Objective: There has been long‐standing debate about whether a medial opening wedge high tibial osteotomy (MOWHTO) gap should be filled with autologous bone graft or any other filler to expedite the healing process. The main purpose of this study was to compare the clinical and radiological outcomes of MOWHTO with an opening gap ≥10 mm, utilizing autograft, allograft, or no graft at 1 year postoperatively.Methods: A total of 68 patients were included in this retrospective study and divided into three treatment groups: Group A (no bone graft), Group B (autologous iliac crest graft), and Group C (allogenous tibia plateau graft). At postoperative 1‐year follow‐up, the area of callus filling in the most medial side of the knee was measured using anteroposterior radiographs, and a modified van Hemert scoring system was used to evaluate bone union outcomes in five mediolaterally divided zones. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and relevant complications were assessed. The correlations between the gap width and bone union scores were evaluated.Results: Patients in the autograft group demonstrated better bone union progression (p = 0.031) and higher bone union scores (p < 0.01) compared to patients in the allograft or no graft groups. There were no significant differences in terms of postoperative WOMAC scores and incidence of complications among the three groups. No discernible linear relationships between the width of the opening gap and the bone union score were found.Conclusion: For MOWHTOs with an average gap opening width of 12.1 mm, autografts resulted in superior bone union outcomes compared to allografts and no graft at 1 year postoperatively. However, no bone graft achieved similar outcomes to allografts, suggesting that routine use of allografts should not be recommended.

Background. The treatment results of core decompression (CD) and biomechanical support are not always satisfactory in osteonecrosis of the femoral head (ONFH). Stem cell therapy has been incorporated into traditional treatment in order to promote bone regeneration. The efficacy and safety of stem cell therapy combined with CD or biomechanical support on advanced and long-term patients with ONFH were unknown. The aim of this study was to assess whether stem cell combination therapy is superior to single CD or porous tantalum rod implantation treatment in ONFH. Methods. A systematic search of the literature was performed to evaluate all included randomized controlled trials (RCTs) on stem cell combination therapy for patients with ONFH in PubMed, Cochrane Library, Web of Science, and Embase sites. We assessed the quality and risk of bias for the included studies. And the outcomes of Harris hip score (HHS), visual analogue scale (VAS), and adverse events were statistically analyzed. Results. We included 10 randomized controlled trials, containing a total of 498 patients with 719 hips. Stem cell therapy combined with CD versus CD alone for HHS of ONFH was different (MD = 8.87, 95% CI = [5.53, 12.22], ). The combination of stem cell therapy and CD can effectively improve HHS. Similarly, the VAS of the stem cell combination therapy group also differed compared with the control group (MD = −14.07, 95% CI = [−18.32, −9.82], ). The result showed that stem cell combination therapy can relieve the pain of patients with ONFH. There was no significant difference in adverse response outcome events between the combination therapy group and the control group (RR = 1.57, 95% CI = [0.62, 3.97], ). Conclusions. Stem cell therapy combined with core decompression is an effective and feasible method with few complications in the clinical treatment of early-stage ONFH. Even in the combination of porous tantalum rod implantation and peripheral blood stem cells, stem cell combination therapy is superior to single biomechanical support treatment. But high-quality, large-sample, multicenter, and long-term follow-up RCTs are still needed to corroborate the efficacy and safety of stem cell combination therapy in ONFH treatment.

Objective: In the field of diagnosing the adult discoid lateral meniscus (DLM), MRI has undergone extensive research. However, the use of MRI for diagnosing DLM in children and adolescents remains controversial. This study aimed to explore the diagnostic efficiency of MRI for DLM in children and adolescents and to determine the diagnostic value of these indicators.Methods: This retrospective study included children (aged between 4 and 11 years) and adolescents (aged between 12 and 17 years) from September 1, 2019 to January 1, 2023, who were diagnosed with lateral meniscus (LM) or DLM injury through arthroscopic surgery. All patients underwent a 3 T MRI examination before surgery. The MRI indicators included the LM width (LMW), ratio of the LMW to the tibia (RMT), percent coverage of the meniscus (PCM), tibial width (TW), height of the medial tibial spine (HMTS), height of the lateral tibial spine (HLTS), tibial eminence width (TEW), lateral slope angle of the medial tibial eminence (LSAMTE), lateral slope angle of the lateral tibial eminence (LSALTE), and presence of three “bow tie signs.” A diagnostic efficacy analysis of all indicators was conducted to determine characteristic MRI diagnostic indicators and analyze their diagnostic value. Pearson's correlation analysis was conducted to evaluate the correlation between diagnostic indicators and baseline information.Results: This study included 90 patients (26 with LM injuries and 64 with DLM injuries). The average age was 12.81 ± 4.34 years, height was 151.24 ± 23.82 cm, weight was 48.20 ± 21.82 kg, and BMI was 19.69 ± 4.22 kg/m². A total of 10 MRI indicators were included and evaluated for their diagnostic value. The comparison between the DLM and LM groups revealed significant differences in LMW, TW, RMT, PCM, LSAMTE, and “bow tie signs” (p < 0.05). In the diagnostic efficacy analysis, LMW had a sensitivity of 85.94%, specificity of 76%, and accuracy of 83.13%; RMT had a sensitivity of 95.31%, specificity of 76%, and accuracy of 89.89%; PCM had a sensitivity of 75.28%, specificity of 60%, and accuracy of 75.28%; LSAMTE had a sensitivity of 72.92%, specificity of 84%, and accuracy of 72.92%; and “bow tie signs” had a sensitivity of 80.95%, specificity of 81.25%, and accuracy of 81.11%.Conclusion: The MRI diagnosis of DLM in children and adolescents can be based on LMW, RMT, PCM, LSAMTE, and “bow‐tie signs,” with these indicators demonstrating good diagnostic efficacy.

Objective: Diffuse‐type tenosynovial giant cell tumors (Dt‐TGCTs) commonly occur in the knee joint and tend to recur postoperatively. However, limited clinical data are available on ankle joint involvement especially associated multiportal arthroscopic treatment outcomes. The purpose of this study was to report the clinical results of multiportal arthroscopy‐assisted resection of Dt‐TGCTs of the ankle.Methods: We retrospectively reviewed the clinical data of 33 patients with Dt‐TGCT of the ankle who underwent multiportal arthroscopic treatment between August 2011 and December 2020. Clinical follow‐up included the visual analogue scale (VAS) score, American Orthopedic Foot and Ankle Society (AOFAS) score, Kofoed score, and recurrence rate to assess surgical outcomes. The number of patients who achieved the patient acceptable symptom state (PASS) based on the AOFAS score was also examined. Additionally, the patients were categorized into two groups based on the final surgical approach: Group A who underwent multiportal arthroscopic synovectomy and Group AO who underwent combined arthroscopic and open surgical excision. Intergroup comparisons were conducted. Intraoperative characteristics, such as the number of patients with involvement of the tarsal tunnel and fibularis tendon and the Outerbridge grading of cartilage damage, were recorded to assess the selection of surgical procedures.Results: Among the 33 patients, 15 were assigned to Group A, and 18 were in Group AO. The median follow‐up duration for the 33 patients was 77 months (range, 28–142 months). The median VAS score was 1 (range, 0–4), the AOFAS score was 96 (range, 65–100), and the Kofoed score was 96 (range, 67–100). A total of 27 patients (82%) achieved PASS based on AOFAS scores, while five patients (15%) had recurrence. No statistically significant difference was observed between the two groups in recurrence rate, follow‐up VAS score, AOFAS score, Kofoed score, or number of patients who reached the PASS (p > 0.05). In the AO group, 16 cases of Dt‐TGCT involved the tarsal tunnel, and 11 cases involved the fibularis tendon. All these patients exhibited extension beyond the joint. In contrast, only one patient in Group A had involvement of the tarsal tunnel. Statistically significant differences were observed between the groups (p < 0.001).Conclusion: This study demonstrated that, with the assistance of a multiportal arthroscopic approach, surgical excision of Dt‐TGCT in the ankle resulted in favorable clinical outcomes with a relatively low recurrence rate. Additionally, patients with extra‐articular involvement were more likely to require concomitant open surgery.

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.