a postoperative range of motion (ROM), International Knee Documentation Committee (IKDC) scores, Lysholm knee scores, and Visual Vascular Quality of Life Questionnaire (VascuQoL) scores. These data from different postoperative periods were compared via paired t‐test to assess postoperative recovery. The secondary outcome was vascular patency of the affected limb, which was evaluated through vascular color Doppler ultrasound.Results: Among the 17,000 knee arthroscopic procedures analyzed, 10 patients were identified with popliteal artery injury (0.059%). The surgeries performed included arthroscopic cystectomy for popliteal cysts, cruciate ligament reconstruction, and posterior horn of the lateral meniscus repair. Treatments for popliteal artery injury included percutaneous intravascular stent implantation (one patient), direct suture repair (four patients), allograft vascular transplantation (one patient), and reconstruction with an autogenous greater saphenous vein (four patients). After a mean follow‐up time of 43.1 ± 13.23 months (ranging from 22 to 58 months), no complications were reported. Compared with patients at 1 month after surgery, patients at 2 years after surgery presented improved knee function and ROM. The average Lysholm score increased significantly from 13.8 ± 4.21 to 68.2 ± 15.50, the IKDC score increased from 11.6 ± 2.46 to 48.1 ± 11.75, and the VascuQoL score improved from 54.8 ± 9.54 to 92.5 ± 15.90. Knee extension improved from 13.3° ± 2.36° to 3.5° ± 4.12°, and knee flexion increased from 49.5° ± 12.57° to 107° ± 21.63°. All patients successfully resumed daily activities postoperatively.Conclusion: Popliteal artery injury is a catastrophic complication that warrants significant attention during knee arthroscopy. This injury can occur in various types of arthroscopic knee procedures. Prompt diagnosis and effective intervention are crucial for minimizing the potential detriment associated with popliteal artery injury.

Hoffa fracture combined with tibial shaft fracture and multiple ligament avulsion injuries is extremely rare. Herein, we report a case of medial Hoffa fracture with associated fracture of tibial shaft and avulsion fractures of multiple ligaments secondary to knee dislocation. A 17-year-old female with history of a motorcycle accident was referred to our hospital after knee joint reduction at a regional trauma center. Preoperative radiology revealed a medial Hoffa fracture associated with tibial shaft fracture, inferior pole patellar fracture, fibular head fracture and multiple ligament avulsion fractures including anterior cruciate ligament, posterior cruciate ligament and medial collateral ligament. A less invasive approach via arthroscopy-assisted technique and minimally invasive plate osteosynthesis (MIPO) technique was used for fracture reduction and fixation. Six months postoperatively, the patient had arthrofibrosis and adhesiolysis under arthroscopy was performed. At the last follow-up of 24 months, the patient regained knee full range of motion and returned to pre-injury level of activities. Although minimally invasive techniques were used to speed recovery, the orthopaedic surgeon should still be aware of the possibility of postoperative arthrofibrosis as multiple site fractures may need longer immobilization.

Objective: Reconstruction of acetabular defects has been extremely challenging in both primary and revision total hip arthroplasty (THA). Impaction bone grafting (IBG) can restore the acetabulum bone mass and anatomically reconstruct the acetabulum. Our study aimed to report the short and medium‐term clinical and radiographic outcomes of IBG for acetabular reconstruction in the cemented THA in the Chinese population.Methods: This was a single‐center retrospective review enrolling 57 patients between May 2013 and July 2019. The patients with acetabular defects were treated with IBG, using low dose irradiated freeze‐dried allograft bone with or without autograft bone, in the cemented THA performed by one senior surgeon. Harris hip score (HHS), standard pelvis anterior–posterior radiograph and lateral hip radiograph were obtained before operation and at 1 week, 3 months, 12 months, and yearly. Graft osteointegration was evaluated by Oswestry's criteria, and complication was documented at the last follow‐up. Independent sample ANOVA test and Pearson chi‐square tests are used for statistical analysis.Results: There were 61 hips in 57 patients. The average follow‐up time was 35.59 months (5–77 months). According to AAOS classification, a total of 18 hips were identified as segmental bone deficiency (type I), with 21 and 22 hips for cavitary bone deficiency (type II) and the combined bone deficiency (type III), respectively. The average HHS was improved from 44.49 (range: 32–58) preoperatively to 86.98 (range: 78–93) postoperatively. Graft osteointegration was satisfactory (Oswestry score ≥2) in all patients. No dislocation occurred in the 57 patients (61 hips) during follow‐up. Although one cup migrated, no revision, re‐revision, radiographic loosening, graft bone lysis, or postoperative complications were detected at the final follow‐up.Conclusions: IBG with low‐dose irradiated freeze‐dried allograft bone in acetabular bone defect reconstruction is a reliable technique for restoring acetabular bone defects in THA.