OBJECTIVE: To review the application progress of customized steel plates in osteotomy and orthopedic treatment for knee osteoarthritis (KOA), and provide reference for orthopedic surgeons and researchers. METHODS: Extensive review of the literature on customized steel plates for osteotomies and knee-preserving surgeries for KOA, 2015-2025, with an overview of the principles of customized steel plate design, clinical applications, and future directions, describing their advantages and shortcomings. RESULTS: Customized steel plates have demonstrated many advantages in osteotomy and orthopedic treatment of KOA, which not only enhance surgical outcomes and optimize mechanical properties, but also reduce the incidence of postoperative complications. However, high cost, long manufacturing period, and selection of patient indications are still important factors restricting their use. CONCLUSION Customized steel plates show promising potential in treating KOA. Not only do they reduce surgical duration and enhance postoperative healing outcomes, but they also effectively lower the incidence of postoperative complications, thereby improving patients' quality of life.
Humans ; Osteoarthritis, Knee/surgery* ; Osteotomy/methods* ; Bone Plates ; Postoperative Complications/epidemiology* ; Steel ; Quality of Life ; Treatment Outcome ; Knee Joint/surgery*

OBJECTIVE: To summarize research progress on enhanced recovery after posterior cruciate ligament (PCL) reconstruction, clarify the core contradictions, effective intervention methods, and evaluation shortcomings in current clinical practice, and provide theoretical support for optimizing clinical rehabilitation strategies. METHODS: Relevant domestic and international literature in recent years was systematically searched. The key technologies and challenges for enhanced recovery after PCL reconstruction were analyzed from three aspects: the core issues of enhanced recovery after PCL reconstruction, treatment strategies, and the post-reconstruction effectiveness evaluation system. RESULTS: Enhanced recovery after PCL reconstruction mainly faces two core problems. First, there is a balance dilemma between graft tendon protection and knee joint function recovery: the tensile capacity of the graft tendon is weak in the early postoperative period, so excessive weight-bearing easily leads to relaxation, while overly conservative immobilization causes muscle atrophy and joint adhesion. Second, the return-to-sport rate is significantly affected by injury type and treatment method: patients with combined multiple ligament or meniscus injuries have a much lower return-to-sport rate than those with isolated PCL injury, and the risk of return-to-sport failure is higher. Current research mainly promotes rehabilitation from two aspects: physical therapy and surgical technology. Physical therapy runs through the perioperative period: preoperatively, muscle strength training, swelling control, and maintenance of joint range of motion are used to optimize surgical conditions; postoperatively, phased intervention is implemented. Surgical technology focuses on minimally invasive and anatomical approaches: arthroscopic surgery reduces injury, double-bundle reconstruction and internal tension-relief technology improve stability, and modified tunnel positioning and special surgical methods avoid the risk of "Killer Turn". Postoperative functional evaluation adopts multi-dimensional indicators: subjective evaluation relies on scales such as Lysholm and International Knee Documentation Committee (IKDC); objective evaluation assesses stability through Telos stress test and posterior drawer test; imaging evaluation takes MRI as the core; psychological evaluation is assisted by the Tampa scale of kinesiophobia-11 (TSK-11). However, there are obvious shortcomings, such as the lack of PCL-specific evaluation tools. CONCLUSION Enhanced recovery after PCL reconstruction requires the integration of precise surgery, individualized rehabilitation, and comprehensive subjective and objective evaluation. In the future, biomaterials and digital technologies should be integrated to optimize the full-cycle management of PCL reconstruction, thereby improving functional recovery and the effect of return to sports.
Humans ; Posterior Cruciate Ligament Reconstruction/rehabilitation* ; Posterior Cruciate Ligament/injuries* ; Recovery of Function ; Knee Joint/physiopathology* ; Knee Injuries/rehabilitation* ; Return to Sport ; Enhanced Recovery After Surgery ; Tendons/transplantation* ; Arthroscopy

OBJECTIVE: To evaluate the clinical efficacy of modified high tibial osteotomy combined with platelet-rich plasma in the treatment of moderate to severe knee osteoarthritis. METHODS: From January 2021 to March 2022, the clinical data of 60 patients with moderate to severe knee osteoarthritis admitted to the Third Affiliated Hospital of Beijing University of Chinese Medicine were analyzed. Among them, 30 patients were treated with modified tibia high osteotomy combined with platelet-rich plasma as the observation group, including 12 males and 18 females, aged from 51 to 74 years old, with an average age of (64.37±5.72) years old. The course of disease ranged from 1 to 7 years with an average of(3.43±1.41) years. Thirty patients were treated with modified high tibial osteotomy combined with sodium hyaluronate as control group, including 10 males and 20 females, aged from 50 to 78 years, with an average age of (64.33±8.18) years. The course of disease was 1 to 7 years with an average of(3.30±1.39) years. Knee X-rays were taken before surgery and at the last follow-up, and the changes of lower limb bearing-line ratio (WBLR), proximal medial tibial Angle (MPTA), femoro-tibial angle (FTA) and posterior tibial slope (PTS) were compared between the two times. Visual analogue scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Lysholm score were used to evaluate knee pain and functional changes before surgery and at 1, 3, and 6 months after surgery. RESULTS: The wounds of all patients healed in stage I after surgery. All 60 patients completed treatment and follow-up, with an average follow-up duration of (8.08±1.75) months, ranged from 6 to 12 months. No serious adverse events or complications occurred. At the last follow-up, WBLR, MPTA and FTA were significantly improved in both groups (P<0.05). At the last follow-up, there was no significant difference in PTS between the two groups compared with pre-operation(P>0.05). At the last follow-up, there were no significant differences in WBLR, MPTA, FTA and PTS between the observation group and the control group (P>0.05). The VAS scores, WOMAC scores and Lysholm scores of both groups were significantly Modified with time after operation (P<0.05). At 1, 3 and 6 months after operation, VAS score, WOMAC score and Lysholm score of the observation group were significantly better than those of the control group, with statistical significance (P<0.05). CONCLUSION For patients with moderate and severe knee osteoarthritis, modified high tibial osteotomy can significantly correct lower limb alignment, and combined with platelet-rich plasma therapy can further significantly relieve knee pain and improve knee function, the effect is better than combined with sodium hyaluronate.
Humans ; Male ; Female ; Osteoarthritis, Knee/physiopathology* ; Middle Aged ; Osteotomy/methods* ; Platelet-Rich Plasma ; Aged ; Tibia/surgery*

OBJECTIVE: To investigate the short-and med-term clinical efficacy of unicompartmental knee arthroplasty(UKA)for the treatment of medial knee osteoarthritis (OA) in elderly patients with anterior cruciate ligament deficiency(ACLD). METHODS: A retrospective analysis was conducted on 31 patients aged over 75 years old with primary medial knee OA and ACLD who underwent UKA between January 2018 and December 2022. The cohort included 12 males and 19 females, aged from 75 to 91 years with an average age of (79.56±4.54) years, with 13 left knee, 16 right knee, and 2 bilateral knees. Clinical outcomes were assessed preoperatively and at final follow-up using the visual analogue scale (VAS), Hospital for Special Surgery(HSS) score, range of motion (ROM), hip-knee-ankle angle (HKA), and tibial component posterior slope angle (TCPSA). Complications such as infection, prosthesis wear, prosthesis loosening, and dislocation were also recorded. RESULTS: All 31 patients were followed up from 12 to 63 months with an average of (28.34±10.56) months. The average postoperative TCPSA was (4.83±1.31)° ranged from 2.5° to 6.8°. At the final follow-up, there was significant improvement in VAS (3.24±0.53) vs. (6.59±0.69), HSS score (85.19±4.45) vs. (64.38±5.94), ROM (118.83±5.38)° vs. (98.85±4.08)°, and HKA (176.83±5.16)° vs. (169.57±6.28)° compared to preoperative values (P<0.05). No cases of infection, prosthesis loosening, or dislocation were reported. CONCLUSION UKA provides favorable short-and mid-term outcomes for elderly patients with medial knee OA and ACLD . However, long-term clinical efficacy needs further investigation through extended follow-up.
Humans ; Male ; Female ; Arthroplasty, Replacement, Knee/methods* ; Aged ; Osteoarthritis, Knee/physiopathology* ; Retrospective Studies ; Aged, 80 and over ; Range of Motion, Articular ; Anterior Cruciate Ligament Injuries/surgery*

OBJECTIVE: To exploring the efficacy of modified patellar triple surgery (including arthroscopic lateral retinaculum release, modified medial patellofemoral ligament reconstruction, and modified Fulkerson osteotomy) in the treatment of early patellofemoral osteoarthritis. METHODS: A retrospective analysis was conducted on 57 patients with patellofemoral arthritis admitted from March 2018 to June 2022, including 22 males and 35 females;aged 22 to 45 years old, average (31.5±5.7) years old; disease course 2 to 8 years (3.7±2.2) years;19 on the left side and 38 on the right side. The tendon graft was taken from the long tendons of the ipsilateral tibia, and the lateral patellar support band release was performed arthroscopically, combined with modified medial patellofemoral ligament reconstruction and modified Fulkerson osteotomy. The changes of Q angle, patellar tilt angle, tibial tuberosity-femoral trochlear groove (TT-TG) and Lysholm knee joint scores before and 12 months after surgery were compared. RESULTS: All patient incisions healed in stageⅠ, and 57 patients were followed up for 12 to 36 with an average of (22.1±2.5) months. The Q angle, patellar inclination angle, and TT-TG values improved from (22.7±1.9)°, (29.2±2.0)°, and (23.3±1.4) mm before surgery to (14.6±2.2)°, (7.6±3.2)°, and (11.8±1.7) mm one year after surgery, with statistically significant differences (P<0.05). The Lysholm score increased from preoperative (65.1±8.7) to postoperative (86.8±7.2) at 1 year (P<0.05), with 41 cases being excellent, 15 cases being good, and 1 case being average. CONCLUSION The improvement of medial patellofemoral ligament reconstruction and lateral retinaculum release can correct the Q angle in early patellofemoral osteoarthritis, while the improvement of Fulkerson osteotomy can correct the TT-TG value, elevate the patella, relieve pressure on the patellofemoral joint, and alleviate anterior knee pain. The clinical efficacy is definite, providing ideas for the clinical treatment of patellofemoral osteoarthritis.
Humans ; Male ; Female ; Adult ; Middle Aged ; Retrospective Studies ; Osteoarthritis, Knee/surgery* ; Patellofemoral Joint/surgery* ; Patella/surgery* ; Young Adult ; Osteotomy ; Arthroscopy

OBJECTIVE: To explore the role of antibiotic-eluting absorbable calcium sulfate in treating periprosthetic infection after one-stage revision of knee arthroplasty. METHODS: A retrospective analysis was performed on 36 patients(36 knees)who underwent phaseⅠrevision for periprosthesis infection after total knee arthroplasty from January 2018 to March 2022. All patients were underwent knee cavity puncture before operation and had positive results of aseptic body fluid culture, 21 patients received revision combined with antibiotic loaded calcium sulfate at stageⅠ(calcium sulfate group) during operation, and 15 patients underwent renovation at stageⅠ(revision group). There were 9 males and 12 females in calcium sulfate group, aged from 54 to 76 years old with an average of(67.6±6.2) years old. There were 15 patients in revision group, including 4 males and 11 females, aged from 60 to 75 years old with average of (69.6±4.1) years old. The levels of serum C-reactive protein (CRP), interleukin-6 (IL-6) at 7, 14, 30 and 90 days after operation were compared between two groups, and the rate of end-infection control at follow-up were compared. The systemic antibiotic application time, hospital stay and postoperative complications were observed between two groups. RESULTS: Calcium sulfate group were followed up for 12 to 29 months with an average of(18.9±4.2) months, and the infection control rate was 90.5%;while revision group were followed up 18 to 29 months with average of (21.6±3.7) months, and the infection control rate was 86.7% (13/15). There were no significant differences in follow-up time and infection control rate between two groups(P>0.05). Postoperative levels of CRP and IL-6 at 7, 14 and 30 days in calcium sulfate group were (32.79±11.48), (15.50±6.52), (9.36±3.32) mg·L^-1 and (17.31±6.15) pg·ml^-1, respectively;which were lower than those in revision group (40.65±11.32), (30.15±10.57), (18.97±5.86) mg·L^-1 and (25.54±6.73) pg·ml^-1, had statistical differences(P<0.05). There were no significant differences in IL-6 levels at 7 and 14 days after operation and CRP levels at 90 days after operation between two groups (P>0.05). The hospitalization time and systemic antibiotic application time in calcium sulfate group were (18.4±2.2) and (63.5±21.4) d, respectively;which were better than those in revision group (20.5±2.4) and (82.7±16.9) d, and had statistical differences(P<0.05). No significant wound complications and hypercalcemia were observed in calcium sulfate group. CONCLUSION Antibiotic eluted absorbable calcium sulfate could be used to treat periprosthetic knee infection, significantly reducing CRP levels in the early postoperative period, shortening hospital stay and systemic antibiotic application time, but it does not significantly improve the control rate of revision infection at stageⅠ.
Humans ; Male ; Female ; Aged ; Prosthesis-Related Infections/surgery* ; Middle Aged ; Calcium Sulfate/administration & dosage* ; Arthroplasty, Replacement, Knee/adverse effects* ; Retrospective Studies ; Anti-Bacterial Agents/therapeutic use* ; Interleukin-6/blood* ; C-Reactive Protein/metabolism* ; Reoperation ; Knee Prosthesis/adverse effects*

The injury of the posterior Angle of the medial meniscus of the knee joint is very common in clinic, and the arthroscopic treatment of the knee joint has been the first choice. However, there are many difficulties in arthroscopic treatment, such as narrow space in the medial posterior corner of the knee joint, insufficient space to deal with the injured meniscus, varion and lateral rotation under 30° flexion, release of the medial collateral ligament of the knee joint, and expansion of the knee joint cavity spinner, all of which could expose and expand the medial space of knee joint. Therefore, it is necessary to master and balance the use to avoid collateral injury. It is also necessary to determine the cause of meniscus injury during arthroscopic treatment, such as degenerative injury, simple meniscus repair and forming can hardly solve the pain of patients. Anterior cross injury is easy to cause instability of the knee joint, which is closely related to the injury of the posterior angle of the medial meniscus of the knee joint. In order to achieve the maximum therapeutic effect, physiological repair should be performed at the same time. There are various types of medial meniscus posterior angle injury, among which the Ramp injury, root fracture and laminae meniscus injury are greatly affected by joint degeneration, narrow knee space or knee stability, and all influencing factors should be fully considered in treatment.
Humans ; Arthroscopy/methods* ; Tibial Meniscus Injuries/surgery* ; Knee Joint/surgery* ; Menisci, Tibial/surgery* ; Knee Injuries/surgery*

OBJECTIVE: To evaluate the early efficacy of computer-assisted production of patient specific instrumentation(PSI) osteotomy plate in unicompartmental knee arthroplasty. METHODS: A retrospective analysis was conducted on 22 patients with knee osteoarthritis who underwent unicompartmental knee arthroplasty using computer-assisted production of PSI osteotomy plate between January 2022 and November 2022. The study included 1 male and 21 females, ranged from 59.8 to 76.5 years old with an average of (68.1±6.3) years old. Surgical time, intraoperative blood loss, incision length, spacer thickness, postoperative complications, postoperative femoral component varus and valgus angle (FVVA), femoral component flexion and extension angle (FFEA), tibial component varus and valgus angle (TVVA), tibial component posterior slope angle (TPSA), hip-knee-ankle mechanical angle (HKAA), and preoperative and postoperative 1-month, 3-month Hospital for Special Surgery knee-rating (HSS) and American Knee Society Score (KSS) were measured. RESULTS: The surgical time was (65.18±6.05) minutes, blood loss was (9.32±5.44) g·L^-1, incision length was (10.34±0.84) cm, and spacer thickness was (3.55±0.86) mm. The FVVA was (1.20±3.69)°, FFEA was (8.17±2.13)°, TVVA was (2.86±1.86)°, TPSA was (2.89±1.18)°, and HKAA was (183.15±1.46)°. The preoperative HSS score was (64.00±2.78) points, and KSS score was (Knee:59.09±6.16;Function:47.13±5.01). The postoperative 1-month HSS score was (74.91±3.57) points, and KSS score was (Knee:73.91±4.72;Function:65.46±6.38). The postoperative 3-month HSS score was (85.00±3.25) points, and KSS score was (Knee:83.00±2.88;Function:76.73±5.10). The comparison of preoperative and postoperative 1-month and 3-month HSS and KSS scores showed a statistically significant difference(P<0.05). CONCLUSION The early clinical efficacy of computer-assisted production of PSI osteotomy plate in unicompartmental knee arthroplasty for the treatment of knee osteoarthritis is satisfactory. This technique can simplify surgical procedures, improve the accuracy of osteotomy and implant placement, and help shorten the learning curve.
Humans ; Male ; Female ; Arthroplasty, Replacement, Knee/methods* ; Middle Aged ; Aged ; Osteotomy/methods* ; Retrospective Studies ; Bone Plates ; Osteoarthritis, Knee/surgery* ; Surgery, Computer-Assisted/methods* ; Knee Joint/surgery*

OBJECTIVE: To investigate the risk factors associated with the development of knee osteoarthritis (OA) following arthroscopic surgery for degenerative lesions of the posterior horn of the medial meniscus. METHODS: Between January 2012 and January 2014, a retrospective analysis was conducted on 506 patients who underwent arthroscopic surgery for degenerative disease of the posterior horn of the medial meniscus. The cohort included 230 males and 276 females, aged from 32 to 58 years old with an average of (46.77±9.02) years old. According to the results of postoperative follow-up, patients were categorized into a knee osteoarthritis(OA) group and a non-OA group. The following parameters were recorded for each subject:gender, medial proximal tibial angle (MPTA), hip-knee-ankle angle (HKA), presence of bone edema on MRI, physical characteristics (including McMurray test results, locking symptoms, and medial knee tenderness points), meniscus protrusion, type of meniscus injury, and free body condition as observed via arthroscopy. Multivariate unconditional Logistic regression analysis was employed to investigate the associated factors influencing the 10-year postoperative incidence of knee osteoarthritis following surgery for degenerative injury of the posterior horn of the medial meniscus. Independent risk factors potentially influencing the development of postoperative OA were identified, and a nomogram-based predictive model for postoperative OA was established. The discriminatory ability and calibration accuracy of the model were assessed using the C-index and Hosmer-Lemeshow goodness-of-fit test, respectively. Furthermore, internal validation was performed using the bootstrap resampling method. RESULTS: Within a 10-year period following arthroscopic surgery, there were 123 patients in the OA group and 383 patients in the non-OA group. Significant differences were observed between two groups with respect to gender (χ²=5.156, P=0.023), MPTA<86.6° (χ²=21.671, P<0.001), varus lower limb alignment( χ²= 80.086, P<0.001). Additionally, meniscus extrusion (χ²=6.371, P=0.012), meniscus transverse tear (χ²=14.573, P<0.001), and bone edema detected on MRI(χ²=9.881, P=0.002) were identified as factors associated with the development of postoperative knee OA. The multifactorial Logistic regression analysis revealed that the lower limb line of force inversion OR=4.324, 95%CI (1.391, 13.443), P=0.011;MPTA <86.6°, OR=2.519, 95%CI (1.150, 5.519), P=0.021;transverse meniscus tear, OR=4.546, 95%CI (1.827, 11.310), P=0.001;meniscus ectropion, OR=5.401, 95%CI (1.992, 14.646), P=0.001;and bone edema manifestation on MRI OR=2.692, 95%CI (1.169, 6.200), P=0.020. They were independent risk factors associated with the development of postoperative OA. The area under the ROC curve predicted by the model was 0.927, 95%CI (0.903, 0.950). The Hosmer-Lemeshow goodness-of-fit test, used to evaluate the accuracy of the model, yielded P=0.689. Additionally, the internally sampled calibration curve demonstrated good consistency with the actual postoperative OA outcomes. CONCLUSION Varus alignment of the lower extremity, MPTA <86.6°, transverse meniscus tear, lateral meniscus injury, and bone marrow edema observed on MRI were independent risk factors for the development of knee osteoarthritis following arthroscopic surgery. Additionally, the prognostic model demonstrated excellent predictive performance.
Humans ; Male ; Female ; Middle Aged ; Arthroscopy/adverse effects* ; Adult ; Retrospective Studies ; Tibial Meniscus Injuries/surgery* ; Osteoarthritis, Knee/epidemiology* ; Risk Factors ; Menisci, Tibial/surgery* ; Incidence ; Postoperative Complications/epidemiology*

OBJECTIVE: To compare the short-term clinical outcomes and radiographic results of robotic-assisted total knee arthroplasty (RATKA) using the ROSA robot with those of traditional total knee arthroplasty (TKA). METHODS: A retrospective analysis was conducted on 55 patients who underwent unilateral TKA due to end-stage knee osteoarthritis(KOA), defined as Kellgren-Lawrence grade Ⅲ or Ⅳ, between June 2024 and December 2024. The patients were divided into two groups based on the surgical approach:the RATKA group and the conventional TKA group. The RATKA group included 25 patients, consisting of 6 males and 19 females, aged from 46 to 84 years old with a mean of ( 65.20±1.93 ) years old. Among them, 11 cases involved the left knee and 14 cases involved the right knee. The traditional TKA group included 30 patients, consisting of 5 males and 25 females, aged from 57 to 85 years old with an average of (68.73±1.36) years old. Among them, 13 cases involved the left knee and 17 cases involved the right knee. Operation time, total perioperative blood loss, and postoperative complications were compared between the two groups. Radiographic evaluation included preoperative and postoperative hip-knee-ankle (HKA) angle, and postoperative lateral tibial component angle (LTC), frontal femoral component angle (FFC), sagittal lateral femoral component angle(LFC), and frontal tibial component (FTC), for the assessment of lower extremity mechanical axis and prosthesis position. The American Knee Society score(KSS), visual analogue scale(VAS) for pain, and range of motion (ROM) of the knee joint preoperatively and postoperatively were compared between the two groups to evaluate the short-term clinical efficacy. RESULTS: All surgeries in both groups were successfully completed without intraoperative vascular or nerve injury. Primary wound healing (GradeⅠ) was achieved in all cases, and no infection occurred during follow-up. A total of 55 patients completed the follow-up, with a follow-up duration ranging from 3 to 6 months with a mean of (4.0±1.1) months. The average operation time was (106.56±9.70) minutes in the RATKA group and (90.10±10.97) minutes in the traditional TKA group, with a statistically significant difference between the two groups (P<0.05). However, there was no statistically significant difference in the total perioperative blood loss between the two groups(P>0.05). Postoperative X-ray examinations showed that the prosthesis was well-positioned in all patients of both groups, with no signs of prosthesis loosening or dislocation. On the 1st day postoperatively, the HKA and FFC angle in the RATKA group were (179.25±2.50)° and (89.24±1.58)°, while those in the traditional TKA group were (177.68±2.73)° and (88.25±1.91)°, both showing statistically significant differences(P<0.05). In contrast, there were no statistically significant differences in the FTC, LTC, or LFC angles between the two groups(P>0.05). At 1 month and 3 months postoperatively, the ROM values were (110.68±4.92)° and (117.28±4.91)° in the RATKA group, and (106.25±6.89)° and (113.43±7.91)° in the traditional TKA group, both showing statistically significant difference(P<0.05). Nevertheless, there were no statistically significant differences in the VAS (both at rest and during movement) or KSS between the two groups at 1 month and 3 months postoperatively(P>0.05). Compared with the preoperative data, both groups showed significant improvements in the HKA angle, VAS(at rest and during movement), knee ROM, and KSS (both clinical and functional scores) postoperatively, with statistically significant differences(P<0.05). CONCLUSION Compared to traditional TKA, ROSA robotic system-assisted TKA in patients with severe knee osteoarthritis achieved superior accuracy in prosthesis positioning and lower limb mechanical axis restoration, showing satisfactory clinical outcomes. Although short-term outcomes are favorable, long-term clinical efficacy requires further investigation.
Humans ; Male ; Female ; Arthroplasty, Replacement, Knee/methods* ; Aged ; Middle Aged ; Aged, 80 and over ; Robotic Surgical Procedures/methods* ; Retrospective Studies ; Osteoarthritis, Knee/surgery* ; Treatment Outcome ; Knee Joint/physiopathology*