Objective:To evaluate the clinical outcomes of a large-diameter autograft of 8-strand semitendinosus/gracilis (8S-ST/G) in reconstruction of anterior cruciate ligament (ACL).Methods:A retrospective analysis was conducted of the 56 patients with primary ACL injury who had been treated by the 8S-ST/G autograft technique at Sports Medicine Service, Beijing Jishuitan Hospital, Capital Medical University between January 2019 and January 2022. The cohort included 42 males and 14 females, with an age of (28.3±7.3) years and a body mass index of (24.4±3.3) kg/m 2. There were 28 left and 28 right knees involved. The preoperative posterior tibial slope measured 14.8°±2.8°. The diameter of 8S-ST/G autograft was (9.3±0.7) mm. The postoperative outcomes documented were knee stability (assessed via KT-1000 arthrometer side-to-side difference, Lachman test, and pivot-shift test), graft maturity, graft roof impingement, and complications. Results:The patients were followed up for (2.4±0.3) years postoperatively. The side-to-side difference decreased significantly from preoperative 6.0 (5.0, 8.0) mm to postoperative 2.0 (0.0, 3.0) mm ( P<0.001). The positive rate of high-grade pivot shift (2+, 3+) reduced significantly from 50.0% (28/56) preoperatively to 3.6% (2/56) postoperatively ( P<0.001). The ACL graft signal grades revealed by the MRI at the final follow-up were grade Ⅰ in 45 cases, grade Ⅱ in 7 cases, and grade Ⅲ in 4 cases. After the 15 patients with their preoperative MRI from other hospitals (showing ACL graft signal of grade I in all) were excluded, the anterior subluxation of lateral compartment (ASLC) and anterior subluxation of medial compartment (ASMC) in the other 41 patients at the final follow-up [(4.8±3.1) mm and 3.0 (2.0, 4.9) mm, respectively] showed no significant differences from the preoperative values [(5.9±3.2) mm and 3.9 (0.0, 6.3) mm, respectively] ( P>0.05). However, in the 30 patients with well-preserved ACL graft signal (grade I), both ASLC and ASMC at the final follow-up [(3.9±2.5) mm and 3.0 (1.5, 4.7) mm] showed significant improvements compared to the preoperative values [(5.5±3.1) mm and 5.1 (2.7, 6.2) mm] ( P<0.05). At the final follow-up, 19.6% (11/56) of the patients showed ACL graft laxity; graft failure occurred in 8.9% (5/56) of the patients, one of whom underwent revision surgery. Second-look arthroscopy revealed concomitant cartilage injuries in 12.5% (7/56) of the patients, cyclops lesions in 3.6% (2/56), and ACL graft impingement in 7.1% (4/56). Conclusion:In the treatment of patients with ACL injury, the 8S-ST/G autograft configuration can significantly improve the stability of the knee joint and graft maturity, but it can not effectively correct the ASLC and ASMC for a subset of patients.

Objective To explore the association between knee torsion and multiple bony abnormali-ties of the lower limb in patients with recurrent patellar dislocation(RPD).Methods The preoperative imaging data of RPD patients treated in our institution between May 2020 and October 2024 were col-lected retrospectively.A total of 238 patients were included in this study,with 83.6%being females.All patients underwent standard hip-knee-ankle CT scans,and lower limb bony structural parameters were reconstructed and measured using Mimics 20.0,focusing on variables such as knee torsion,femo-ral anteversion(FAA),femoral distal torsion angle(DFTA),supratrochlear spur,tibial tuberosity to trochlear groove distance(TT-TG),Caton-Deschamps index,and tibial torsion.Bony abnormalities were categorized based on previously established risk thresholds.Moreover,chi-square tests were em-ployed to compare the composition ratio differences between knee torsion and multiple lower limb osse-ous abnormalities.Results Among all affected knees,the proportion of excessive knee torsion was 33.6%,while in cases with osseous abnormalities,the value was over 40%.Compared with cases of low knee torsion,patients with excessive knee torsion showed significantly higher proportions of FAA(41.3%vs.27.2%,P=0.028),excessive DFTA(60%vs.32.9%,P<0.001),supratrochlear spur(55%vs.38.6%,P=0.016),trochlear dysplasia(93.8%vs.73.4%,P<0.001),excessive TT-TG(68.8%vs.43.7%,P<0.001),and patella alta(50%vs.22.2%,P<0.001).Additionally,95%of knees with excessive torsion exhibited two or more bony risk factors,whereas 55%had four or more bony structural abnormalities,which was significantly higher than those of low knee torsion(55%vs.21.5%,P<0.001).Conclusion In RPD patients,excessive knee torsion is associated with multiple low-er limb bony abnormalities.Moreover,patients with high knee torsion(>12°)are significantly more likely to have multiple bony abnormalities than those with low torsion.Therefore,in surgical decision-making for such patients,lower limb bony abnormalities should be assessed comprehensively.

Objective To explore the incidence of global anterior tibial subluxation(ATS)after an-terior cruciate ligament(ACL)injury and analyze its risk factors.Methods The weight-bearing magnet-ic resonance imaging(MRI)scans of 280 consecutive patients with ACL injury in year 2022 and 2023 were retrospectively analyzed.According to the relative relationship between the tibial plateau and the femoral condyle,all patients were divided into three groups of the ATS-negative group(no ATS in neither the medial nor the lateral tibial plateau),the mild ATS-positive group(only ATS of the lateral tibial plateau),and the global ATS-positive group(ATS of both the medial and lateral tibi-al plateau).Moreover,the posterior tibial slope(PTS),the continuity of anterolateral ligament(ALL),the integrity of meniscus,the time from injury to surgery(TFIS)and results of physical ex-aminations were detected to find the risk factors of global ATS.Results Among the 280 consecutive pa-tients,41 patients were finally confirmed to have global AT,reaching an incidence of 14.6%.More-over,there were 110(39.3%)patients of mild ATS and 129(46.1%)without ATS.Meanwhile,the PTS,as well as the incidence of combined medial meniscus injury and TFIS of the global ATS-posi-tive group were significantly higher than the other two groups(P<0.05).In addition,the incidence of combined ALL and lateral meniscus injury,grade of pivot-shift test and KT-1000 side-to-side differ-ence of the global ATS-positive group were significantly higher than the ATS-negative group(P<0.05),without significant differences from the mild ATS-positive group(P>0.05).Furthermore,results of logistic multi-factor regression analysis showed that PTS>12 degrees,TFIS>6 months and combined medial meniscus injury were all independent risk factors of global ATS after ACL injury.Conclusion In this study,the incidence of global ATS after ACL injury was 14.6%.Clinically,ACL-injured pa-tients with PTS>12 degrees,TFIS>6 months or combined medial meniscus injury should be warned against the global ATS.

Objective To construct a LASSO-logistic regression model for the risk of complications of cardiopulmonary resuscitation(CPR)based on clinical data and relevant parameters of external chest compression and to provide a reference for the prevention of com-plications of cardiopulmonary resuscitation.Methods One hundred cardiac arrest survivor patients admitted to Shijiazhuang Circular Chemical Industrial Park Hospital from April 2020 to May 2023 were selected and divided into complication and non-complication groups according to complications.The clinical data,chest compression-related parameters of the 2 groups were compared,and LASSO regression was used to initially screen the influencing factors of CPR complications.Logistic regression was used to analyze the influencing factors of CPR complications,and Nomogram was drawn to predict the risk of CPR complications.Results LASSO regression screening showed that the coefficients of body mass index,thoracic anteroposterior diameter,rescuer education level,and rescuer gender were compressed.When λ was 1.786,the number of influencing factors was minimized,and the model performance was excellent.At this time,seven predic-tive variables including rescuer identity,rescuer CPR training,application of air mattress,application of decompression pad,compression depth,compression duration,and strict control of fluid volume were selected to achieve the best selection of influencing factors.Logistic regression analysis showed that rescuer being a nurse,rescuer having received CPR training,application of air mattress bed,application of decompression pad,and strict control of fluid volume were related protective factors for CPR complications,while compression depth and compression duration were related risk factors for CPR complications(P＜0.05).The nomogram diagram of the logistic prediction model for CPR complication risk showed that its C-index was 0.932,indicating good discrimination,and the calibration curve fitted well with the ideal curve.The constructed prediction model had good consistency with the actual observed results.Conclusion CPR complications included sternal fractures,lung contusions,and rib fractures.The risk closely relates to the rescuer,the rescuer's CPR training,the appli-cation of air mattress bed,the application of decompression pad,the depth of compression,the duration of compression,and the strict con-trol of fluid volume.

Objective To explore the clinical,radiological,and arthroscopic outcomes of anterior cru-ciate ligament(ACL)reconstruction combined with posterior tibial slope(PTS)reducing osteotomy in patients with increased PTS and excessive anterior tibial subluxation(ATS)due to primary ACL inju-ry.Methods This retrospective study included patients who underwent ACL reconstruction between 2016 and 2022 in our department.The inclusion criteria were PTS≥15° and ATS≥6 mm,and all pa-tients received ACL reconstruction combined with PTS reducing osteotomy with a follow-up of more than 2 years.Before and after the operation,they were assessed KT-1000 side-to-side difference(KT SSD),pivot shift grade,Lachman test,anterior tibial subluxation of the medial and lateral compart-ments(ASMC and ASLC),magnetic resonance imaging(MRI),and arthroscopic findings of associat-ed injuries.Moreover,graft laxity was defined as graft laxity observed on MRI or arthroscopy,KT SSD>3 mm,or pivot>1+,while graft failure was defined as graft rupture on MRI or arthroscopy,KT SSD>5 mm,or pivot>2+.Meanwhile,clinical outcomes were compared preoperatively and post-operatively,and graft status and associated injuries were described.Results A total of 30 patients were included,with an average age of 31 years,and 23%of female.The inter-observer reliability for mea-surements of PTS and ATS was greater than 0.80.Compared to preoperative values,postoperative PTS(18.2° vs.6.8°,P<0.001),KT SSD(7.8 mm vs.1.2 mm,P<0.001),ASLC(7.5 mm vs.4.5 mm,P=0.002),and ASMC(5.0 mm vs.2.7 mm,P=0.034),all showed significant improvements.In addi-tion,the proportion of patients with postoperative pivot grade of 2+to 3+(73.3%vs.6.7%,P<0.001)and Lachman grades Ⅱ-Ⅲ(70%vs.3.3%,P<0.001)reduced significantly.At the last follow-up,the incidence of graft laxity was 20%,and that of the graft failure was 13.3%.Among all pa-tients,1 patient(3.3%)had graft roof impingement or cyclops lesion,and 3(10%)suffered from concomitant cartilage injury,with 4(13.3%)undergoing intercondylar notchplasty due to intercondylar notch hyperplasia.However,no complications related to osteotomy,such as infection,non-union,or fixation failure,were observed.Conclusion Over a follow-up period of at least 2 years,for primary ACL injury patients with steep PTS and excessive ATS,combined ACL reconstruction with PTS reduc-ing osteotomy improves knee stability,but significantly reduces PTS,the incidence of severe pivot grade,anterior tibial subluxation in both medial and lateral compartments,and delays the occurrence of graft laxity and failure.

Objective:To explore the application value of pterygium excision(PE)combined with autologous limbal stem cell transplantation(LSCT)in the treatment of pterygium.Methods:The clinical data of 125 patients with pterygium admitted to Yucheng County People's Hospital from Feb 2021 to Feb 2023 were retrospectively analyzed.The patients were divided into two groups according to the surgical method,with 58 patients undergoing PE combined with amniotic membrane transplantation as the control group and 67 patients undergoing PE combined with LSCT as the observation group.The surgical-related indicators and postoperative complications were compared between the two groups,as well as the pre-and post-operative visual acuity,corneal parameters[corneal astigmatism,corneal fluorescein staining(FL)score],tear secretion function[tear film breakup time(BUT),Schirmer test].Results:The operation time,corneal wound healing time,regression time of hyperemia and edema,and suture removal time in the observation group were shorter than those in the control group(P＜0.01).The visual acuity level in the observation group was higher than that in the control group at 7 days,1 month,and 3 months after surgery(P＜0.05).The corneal astigmatism degree and FL score in the observation group were lower than those in the control group at 1 month and 3 months after surgery,while BUT and Schirmer test were higher than those in the control group(P＜0.05).There was no significant difference in the total incidence of complications between the two groups after surgery(P＞0.05).Conclusion:The combined treatment of PE and LSCT for pterygium is effective,which can accelerate the recovery process after surgery,improve corneal morphology and tear secretion function,enhance visual acuity,and ensure surgical safety.

Objective To explore the association between knee torsion and multiple bony abnormali-ties of the lower limb in patients with recurrent patellar dislocation(RPD).Methods The preoperative imaging data of RPD patients treated in our institution between May 2020 and October 2024 were col-lected retrospectively.A total of 238 patients were included in this study,with 83.6%being females.All patients underwent standard hip-knee-ankle CT scans,and lower limb bony structural parameters were reconstructed and measured using Mimics 20.0,focusing on variables such as knee torsion,femo-ral anteversion(FAA),femoral distal torsion angle(DFTA),supratrochlear spur,tibial tuberosity to trochlear groove distance(TT-TG),Caton-Deschamps index,and tibial torsion.Bony abnormalities were categorized based on previously established risk thresholds.Moreover,chi-square tests were em-ployed to compare the composition ratio differences between knee torsion and multiple lower limb osse-ous abnormalities.Results Among all affected knees,the proportion of excessive knee torsion was 33.6%,while in cases with osseous abnormalities,the value was over 40%.Compared with cases of low knee torsion,patients with excessive knee torsion showed significantly higher proportions of FAA(41.3%vs.27.2%,P=0.028),excessive DFTA(60%vs.32.9%,P<0.001),supratrochlear spur(55%vs.38.6%,P=0.016),trochlear dysplasia(93.8%vs.73.4%,P<0.001),excessive TT-TG(68.8%vs.43.7%,P<0.001),and patella alta(50%vs.22.2%,P<0.001).Additionally,95%of knees with excessive torsion exhibited two or more bony risk factors,whereas 55%had four or more bony structural abnormalities,which was significantly higher than those of low knee torsion(55%vs.21.5%,P<0.001).Conclusion In RPD patients,excessive knee torsion is associated with multiple low-er limb bony abnormalities.Moreover,patients with high knee torsion(>12°)are significantly more likely to have multiple bony abnormalities than those with low torsion.Therefore,in surgical decision-making for such patients,lower limb bony abnormalities should be assessed comprehensively.

Objective:To explore the application value of pterygium excision(PE)combined with autologous limbal stem cell transplantation(LSCT)in the treatment of pterygium.Methods:The clinical data of 125 patients with pterygium admitted to Yucheng County People's Hospital from Feb 2021 to Feb 2023 were retrospectively analyzed.The patients were divided into two groups according to the surgical method,with 58 patients undergoing PE combined with amniotic membrane transplantation as the control group and 67 patients undergoing PE combined with LSCT as the observation group.The surgical-related indicators and postoperative complications were compared between the two groups,as well as the pre-and post-operative visual acuity,corneal parameters[corneal astigmatism,corneal fluorescein staining(FL)score],tear secretion function[tear film breakup time(BUT),Schirmer test].Results:The operation time,corneal wound healing time,regression time of hyperemia and edema,and suture removal time in the observation group were shorter than those in the control group(P＜0.01).The visual acuity level in the observation group was higher than that in the control group at 7 days,1 month,and 3 months after surgery(P＜0.05).The corneal astigmatism degree and FL score in the observation group were lower than those in the control group at 1 month and 3 months after surgery,while BUT and Schirmer test were higher than those in the control group(P＜0.05).There was no significant difference in the total incidence of complications between the two groups after surgery(P＞0.05).Conclusion:The combined treatment of PE and LSCT for pterygium is effective,which can accelerate the recovery process after surgery,improve corneal morphology and tear secretion function,enhance visual acuity,and ensure surgical safety.

Objective To explore the incidence of global anterior tibial subluxation(ATS)after an-terior cruciate ligament(ACL)injury and analyze its risk factors.Methods The weight-bearing magnet-ic resonance imaging(MRI)scans of 280 consecutive patients with ACL injury in year 2022 and 2023 were retrospectively analyzed.According to the relative relationship between the tibial plateau and the femoral condyle,all patients were divided into three groups of the ATS-negative group(no ATS in neither the medial nor the lateral tibial plateau),the mild ATS-positive group(only ATS of the lateral tibial plateau),and the global ATS-positive group(ATS of both the medial and lateral tibi-al plateau).Moreover,the posterior tibial slope(PTS),the continuity of anterolateral ligament(ALL),the integrity of meniscus,the time from injury to surgery(TFIS)and results of physical ex-aminations were detected to find the risk factors of global ATS.Results Among the 280 consecutive pa-tients,41 patients were finally confirmed to have global AT,reaching an incidence of 14.6%.More-over,there were 110(39.3%)patients of mild ATS and 129(46.1%)without ATS.Meanwhile,the PTS,as well as the incidence of combined medial meniscus injury and TFIS of the global ATS-posi-tive group were significantly higher than the other two groups(P<0.05).In addition,the incidence of combined ALL and lateral meniscus injury,grade of pivot-shift test and KT-1000 side-to-side differ-ence of the global ATS-positive group were significantly higher than the ATS-negative group(P<0.05),without significant differences from the mild ATS-positive group(P>0.05).Furthermore,results of logistic multi-factor regression analysis showed that PTS>12 degrees,TFIS>6 months and combined medial meniscus injury were all independent risk factors of global ATS after ACL injury.Conclusion In this study,the incidence of global ATS after ACL injury was 14.6%.Clinically,ACL-injured pa-tients with PTS>12 degrees,TFIS>6 months or combined medial meniscus injury should be warned against the global ATS.

Objective To explore the clinical,radiological,and arthroscopic outcomes of anterior cru-ciate ligament(ACL)reconstruction combined with posterior tibial slope(PTS)reducing osteotomy in patients with increased PTS and excessive anterior tibial subluxation(ATS)due to primary ACL inju-ry.Methods This retrospective study included patients who underwent ACL reconstruction between 2016 and 2022 in our department.The inclusion criteria were PTS≥15° and ATS≥6 mm,and all pa-tients received ACL reconstruction combined with PTS reducing osteotomy with a follow-up of more than 2 years.Before and after the operation,they were assessed KT-1000 side-to-side difference(KT SSD),pivot shift grade,Lachman test,anterior tibial subluxation of the medial and lateral compart-ments(ASMC and ASLC),magnetic resonance imaging(MRI),and arthroscopic findings of associat-ed injuries.Moreover,graft laxity was defined as graft laxity observed on MRI or arthroscopy,KT SSD>3 mm,or pivot>1+,while graft failure was defined as graft rupture on MRI or arthroscopy,KT SSD>5 mm,or pivot>2+.Meanwhile,clinical outcomes were compared preoperatively and post-operatively,and graft status and associated injuries were described.Results A total of 30 patients were included,with an average age of 31 years,and 23%of female.The inter-observer reliability for mea-surements of PTS and ATS was greater than 0.80.Compared to preoperative values,postoperative PTS(18.2° vs.6.8°,P<0.001),KT SSD(7.8 mm vs.1.2 mm,P<0.001),ASLC(7.5 mm vs.4.5 mm,P=0.002),and ASMC(5.0 mm vs.2.7 mm,P=0.034),all showed significant improvements.In addi-tion,the proportion of patients with postoperative pivot grade of 2+to 3+(73.3%vs.6.7%,P<0.001)and Lachman grades Ⅱ-Ⅲ(70%vs.3.3%,P<0.001)reduced significantly.At the last follow-up,the incidence of graft laxity was 20%,and that of the graft failure was 13.3%.Among all pa-tients,1 patient(3.3%)had graft roof impingement or cyclops lesion,and 3(10%)suffered from concomitant cartilage injury,with 4(13.3%)undergoing intercondylar notchplasty due to intercondylar notch hyperplasia.However,no complications related to osteotomy,such as infection,non-union,or fixation failure,were observed.Conclusion Over a follow-up period of at least 2 years,for primary ACL injury patients with steep PTS and excessive ATS,combined ACL reconstruction with PTS reduc-ing osteotomy improves knee stability,but significantly reduces PTS,the incidence of severe pivot grade,anterior tibial subluxation in both medial and lateral compartments,and delays the occurrence of graft laxity and failure.