Importance: The timing of surgery has been regarded as a key factor in anterior cruciate ligament reconstruction (ACLR), and early vs delayed ACLR remains a controversial topic.Objective: To synthesize up-to-date published data from randomized clinical trials (RCTs) comparing early vs elective delayed ACLR for patients with ACL deficiency, in terms of clinical outcomes and complications.Data Sources: The PubMed, Cochrane Library, and Web of Science databases were systematically searched until September 9, 2022.Study Selection: All published RCTs comparing clinical and functional outcomes and complications associated with early ACLR vs elective delayed ACLR.Data Extraction and Synthesis: Two reviewers independently extracted relevant data and assessed the methodological quality following the PRISMA guidelines.Main Outcomes and Measures: Due to the clinical heterogeneity, the random-effects model was preferred. The primary outcomes were functional outcomes and complications. The Mantel-Haenszel test was used to evaluate dichotomous variables and the inverse variance method was used to assess continuous variables.Results: This meta-analysis included 972 participants in 11 RCTs stratified by follow-up duration. The following factors did not differ between early and delayed ACLR: operative time (mean difference, 4.97; 95% CI, −0.68 to 10.61; P = .08), retear (OR, 1.52; 95% CI, 0.52-4.43; P = .44), and infection (OR, 3.80; 95% CI, 0.77-18.79; P = .10). There were also no differences between groups in range of motion, knee laxity, International Knee Documentation Committee (IKDC rating scale), and Tegner score. IKDC score (mean difference, 2.77; 95% CI, 1.89-3.66; P < .001), and Lysholm score at 2-year follow-up (mean difference, 2.61; 95% CI, 0.74-4.48; P = .006) significantly differed between early and delayed ACLR. In addition, the timing of surgery was redefined in the included RCTs and subgroup analyses were performed, which validated the robustness of the principal results.Conclusion and Relevance: This systematic review and meta-analysis found that early ACLR was not superior to delayed ACLR in terms of most factors analyzed, except for IKDC and Lysholm scores. This information should be available to patients with ACL deficiency and clinicians as part of the shared decision-making process of treatment selection.

Background: Mobile bearing fracture is a rare long‐term complication of unicompartmental knee arthroplasty (UKA), and relevant reports are sparse. Hence, its treatment options need further exploration.Case Presentation: This study presents the case of fracture of a polyethylene insert that occurred 12 years after mobile bearing medial UKA in a 75‐year‐old overweight woman who then underwent surgical intervention at our institution. However, we encountered significant challenges in removing the fragments from the broken bearing, resulting in retention of the remaining one‐third of the fragment. We solved this problem by replacing the fractured insert with thicker mobile bearing. During the 1‐month postoperative follow‐up, the patient achieved good range of motion and excellent satisfaction, with no reported complications and a Knee Society Score of 90. Additionally, we reviewed the literature on the treatment for mobile bearing fractures after UKA.Conclusions: Bearing fracture is a rare cause of failure of mobile bearing UKA. This case highlights the challenges of UKA fracture bearing retrieval and underscores that mobile bearing replacement can be an effective intervention. The case we report shows that when removal of a residual meniscal bearing in a posterior dislocation is difficult to achieve, compromise may be an appropriate option because it does not cause additional complaints to the patient. This case emphasizes the importance of the surgeon having a thorough preoperative understanding of the location and potential pitfalls of fracture fragments in such situations.

Objective: Total hip arthroplasty (THA) combined with proximal femoral reconstruction is a novel osteotomy technique developed to address severe hip deformities. There is a paucity of robust clinical and radiological evidence regarding the outcomes of this novel osteotomy technique. This study aimed to evaluate the clinical and radiological outcomes of THA combined with proximal femoral reconstruction during the early follow‐up.Methods: This is a retrospective case series of 63 hips who underwent THA combined with proximal femoral reconstruction at a single institution between January 2020 and July 2023. The mean age of patients was 39.6 ± 12.6 years. The mean follow‐up was 25.6 ± 3.8 months. Surgical characteristics and perioperative variables were evaluated to assess the efficacy of this technique. Harris hip score (HHS) was utilized to evaluate hip function. Leg length discrepancy (LLD) was evaluated in X‐ray. The incidence of major adverse events including deep vein thrombosis (DVT), osteolysis, nonunion of the osteotomy, intraoperative femoral fracture, and infection was also evaluated. Paired‐samples t‐test was used to compare preoperative and postoperative HHS and LLD.Results: The mean operative time was 125.1 min. The mean size of the acetabular components used was 45.2 mm, and the stem size was 7.5. The primary friction interface was ceramic‐on‐ceramic, accounting for 92.1% of cases. The average length of hospital stay was 8.5 days. The mean cost of treatment was 46,296.0 Yuan. There was a significant improvement in postoperative HHS (p < 0.001) and LLD (p < 0.001) compared to preoperative values. The incidence of deep venous thrombosis was 4.8%; osteolysis rates for the cup and stem were 4.8% and 6.4%, respectively. The non‐union and dislocation rates were 1.6% and 3.2%, respectively. There was no incidence of postoperative infection.Conclusion: The novel osteotomy surgical procedure yields reliable and impressive clinical and radiological outcomes, with minimal complications. We advocate for its use in complex primary THA cases involving severe proximal femoral deformities.

The objective of this study was to compare the differences in re-rupture rates, complications, and functional assessments of Achilles tendon ruptures (ATRs) treated operatively or nonoperatively to guide clinical treatment choices. A literature search was performed in the PubMed, Cochrane Library, and Embase databases up to March 1, 2025, for randomized controlled trials (RCTs) involving patients with ATR receiving operative and nonoperative therapies. Primary outcomes included re-rupture rates, complications, and functional assessment. Meta-analysis of the extracted data was carried out using Review Manager 5.3 and Stata 17.0. A total of 14 RCTs were included in the meta-analysis, comprising 1,628 participants. The meta-analysis results revealed a considerably lower re-rupture rate in both the minimally invasive (MI) group (risk ratio [RR], 0.28; 95% confidence interval [CI]: 0.11 to 0.74) and the open group (RR, 0.30; 95% CI: 0.19 to 0.50). For complications, subgroup analysis showed no significant difference between the MI and nonoperative groups (RR, 2.40; 95% CI: 0.52 to 10.98), whereas the open group had a higher complication rate (RR, 3.03; 95% CI: 1.75 to 5.26) than nonoperative groups. There was no significant difference in the functional assessment between operative and nonoperative groups. Regarding return to work, the MI group returned to work earlier compared to the nonoperative group. Open operative treatment significantly reduces the rate of re-rupture compared to nonoperative treatment but is accompanied by a higher risk of complications. MI treatment offers both of these advantages, along with superiority in return to work.

Cloning and Bioinformatics Analysis of the EfNAC Gene in Erianthus fulvus