With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

Objective To evaluate the short-term clinical effect of arthroscopic repair of rotator cuff injury with all-suture anchor using a prospective and single-cohort clinical trial.Methods Twenty-five patients with rotator cuff injuries(1.5 cm0.05).Conclusion Arthroscopic rotator cuff repair with all-suture anchor is feasible and safe,and has good short-term clinical effect.

Objective:To investigate the effect of rehabilitation nursing protocol based on the behavioral change wheel (BCW) theory on recovery after shoulder arthroscopy in patients with type 2 diabetes mellitus and rotator cuff injury, and providing reference for overall rehabilitation.Methods:A prospective, single-blind, quasi-experimental study was used. A total of 76 patients with type 2 diabetes mellitus who underwent arthroscopic rotator cuff repair in Northern Jiangsu People′s Hospital from January to March 2023 were conveniently selected, and the patients were assigned to the control group and the experimental group with 38 patients in each group according to the order of visit time. The control group received routine nursing, and the experimental group received nursing intervention based on BCW theory on the basis of routine nursing. The joint motion (ROM), Constant-Murley shoulder function score (CMS), fasting blood glucose and other indexes of the two groups were compared at different time points.Results:During the intervention period, the two groups were followed up regularly, and 38 patients were included in each group. The control group included 15 males and 23 females, aged (63.05 ± 7.36) years. The experimental group included 14 males and 24 females, aged (61.34 ± 8.95) years. One month after surgery, the shoulder flexor of experimental group was (140.26 ± 22.90) °, which was better than (121.79 ± 36.52) °of control group, the lateral internal rotation of experimental group was (4.00 (3.00, 6.00) points, which was better than 3.00 (3.00, 6.00) points of control group,and the difference was statistically significant ( t=6.98, Z=-2.14, both P< 0.05). Three months after surgery, the anterior flexion of experimental group was (157.11 ± 13.64) °, which was better than (136.05 ± 30.16) ° of control group, and the lateral internal rotation of experimental group was 7.00 (3.00, 7.25) points, which was better than 4.00 (3.00, 7.00) points of control group, the difference was statistically significant ( t=15.37, Z=-2.06,both P<0.05). Six months after surgery, shoulder joint abduction in the experimental group was (161.32 ± 21.63) °, which was better than (148.76 ± 28.80) °in the control group, side rotation in the experimental group was 9.50 (8.00, 10.00) points,which was better than 8.00 (7.00, 9.25) points in the control group, and the difference was statistically significant ( t=4.62, Z=-2.57, both P<0.05). Repeated measurement ANOVA showed that the anterior flexor, abduction and lateral rotation of shoulder joint motion had statistical significance in terms of time difference ( F=70.52, 77.68, 33.16, all P<0.05), there was statistical significance in shoulder flexor in terms of group and interaction ( F=13.06, 4.00,both P< 0.05 ). Generalized estimating equation showed that there was statistically significant difference in lateral internal rotation in terms of time and group (wald χ2=4.23, 246.77, both P<0.05). Six months after surgery, the CMS score of experimental group was (83.99 ± 9.41) points, which was better than (76.36 ± 11.59) points of control group, and the difference was statistically significant ( t=-3.15, P<0.05). Six months after surgery, the blood glucose of the experimental group was (6.53 ± 1.29) mmol/L, which was better than (7.18 ± 1.46) mmol/L of the control group, the difference was statistically significant ( t=4.21, P<0.05). Repeated measurement ANOVA showed statistically significant differences in time and interaction ( F=17.36, 4.20, both P<0.05). Conclusions:The intervention program based on BCW theory is beneficial to improve the range of motion and function of shoulder joint in patients with type 2 diabetes after rotator cuff injury, regulate blood sugar, and promote their full recovery.

Objective:To evaluate the early clinical outcomes of modified suspended fixation with triple plates and double beams through a limited incision in the treatment of acroxoclavicular dislocation.Methods:A retrospective study was conducted to analyze the 23 patients with acromioclavicular dislocation who had been treated at Department of Orthopedics, The People's Hospital of Northern Jiangsu from June 2021 to August 2023 by modified suspended fixation with triple plates and double beams through a limited incision. There were 9 males and 14 females with an age of (52.2±10.6) years. The incision length, operation time, intraoperative bleeding and complications were recorded. The visual analogue scale (VAS) pain score, Constant-Murley shoulder score, American Shoulder and Elbow Surgeons (ASES) score, range of shoulder motion (anterior flexion, abduction, lateral rotation) were recorded and compared between preoperation and the last follow-up. The coracoclavicular distance (CCD), clavicle tract width and coracoid tract width were measured and compared between postoperative day 2 and the last follow-up.Results:The patients were followed up for 12 (12, 16) months. The incision length was 5 (4, 5) cm, the operation time 50 (40, 60) min, and the intraoperative bleeding 30 (20, 30) mL. No such complications occurred as incision infection, fracture, or failure of internal fixation. The VAS pain score, Constant-Murley shoulder score, ASES score, anterior flexion, abduction and lateral rotation of the shoulder at the last follow-up were, respectively, 0 (0, 0) point, (92.8±4.9) points, (90.4±5.7) points, 175 °(170°, 180°), 175°(170°, 175°), and 85°(80°, 85°), significantly improved compared with the preoperative values [6 (5, 6) points, (40.4±7.2) points, (39.3±7.1) points, 85°(80°, 85°), 85°(80°, 90°), and 35°(35°, 40°)] ( P<0.05). The CCD was (6.1±1.3) mm at postoperative day 2 and (7.5±1.7) mm at the last follow-up, showing a significant difference ( P<0.05). Compared with postoperative day 2, the CCD widening at the last follow-up was <4mm in all patients, giving an excellent rate of 100% (23/23). The medial clavicle tract widening and the medial coracoid tract widening at the last follow-up were both <2 mm in all patients, giving an excellent rate of 100% (23/23). The lateral clavicle tract widening at the last follow-up was >2 mm in 2 patients, giving an excellent rate of 91% (21/23). Conclusions:In the treatment of acroxoclavicular dislocation, our modified suspended fixation with triple plates and double beams through a limited incision can lead to reliable reduction fixation and good recovery of shoulder function, showing advantages of short surgical time, easy surgical operation, high safety, and minimal postoperative widening of bone tracts.

Background and Objectives: This study aims to clarify the systems underlying regulation and regulatory roles of hydrogen combined with 5-Aza in the myogenic differentiation of adipose mesenchymal stem cells (ADSCs). Methods: and Results: In this study, ADSCs acted as an in vitro myogenic differentiating mode. First, the Alamar blue Staining and mitochondrial tracer technique were used to verify whether hydrogen combined with 5-Aza could promote cell proliferation. In addition, this study assessed myogenic differentiating markers (e.g., Myogenin, Mhc and Myod protein expressions) based on the Western blotting assay, analysis on cellular morphological characteristics (e.g., Myotube number, length, diameter and maturation index), RT-PCR (Myod, Myogenin and Mhc mRNA expression) and Immunofluorescence analysis (Desmin, Myosin and β-actin protein expression). Finally, to verify the mechanism of myogenic differentiation of hydrogen-bound 5-Aza, we performed bioinformatics analysis and Western blot to detect the expression of p-P38 protein. Hydrogen combined with 5-Aza significantly enhanced the proliferation and myogenic differentiation of ADSCs in vitro by increasing the number of single-cell mitochondria and upregulating the expression of myogenic biomarkers such as Myod, Mhc and myotube formation. The expressions of p-P38 was up-regulated by hydrogen combined with 5-Aza. The differentiating ability was suppressed when the cells were cultivated in combination with SB203580 (p38 MAPK signal pathway inhibitor). Conclusions Hydrogen alleviates the cytotoxicity of 5-Aza and synergistically promotes the myogenic differentiation capacity of adipose stem cells via the p38 MAPK pathway. Thus, the mentioned results present insights into myogenic differentiation and are likely to generate one potential alternative strategy for skeletal muscle related diseases.

Objective:To compare the clinical efficacy between reservation and sacrifice of remnants in the footprint area in arthroscopic repair of rotator cuff tear.Methods:A retrospective study was conducted to analyze the clinical data of 32 patients with rotator cuff tear plus remnants in the footprint area (2 cm < tear size <5 cm) who had been admitted to Department of Sports Medicine, The People's Hospital of Northern Jiangsu from May 2020 to July 2021. The patients were divided into 2 groups according to reservation or sacrifice of remnants in the footprint area in arthroscopic repair of rotator cuff tear. In the remnant-reservation group (16 cases): 5 males and 11 females with an age of (61.8±9.9) years, 9 left and 7 right shoulders affected, and (3.7±1.1) cm in size of rotator cuff tear; in the remnant-sacrifice group (16 cases): 4 males and 12 females with an age of (61.3±8.8) years, 8 left and 8 right shoulders affected, and (3.9±0.9) cm in size of rotator cuff tear. The 2 groups were compared in terms of visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley shoulder function score (Constant score), and range of motion of the affected shoulder before surgery, 3 months after surgery and at the last follow-up. The ratio of bilateral abductor muscle strengths (affected side/healthy side) was analyzed and compared between the 2 groups, and the healing of the rotator cuff was evaluated by MRI at the last follow-up.Results:The 2 groups were comparable because there were no significant differences in all their preoperative demographic data ( P>0.05). The 32 patients were followed up for (14.3±3.5) months after surgery. At 3 months after surgery, the VAS score in the remnant-reservation group [1.0 (0.0,1.0) point] was significantly lower than that in the remnant-sacrifice group [1.0 (1.0,1.0) point] ( P<0.05), but there was no significant difference between the 2 groups in ASES score, Constant score or range of motion of the affected shoulder ( P>0.05). At the last follow-up, the ASES score, forward flexion, abduction and ratio of bilateral abductor muscle strengths (affected side/healthy side) in the remnant-reservation group [(96.1±4.8) points, 170.0 (170.0,170.0)°, 160.0 (160.0,170.0)°, and 85.5%±13.8%]were significantly better than those in the remnant-sacrifice group [(91.4±5.9) points, 160.0 (160.0,170.0)°, 150.0 (140.0,155.0)°, and 72.6%±16.9%] ( P < 0.05), but there were no statistically significant differences between the 2 groups in VAS score, Constant score, neutral external rotation angle, or body-side internal rotation ( P>0.05). The Sugaya grading for MRI rotator cuff healing was significantly different between the 2 groups at the last follow-up ( P<0.05). Conclusion:In arthroscopic repair of rotator cuff tear, reservation of remnants in the footprint area can significantly relieve postoperative shoulder pain, and has obvious advantages in restoration of shoulder forward flexion, abduction and abductor muscle strength, leading to better healing of the rotator cuff and the large nodule than the remnant-sacrifice technique.

Objective:To investigate the clinical efficacy of Dog-Bone double button in the treatment of acute acromioclavicular dislocation under shoulder arthroscopy.Methods:A retrospective analysis was conducted of the 20 patients with acute acromioclavicular dislocation who had been treated at Department of Sports Medicine, Northern Jiangsu People's Hospital of Jiangsu Province from November 2018 to December 2020 by Dog-Bone double button under shoulder arthroscopy. They were 11 males and 9 females, aged from 31 to 63 years. Recorded were their visual analogue scale (VAS), Constant-Murley shoulder function score and range of shoulder anteflexion at preoperation and the last follow-up, as well as complications and the X-ray parameters at one month postoperation and the last follow-up [including coracoclavicular distance (CCD), distance between the upper and lower Dog-Bone titanium plates (DDD), angle between the coracoid process tunnel and the tangent line of the superior clavicle (CTCA), and widths of the clavicle tunnel and the coracoid process tunnel].Results:The 20 patients were followed up for 6 to 12 months (average, 10.5 months). Their preoperative VAS score, Constant score, and range of shoulder anteflexion were 3.0 (3.0, 4.0), 57.0 (54.3, 61.5) and 130° (110°, 140°), which were significantly improved to 0 (0, 0.8), 90.0 (86.5, 91.0) and 170° (170°, 180°) at the last follow-up ( P<0.05). Their CCD, DDD, CTCA, and widths of the clavicle tunnel and the coracoid process at one month postoperation were (5.0±1.0) mm, (32.4±3.5) mm, 91.7° (88.5°, 104.9°), 3.0 (3.0, 3.0) mm and 3.0 (3.0, 3.0) mm, which were significantly improved to (6.3±1.3) mm, (32.8±3.7) mm, 84.8° (81.8°, 92.0°), 3.5 (3.4, 3.6) mm and 3.2 (3.1, 3.3) mm with the exception of DDD at one month postoperation ( P<0.05). The last follow-up observed postoperative reduction loss in only one patient. Conclusion:For acute acromioclavicular joint dislocation, the Dog-Bone fixation technique under shoulder arthroscopy can lead to fine surgical efficacy and patient satisfaction, because it has advantages of limited trauma, good functional recovery of the shoulder, and effective prevention of reduction loss.

To investigate cerebral autoregulation(CA)in patients with severe unilateral carotid artery stenosis by near infrared spectroscopy. Thirty patients who underwent general anesthesia in our hospital from January 2015 to February 2017 were enrolled in this study.The stenosis group included 15 patients with severe unilateral internal carotid artery stenosis,and the control group included 15 patients without carotid artery stenosis.Both groups were matched in sex and age.Cerebral tissue oxygenation index(TOI)and mean arterial pressure were recorded continuously under stable general anesthesia.The Pearson correlation coefficient()was calculated to judge the CA status. TOI was not significantly different between the stenosis side and the non-stenosis side in the stenosis group(66.52±6.50 65.23±4.50;=0.93, =0.368)or between the stenosis side in the stenosis group and the stenosis side in the control group(66.52±6.50 64.22±3.87;=1.18, =0.248).The values of stenosis side and non-stenosis side in the stenosis group were 0.36±0.12 and 0.17±0.11,respectively,and the values of the stenosis side in the stenosis group and the stenosis side of the control group were 0.36±0.12 and 0.13±0.08,respectively.In the stenosis group,5 patients had transient ischemic attack and 2 patients had a history of stroke within 3 months before operation.When an value of 0.342 was used as the judgment point of CA abnormality,the sensitivity and specificity were 0.625 and 0.909,respectively. Within the range of normal blood pressure fluctuation,cerebral blood flow is linked to blood pressure at the stenosis side in patients with severe unilateral carotid artery stenosis.
Blood Pressure ; Carotid Stenosis ; Cerebrovascular Circulation ; Homeostasis ; Humans ; Ischemic Attack, Transient