Medial meniscus deficiency is associated with progressive joint degeneration and impaired load distribution in the knee. While meniscus allograft transplantation is an established treatment for young and active patients, its accessibility is limited in many regions. This technical note describes a reproducible arthroscopic technique for medial meniscus replacement using an autograft harvested from the peroneus longus tendon. After subtotal meniscectomy, tibial tunnels are created at the native root attachment sites, and the graft is shaped and passed through the posterior tunnel. The graft is secured with an all‐inside suture device and tensioned anteriorly. This method provides a biologically compatible and cost‐effective alternative for meniscal reconstruction in patients without access to allograft tissue. Technique Video: video See video under supplementary data.

Osteonecrosis of the femoral head (ONFH) is a debilitating condition characterized by bone tissue necrosis due to vascular insufficiency, often triggered by corticosteroid use. Steroids are commonly employed in the management of autoimmune diseases, organ transplantation, and COVID-19. Early detection is crucial, as ONFH primarily affects young and middle-aged individuals and often progresses to femoral head collapse if untreated. To evaluate the protective effects of Apelin-13 (Ap-13) on steroid-induced ONFH (SONFH) in a rat model. Thirty-two female Sprague-Dawley rats were randomized into four groups: Control, Ap-13 only, ONFH, and ONFH + Ap-13. SONFH was induced using lipopolysaccharide (LPS) and methylprednisolone (MPS). The treatment group received daily intraperitoneal Ap-13 injections. At the fourth week, radiological, histopathological, immunohistochemical, and biochemical analyses were conducted on femoral heads. Micro-CT showed no significant differences in bone mineral density or trabecular parameters. Histopathology revealed increased osteonecrosis, empty lacunae, and vascular thrombosis in the ONFH group, which were significantly reduced in the ONFH + Ap-13 group (p < 0.05). Ap-13 decreased serum malondialdehyde (MDA) levels (p = 0.0002), reduced caspase-3 expression (p < 0.05), and elevated VEGF expression (p = 0.046), indicating reduced oxidative stress, apoptosis, and enhanced vascularization. Additionally, LDL and triglyceride levels were significantly lower in the Ap-13 treated group (p < 0.05). Apelin-13 demonstrates protective effects against SONFH by reducing oxidative stress, apoptosis, and improving vascularization. It may represent a promising noninvasive therapeutic strategy for early-stage ONFH.

Thromboangiitis obliterans (TAO) is a rare, tobacco‐associated vasculitis that primarily affects the distal extremities of young males. In advanced stages, it often leads to chronic limb ischemia with ischemic ulceration, culminating in amputation. Data on risk factors for reamputation in this population remain limited. This study aimed to identify clinical, radiological and microbiological predictors of reamputation in patients with TAO‐related foot ulcers undergoing amputation. A retrospective cohort study was conducted on 25 patients (31 limbs) with Fontaine stage IV TAO ulcers who underwent lower extremity amputation between January 2021 and December 2024. Patients were stratified into two groups based on whether they underwent repeat amputation (Group 1) or a single procedure (Group 2). Preoperative magnetic resonance imaging, intraoperative tissue cultures and laboratory data were evaluated. Smoking status, hospitalisation metrics and adjunctive therapies were recorded. Statistical analysis included Mann–Whitney U, Fisher's exact test, ROC curve analysis and multivariate logistic regression. Seventeen limbs required reamputation. Persistent smoking was observed in 100% of Group 1 compared with 58.4% of Group 2 ( p = 0.015). Positive intraoperative cultures were significantly more frequent in Group 1 (64.7% vs. 21.4%; p = 0.029), with all multidrug‐resistant organisms confined to this group. Length of hospital stay was significantly longer in Group 1 (25.2 ± 6.4 vs. 15.8 ± 5.3 days; p = 0.001). ROC analysis identified > 19 days of hospitalisation as a threshold for reamputation risk (AUC = 0.781; p = 0.018). Multivariate analysis identified three independent predictors of reamputation: persistent smoking (OR: 5.2, 95% CI: 1.2–22.8; p = 0.015), positive intraoperative culture (OR: 4.7, 95% CI: 1.1–20.1; p = 0.041), and hospitalisation longer than 19 days (OR: 6.5, 95% CI: 1.4–29.4; p = 0.018). Reamputation in advanced‐stage TAO is strongly associated with modifiable factors, particularly ongoing tobacco use, Gram‐negative infection and prolonged hospital stay. Early identification and targeted intervention addressing these variables may improve limb preservation outcomes in this high‐risk population.

Rationale: Isolated medial tibial plateau depression fractures are uncommon injuries. Elevation of the depressed articular surface is traditionally supplemented with bone grafting or bone substitute to support the subchondral defect. However, the necessity of graft augmentation in selected fracture patterns remains uncertain. Patient concerns: An 18-year-old male presented with right knee pain and swelling following a high-energy motorcycle accident. Diagnoses: Radiographs and computed tomography demonstrated an isolated medial tibial plateau depression fracture with minimal displacement (≤ 10 mm), classified as Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association 41-B1.2. Interventions: The depressed articular surface was anatomically elevated and stabilized using a proximal medial locking plate without bone graft or bone substitute augmentation. Outcomes: The patient remained non-weight-bearing for 12 weeks, and radiographic union was achieved by 3 months. At the 12-month follow-up, radiographs demonstrated maintained anatomic reduction with < 1 mm residual articular depression, no implant-related or wound complications, and the Knee Injury and Osteoarthritis Outcome Score improved from 2 to 71. Lessons: This case suggests that, in carefully selected isolated medial tibial plateau depression fractures, stable anatomic reduction and rigid subchondral fixation may provide favorable clinical and radiographic outcomes without routine graft augmentation. Larger clinical studies are needed to further define the indications for this treatment strategy.

OBJECTIVE: Chronic unreduced anterior shoulder dislocation (CUSD) is a rare and challenging clinical condition. The aim of this study was to evaluate the clinical outcomes of open reduction and capsulolabral complex repair in patients with CUSD.MATERIAL AND METHODS: Ten surgically treated patients with CUSD and complete follow-up between 2001 and 2007 were included. All surgeries were performed by the senior author through a standard deltopectoral approach. Demographic data, etiology, follow-up duration and complications were recorded. Constant–Murley Shoulder Score (CMSS) was used preoperatively and at the final follow-up.RESULTS: The mean age was 43.5 ± 20.0 years, and 60% were male. Falls were the most common etiology (70%). The mean CMSS increased significantly from 43.2 ± 13.0 preoperatively to 74.8 ± 19.4 at final follow-up (p=0.002). No redislocations, infections or surgical complications occurred.CONCLUSIONS: Open reduction and capsulolabral complex repair in chronic anterior shoulder dislocation provides satisfactory functional improvement with low complication rates. With appropriate patient selection, this approach is a safe and reliable surgical option.

Background: Hallux valgus (HV) is a three-dimensional deformity, and preoperative assessment of sesamoid position and first metatarsal rotation is important for surgical planning. Weight-bearing computed tomography (WBCT) enables three-dimensional assessment but was unavailable at our institution during the study period. Therefore, this study was a retrospective, exploratory, descriptive radiographic study of a modified weight-bearing metatarso-sesamoid (MS) projection, rather than a diagnostic-accuracy, comparative, or feasibility study. Methods: Between 2022 and 2024, 18 patients (16 female, 2 male; mean age 46 years, range 25–75 years) with 22 feet scheduled for HV surgery were included. Preoperative weight-bearing AP, lateral, and modified MS radiographs were evaluated. The alpha angle, sesamoid rotation angle (SRA), AOFAS tibial sesamoid grade, and the pronation/subluxation (P/S) pattern were recorded on the modified MS view. Because the alpha angle and P/S classification were originally defined on axial CT, we applied them to plain radiography as an exploratory approach. We did not validate them against a CT reference standard. Intraobserver and interobserver measurement agreement on the same existing radiographs was assessed through repeated blinded measurements by the primary observer after four weeks and through independent evaluations by a second blinded observer. We quantified reliability using ICC(2,1), unweighted kappa, and linearly weighted kappa, with 95% CIs. Technical acquisition performance was recorded. Results: On AP radiographs, IMA1–2 showed 2 mild, 15 moderate, and 5 severe deformities; HVA showed 1 normal, 11 mild, and 10 moderate cases; and Agrawal lateral sesamoid (LS) severity showed 1 mild, 20 moderate, and 1 severe case. On the modified MS view, the alpha angle ranged from 6° to 30° (mean ± SD 15.6 ± 6.6°), and the SRA from 6° to 45° (18.2 ± 8.3°). Using the CT-derived thresholds as descriptive reference labels only, alpha values were at or below 15.8° in 13 feet and above 15.8° in 9 feet, and SRA values were within the 7–18° reference range in 11 feet. AOFAS tibial sesamoid grade was 0 in 6 feet, 1 in 11, and 2 in 5. P/S patterns were P−/S− in 9 feet, P−/S+ in 4, P+/S− in 4, and P+/S+ in 5. Intraobserver ICCs were 0.996 (95% CI 0.991–0.998) for the alpha angle and 0.998 (0.994–0.999) for the SRA; interobserver ICCs were 0.988 (0.972–0.994) and 0.975 (0.947–0.981), respectively. Interobserver agreement was substantial for the P/S pattern (κ = 0.746, 95% CI 0.476–0.937) and excellent for the AOFAS grade (linear weighted κ = 0.878, 95% CI 0.663–1.000); intraobserver agreement was κ = 1.000 for both. The modified MS view provided a diagnostic image on the first acquisition in 15 of 18 patients; 3 patients required a single repeat acquisition, which was adequate in every case, and no procedure-related discomfort or intolerance was recorded. Acquisition time and radiation exposure were not recorded. Conclusions: Weight-bearing CT remains the reference standard for three-dimensional assessment. In this small cohort study, the modified MS projection could be obtained in every patient and showed high intraobserver and interobserver measurement agreement when the same existing radiographs were assessed. These findings describe measurement agreement on the same existing radiographs and the acquisition experience. Because no WBCT reference standard was available, the study cannot determine which projection reflects the underlying anatomy and provides no evidence of diagnostic accuracy, superiority over AP radiography, or clinical benefit. Standardized prospective studies with direct WBCT validation are required.