Background: This trial assessed the safety and efficacy of intra-articular hyaluronic acid (IAHA) injections at various intervals after ACL reconstruction (ACLR) to determine optimal timing, given mixed results in previous studies on early versus delayed administration.
Methods: Ninety ACL tear patients undergoing arthroscopic ACLR were divided into three groups: Early HA group received HA on day 2 and saline at 8 weeks; Late HA group received saline on day 2 and HA at 8 weeks; Placebo group received saline at both times. Clinical and biochemical parameters were assessed at baseline, monthly up to 6 months, and at 12 months, using range of motion (ROM), knee circumference, Lysholm score, IKDC, VAS, EQ5D5L, Tegner scores, serum ESR, and CRP. Synovial markers TNF-alpha was measured at baseline, day 2, and 3 months.
Results: Early HA group showed significantly better ROM than Placebo (P=0.041) and Late HA groups (P=0.029) at one- and two-months’ post-surgery. Pain was significantly lower in Early HA group at one month compared to Placebo (P=0.033). Early HA group achieved a faster median recovery to a Lysholm score of 83 (P=0.01) and had superior Lysholm scores at two months. EQ5D5L and IKDC scores were also significantly better at one and two months in Early HA group. Both HA groups had a significant decrease in TNF-alpha from baseline (P<0.05). No adverse events were reported.
Conclusion: Early IAHA injection post-ACLR reduces pain and enhances ROM in the early postoperative period, improving functional outcomes and quality of life. This treatment is safe for postoperative use.

Lower back pain is associated with vertebral biomechanics. Vertebral endplates (EPs) play a key role in load transfer and distribution. Synchrotron computed tomography (sCT) allows for detailed visualisation of the microstructure of intact EPs under near-physiological loads. sCT, coupled with digital volume correlation (DVC), can be applied to quantify three-dimensional (3D) strain fields. In this study, we further coupled DVC data and a finite element model (FEM) to determine the material properties of murine EPs. Then, the model was extended to investigate EP biomechanics under different motions and disease conditions. We show that the FEM-predicted strains after optimisation were spatially correlated with the DVC measurements. The extrusive macrostructures on EPs are important for load absorption and redistribution under different motions. The FEM also predicted that abnormal intervertebral disc (IVD) stress may be the cause of osteoporosis (OP)- and pycnodysostosis (PYCD)-related IVD degeneration. Our study validated the efficacy of using DVC results to increase the accuracy of FEM predictions. These methodologies can potentially be scaled up to large animals and humans.

Purpose:
Accurate cup placement is challenging in total hip arthroplasty (THA) for dysplastic hip osteoarthritis (DHOA) because of the complex morphology of the acetabulum. Studies have reported good accuracy for total hip arthroplasty (THA) using computed tomography-based navigation (CTN); however, in recent years, portable navigation (PN) has become more widely applied because of its low cost and ease of use. This study aimed to compare the accuracy of portable navigation with that of CT-based navigation.
Methods:
A total of 114 patients underwent THA for DHOA via the standard posterior approach in the lateral decubitus position using the CTN (CTN-THA group) or PN (PN-THA group) system. After propensity score-matching, 32 patients were included in each group. The accuracy of cup inclination, anteversion, cup placement position, and operative time were compared between the groups.
Results:
There was no difference in accuracy error between the CTN-THA (inclination 2.8±2.0° and anteversion 3.4±2.1°) and PN-THA groups (inclination 2.5±1.8° and anteversion 2.6±2.2°). The CTN-THA group (inclination 2.2±2.0° and anteversion 2.1±1.6°) achieved better navigation error compared to the PN-THA group (inclination 2.6±2.2° and anteversion 3.8±3.3°). The error of cup placement position in the anteroposterior direction was significantly larger in the PN-THA group (4.27±3.02 mm) than in the CTN-THA group (2.13±2.17 mm). The operative time was significantly longer in the CTN-THA group (115±41 min) than in the PN-THA group (87±19 min).
Conclusions:
CTN-THA exhibited better accuracy than PN-THA for both cup placement angles and positions. CTN-THA tended to increase the operative time compared to PN-THA.

Introduction: Platelet rich plasma contain numerous growth factors and activates natural healing cascade and tissue regeneration which has shown to relieve pain and improve quality of life. Whether activating PRP using an agent enhances its potency has not been well studied in literature. Our study aims to compare activated and non-activated platelet rich plasma in the management of osteoarthritis (OA) of the knee.
Methods: 60 patients diagnosed with OA classified from grade 0-4 on Kellgren Lawrence scale were divided into 2 groups of 30 each. Group 1 received intra-articular injection of activated PRP and group 2 were given normal PRP. Calcium chloride was used to activate PRP and given at 2 weeks intervals. Outcomes assessed by WOMAC and KOOS score at presentation, 10 weeks, 16 weeks and 6 months.
Results: In the activated group, the KOOS score showed a mean of 47.4 at pre-injection period which increased to 59.6 at 10 weeks and 69.8 at 16 weeks whereas in the inactivated group the score was 49+/-4.4 at pre-injection period and 57.3 at 10 weeks and 66.1 at 16 weeks respectively, which was significant (p value= .003), but at the end of 6 months, group 1 showed 71.7 and group 2 70.0 which was statistically insignificant. We also observed a decrease in the WOMAC score during the post procedure period and it was found to be statistically significant throughout the study (p value = .003)
Conclusions: Activated PRP showed earlier and more consistent outcomes at early follow up periods though significant improvement in functional outcomes in both groups with early osteoarthritis of the knee (KL grade 2 and 3) on long term follow up.

Patellectomy, an uncommon procedure in the current era, poses a challenge in total knee replacement (TKR), creating anteroposterior instability, anterior knee pain, and loss of mechanical advantage. The TKR is even more complicated when the patellectomy is performed secondary to lower limb malalignment with patellofemoral pain and instability. Here we propose a surgical technique to perform patellar reconstruction with concomitant TKR to tackle this complex scenario.