Background: Controversy remains over the choice of anaesthetic technique for patients undergoing surgery for hip fracture. Aim: The aim was to compare the risk of complication of neuraxial anaesthesia with that of general anaesthesia in patients undergoing hip fracture surgery. Methods: This systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and was registered at PROSPERO (CRD42022337384). The study included eligible randomised controlled trials published before February 2022. Data synthesis was performed to compare the differences between general and neuraxial anaesthesia. Meta-regression analysis was performed to investigate the influence of the publication year. A subgroup analysis was performed based on patient age and the anaesthetic technique used. A grading of recommendations, assessment, development and evaluations assessment was performed to assess the quality of each outcome. Results: Twenty randomised controlled trials and 4802 patients were included. Data synthesis revealed significant higher risk of acute kidney injury in the general anaesthesia group (P=0.01). There were no significant differences between the two techniques in postoperative short-term mortality (P=0.34), delirium (P=0.40), postoperative nausea and vomiting (P=0.40), cardiac infarction (P=0.31), acute heart failure (P=0.34), pulmonary embolism (P=0.24) and pneumonia (P=0.15). Subgroup analysis based on patient age and use of sedative medication did not reveal any significant differences. Meta-regression analysis of the publication year versus each adverse event revealed no statistically significant differences. Conclusion: A significantly higher risk of postoperative acute kidney injury was found in patients receiving general anaesthesia. This study revealed no significant differences in terms of postoperative mortality and other complications between general and neuraxial anaesthesia. The results were consistent across the age groups.

Sarcopenia and osteoarthritis are prevalent age-related diseases that mutually exacerbate each other, creating a vicious cycle that worsens both conditions. Exercise is key to breaking this detrimental cycle. Facing increasing demand for rehabilitation services within this patient demographic, ChatGPT-4 and wearable device may increase the availability, efficiency and personalization of such health care. To evaluate the clinical efficacy and cost-effectiveness of a rehabilitation system implemented on mobile platforms, utilizing the integration of ChatGPT-4 and wearable devices. The study design is a prospective randomized open blinded end-point (PROBE) non-inferiority trial. 278 patients diagnosed with osteoarthritis and sarcopenia will be recruited and randomly assigned to the intervention group and the control group. In the intervention group patients receive mobile phone-based rehabilitation service where ChatGPT-4 generates personalized exercise therapy, and wearable device guides and monitor the patient to implement the exercise therapy. Traditional clinic based face-to-face exercise therapy will be prescribed and implemented in the control group. All patients will receive three-months exercise therapies following the frequency, intensity, type, time, volume and progression (FITT-VP) principle. The patients will be assessed at baseline, one month, three months, and six months after initiation. Outcome measures will include ROM, gait patterns, Visual Analogue Scale (VAS) for pain assessment, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS) for functional assessment, Short-Form Health Survey 12 (SF-12) for quality of life, Minimal Clinically Important Difference (MCID), Patient Acceptable Symptom State (PASS), and Substantial Clinical Benefit (SCB) for clinically significant measures. A rehabilitation system combining the capabilities of ChatGPT-4 and wearable devices potentially enhance the availability and efficiency of professional rehabilitation services, thus enhancing the therapeutic outcomes for a substantial population concurrently afflicted with sarcopenia and osteoarthritis.

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.

This retrospective study aimed to compare the effectiveness between concurrent meniscoplasty and conservative management on the asymptomatic side in children with unilaterally symptomatic bilateral discoid lateral meniscus operated on the symptomatic side in a tertiary level of clinical care. Patients aged under 14 with unilaterally symptomatic bilateral discoid lateral meniscus underwent arthroscopic meniscoplasty were eligible. Patients were either underwent meniscoplasty on the symptomatic side, with the asymptomatic side conservatively treated (group 1) or underwent meniscoplasty on both sides concurrently (group 2). Functional outcomes were evaluated using the Lysholm score and Ikeuchi score. Relative cost collected through the hospital data was applied by the Kruskal-Wallis test. The occurrence of symptoms was applied by the Kaplan–Meier model. A total of 50 patients (39 female and 11 male) were eligible. For the average Lysholm scores, groups 1 and 2 of the previously asymptomatic side were 90.86 ± 8.25 and 92.62 ± 8.68. For the symptomatic side, the Lysholm scores were 91.38 ± 8.90 and 95.71 ± 7.45. For the average cost of treatment, a significant difference was discovered between group 1 and 2 (P < .0001). The Kaplan–Meier survival analysis of the occurrence of symptoms showed no statistical difference between the 2 groups (P = .162), and the terminal survival rates in the 2 groups were 86.2% and 81.0%, respectively. Conservative treatment reached the same clinical outcomes as the concurrent meniscectomy, with a potential of longer mean survival time and lower demand of cost in treatment.

Objective Pelvic compensation is common in femoroacetabular impingement (FAI) patients to reduce symptoms and increase range of motion. However, little attention was given to the postoperative clinical effect of pelvic compensation. Therefore, this study aims to compare the outcomes between pelvic compensation and normal pelvic position in femoroacetabular impingement (FAI) patients after hip arthroscopy.Methods The retrospective study was conducted from January 2019 to June 2022, recruited consecutive patients who were diagnosed with FAI and received subsequent arthroscopic treatment. All patients completed an X-ray in the anterior-posterior standing position before and 4 weeks after surgery. Patients with pelvic compensation were compared with those who did not. Functional outcomes included hip disability and osteoarthritis outcome score (HOOS), modified Harris (mHHS) score, and lower-extremity activity scale (LEAS). Secondary outcomes included the EuroQol Five Dimensions Questionnaire (EQ-5D) and patient satisfaction. The intraclass correlation coefficient (ICC) was used to analyze interobserver and intraobserver reliability.Results Ninety patients with a mean age of 39.40 years were included in the study. No significant compensation changes were noted within groups after the elimination of impingement. The functional scores showed no significant difference between groups (p(HOOS) = 0.352, p(mHHS) = 0.183, p(LEAS) = 0.865). The EQ-5D revealed statistically better performance in usual activities in the compensatory group (p = 0.044). There are no significant between-group differences in patients' satisfaction evaluations.Conclusion As assessed by Patient-Reported Outcome Measures (PROMs), patients with compensatory pelvic tilt demonstrated similar clinical outcomes without extra adverse events to patients with normal pelvic positioning in short-term follow-ups. Furthermore, compensatory pelvic tilt did not significantly enhance the range of motion or functional outcome at short-term follow-ups.

Background: In recent studies, there have been no reports on the diagnostic value of musculoskeletal ultrasound in pediatric patients with a discoid lateral meniscus (DLM). This study aims to evaluate the diagnostic value of musculoskeletal ultrasound in pediatric DLM patients and to investigate potential correlations between ultrasound indices and subgroup classifications on the basis of ultrasound findings. Methods: This study included patients aged 18 years or younger from 1 September 2021, to 1 January 2023, who were diagnosed with lateral meniscus (LM) or DLM injuries through arthroscopic surgery. Ultrasound and MRI assessments were performed before surgery. Radiological measurements were conducted by one evaluator to determine the diagnostic value of the two methods. The McNemar–Bowker test was used to compare the sensitivity and specificity between the two methods. Spearman’s correlation was used for correlation analysis of different injury types. Cluster analysis was used to explore the basis for classifying the DLM. Results: This study included 72 patients (37 females and 35 males). The average age was 11.18 ± 4.25 years, and the BMI was 18.50 ± 3.46 kg/m ² . The results revealed the high diagnostic efficacy of ultrasound and MRI. There was no significant difference in sensitivity or specificity in diagnosing DLM via ultrasound compared with MRI ( P >0.05). Subgroup analysis did not reveal a significant difference between complete/incomplete DLM type or child/adolescent age ( P >0.05). Correlation analysis revealed that DLM patients were more likely to suffer from vertical tears (r = 0.34, P = 0.015) and locking symptoms (r = 0.36, P = 0.032). In the 30-degree flexion assessment, body thickness was useful for detecting vertical (r = 0.26, P = 0.049) and bucket tears (r = 0.3, P = 0.026). Cluster analysis of all DLM patients revealed two subtypes: DLM type I, with more anterior horn tears, and Type II DLM, with more popliteal hiatus tears ( P = 0.020). Conclusion: MUS has proven to be a valuable diagnostic tool with comparable diagnostic efficiency to that of MRI in pediatric DLM. Ultrasound indices correlated with different injury types and related symptoms. Cluster analysis revealed that pediatric DLMs can potentially be classified into two types. The two types of injuries differ in terms of injury area.