This randomized-controlled trial evaluated the safety and efficacy of intra-articular hyaluronic acid (IAHA) injection at different times after ACL reconstruction (ACLR) surgery. Ninety patients with ACL tears who underwent arthroscopic ACLR were divided into three groups: the early HA group received HA on day two and saline at eight weeks, the late HA group received saline on day two and HA at eight weeks, and the placebo group received saline at both times. Clinical and biochemical parameters were evaluated at baseline, monthly up to 6 months, and at 12 months. The early HA group demonstrated significantly better ROM than placebo (P=0.041) and late HA group (P=0.029) after one and two months. The pain (VAS) at one month was also significantly less in early HA group compared to placebo group (P=0.033). The early HA group had a considerably faster median recovery time to the desired Lysholm score of 83 (p=0.01) than the placebo group and had better Lysholm scores than the other two groups at the end of 2 months. The EQ5D5L and IKDC scores were also significantly better at 1st and 2nd months in early HA group. In both HA groups, synovial inflammatory marker TNF -alpha significantly decreased from the baseline (P<0.05), but there were no significant differences between the three groups. None of the patients develop any adverse events. To conclude, early intra-articular hyaluronate injection following ACLR is both safe and beneficial, leading to reduced pain, improved range of motion, enhanced knee function, and better health-related quality of life

There is controversy regarding the ideal graft choice for anterior cruciate ligament (ACL) reconstruction. Bone-patellar tendon-bone and hamstring autografts have been considered the standard choice of graft for decades. Despite the good clinical outcomes, donor-site morbidity is concern for both of these grafts. Peroneus longus tendon(PLT) autograft has also been considered as a potential graft for many orthopaedic reconstructive procedures. The biomechanical properties and thickness of PLT permit its use for ACL reconstruction. The tensile strength of a peroneus longus tendon autograft is the same as that of a hamstring autograft and greater than that of a bone-patellar tendon-bone graft and a quadriceps tendon graft. My aim to use the peroneus longus tendon autograft during single-bundle ACL reconstruction. 12 patients (10 men and 2 women) with complete ACL tear treated with arthroscopic reconstruction with peroneus longus graft. Average FU period was 17.2 months. Assessment of post-surgical pain, knee stability, and ankle function were performed using Lysholm knee score and AOFAS (American orthopaedic foot and ankle score) respectively. Excellent results were obtained on 10 cases while one case had fair results. Conclusive evidence shows that PLT can be an appropriate autograft source for ACL reconstruction, avoiding potential complications of autografts obtained from the knee region.

Femoroacetabular impingement syndrome (FAIS) is defined as non-physiological contact between subcapital region of the femur and the acetabular rim, which is happening in normal range of motion in hip joint.
Hip arthroscopy is well established method for treating femoroacetabular impingement syndrome (FAIS) nowadays.
Preoperative templating is crucial step in FAIS surgery due to its predominantly biomechanical nature. The main goal here is to determine which regions of hip joint are affected in particular positon of the joint elements. Based on this evaluation surgeon is aware in which areas and how much of bone removal is necessary .
As a source, a standard CT imaging of hip and pelvis is used. 3D reconstruction and 3D model segmentation and refinement is then performed. Once the center of rotation of femoral head is determined, dynamic simulation if performed in physiologic range of motion (ROM) cycle.
The areas of contact in normal ROM are then marked for further use in surgical procedure - arthroscopic bony trimming.
Although automated software for such purposes exist present, they’re not used widely in daily clinical practice Furthermore, our approach is much more flexible and allows usage in many other applications, such as personalized surgical instrumentation (PSI) design, which will be shown in our presentation.

Introduction: The effectiveness of rotator cuff repairs can be determined not only by evaluation of symptoms and clinical examination, but patient-reported outcome measures (PROMs) as well. While the MCID for various validated shoulder scores such as the Oxford Shoulder Score (OSS) have been reported at 1 and 2 years post-operatively, there are no studies proposing the MCID of the OSS at 5 years post-operatively. Hence, the purpose of this study is to determine the MCID of the OSS at 5 years post-operatively in a cohort of patients who have undergone arthroscopic rotator cuff repair. Methods: Prospectively collected data of 123 patients who underwent arthroscopic rotator cuff repair performed by a fellowship-trained shoulder surgeon in a single high-volume institution between 2015-2017 was retrospectively reviewed. Functional outcome was assessed by the Oxford Shoulder Score (OSS) at 6 months, 2 years, and 5 years post-operatively. The MCID for OSS was determined through 2 methods: an anchor-based linear regression approach as well as a distribution-based approach. Results: A total of 123 patients who underwent arthroscopic rotator cuff repair were included in this study. At 5 years post-operatively, the MCID of OSS identified by the anchor-based linear regression approach for satisfaction was 2.8 (95% CI 2.0 - 3.6), and that for expectation fulfilment was 2.6 (95% CI 1.9 – 3.3). The MCID of OSS identified by the distribution-based approach was 2.5. Conclusion: Taking the higher value to be the minimum change in score required, the proposed MCID for OSS at 5 years post-operatively is 2.8.

Introduction
Osteoarthritis (OA) affects over 240 million people worldwide, predominantly in the knee, with the elderly population over 65 being most affected. Various risk factors contribute to biological changes in joint microenvironments, leading to cartilage overload and chondrocyte aging. Adipose-derived MSCs (ADSCs) have emerged as a promising therapy for knee OA, improving joint conditions effectively. This systematic review focuses on evaluating the efficacy of ADSC therapies in treating knee OA in patients over 65 years of age.

Materials and Methods
A literature search was conducted in PubMed, Scopus, and Cochrane databases for English-language human clinical trials until Feb 7, 2024. Study characteristics including authors, publication year, study type, patient demographics, ADSC culture method, cell count, follow-up duration, adverse events, complications, and clinical outcomes were extracted and analyzed.

Results
Seven clinical trials meeting inclusion criteria were identified, involving autologous adipose-derived stem cells. Four studies utilized stem cells as a stromal vascular fraction (SVF), two as cultured ADSCs, and one investigated the microfragmented adipose tissue (MAT) procedure. All studies reported improved clinical outcomes in 339 knees, with increased scores in KOOS, WOMAC, IKS, VAS, and Lysholm knee scales post-treatment. Complications were minimal, with only 62 knees experiencing adverse events, none of which were significant.

Conclusions
This systematic review underscores the effectiveness and safety of autologous adipose-derived stem cell therapy in improving clinical outcomes for knee OA in elderly patients. It suggests a viable alternative to surgery for refractory cases, offering hope for those not yet in end-stage OA.

Introduction: Arthroscopic-assisted uni-portal spinal surgery (AUSS) as a new endoscopic technique has both working and observation channels, but both are located in the same incision, and each channel can move freely. The purpose of this study was to describe the technique of extraforaminal approach of AUSS for the treatment of far lateral disc herniation (FLDH) and to analyze early clinical results after endoscopic discectomy. Methods: A total of 31 patients of a single center surgically treated for FLDH between 2022 and 2023 were retrospectively included in this study. All patients underwent uni-portal arthroscopic discectomy via extraforaminal approach.The VAS score for lower back and lower limb radiation pain, ODI score, modified MacNab score, estimated blood loss and recurrence and complication rates were examined as indicators for clinical outcomes and adverse events.Results: The mean operative time was 35.8 minutes. The mean quantity of bleeding was 40 mL.The mean VAS score for radicular leg pain dropped from a preoperative score of 8.1 ± 0.6 to a final follow-up score of 1.9 ± 1.1 (p < 0.001). The final outcome according to the modified Macnab criteria was excellent in 10 patients (32.2%), good in 16 (51.6%), fair in 5 (16.1%), and poor in 0. Complications were limited to one dural tear (4.8%). There was no postoperative complication and disc reherniation. Conclusions: The extraforaminal approach of arthroscopic-assisted uni-portal spinal surgery was a feasible and advantageous endoscopic technique for the treatment of FLDH. AUSS may be considered as an alternative surgical treatment for FLDH.

The fastest growing sport in the world today is women's football. The European Football Federation has documented a 7.1% year-on-year increase in the number of active female athletes between 2016 and 2017. Therefore, in the last decade, a significant increase in orthopedic injuries among female soccer players has been observed around the world. Epidemiologically, it has been proven that the incidence of bone and joint injuries is 3.42 per 1000 hours of play. Studies show that the three most common injuries are knee, ankle and tendon injuries and their incidences are significantly different from injuries in men. The most common injury of all is an anterior cruciate ligament injury, which is at least twice as common in women as in men regardless of injury exposure and level of participation in sports. Due to the specificity of sport activity, they engage in, dilemmas related to both operative treatment and post-operative rehabilitation have arisen over time. The aim of this paperwork is to present the modern aspects of operative treatment from preoperative preparation, surgical treatment that to the greatest extent implies an adequate choice of graft, operative technique, and the application of bioregenerative medicine, to the specificity of postoperative rehabilitation protocols. The paper will present experience from the available literature, as well as personal experience in the treatment of female football players in the last two years.

Joint osteonecrosis, a painful condition characterized by the death of bone tissue, is a sequelae of antileukemic treatment in adolescents with acute lymphoblastic leukemia (ALL). It can result in pain, limited mobility, and decreased life quality. There is limited research on the treatment options specifically for adolescents with joint osteonecrosis, making it a significant treatment challenge. We have analyzed two adolescents with several joints affected. The first is a girl (17) who has been affected by joint issues in both hips, shoulders, knees, and elbows. The treatment options for her condition range from nonoperative treatments to joint arthroplasty, depending on the stage and severity of her symptoms. The second case a boy (16) with capitellar osteonecrosis in both elbows and talar osteonecrosis with loose bodies. These conditions were treated arthroscopically in all four joints affected. The results showed that conservative management was less effective in relieving symptoms for these two adolescent. Both of them needed surgical interventions such as core decompression or joint replacement to improve pain and restore function. Overall, the patient experienced significant improvement in their shoulder, hip, and elbow function and mobility after surgery. Their scores in all assessment tools increased, indicating a successful outcome of the surgical intervention. Joint osteonecrosis in adolescents presents a significant treatment challenge, but with a multidisciplinary approach that includes conservative management, surgical interventions, and medication therapy, successful outcomes can be achieved. Further research is needed to better understand the underlying causes of joint osteonecrosis and to develop more targeted treatment options.

INTRODUCTION: ACL avulsion fractures are not a common pathology. Many arthroscopic techniques and devices have been used. The purpose of this study was that we use arthroscopic transosseous equivalent fixation without damage of physis. We thought that this technology can even be used on adults and adolescents without damage of physis. METHODS: From June 2016 and November 2019, nine patients who underwent arthroscopic transosseous equivalent fixation for ACL avulsion fracture and were
followed more than one year. There were 4 males and 5 females with an average age of 20 years. All patient treated in acute stage. We also obtained kneeling stress radiographs of the affected and unaffected knee to evaluate the laxity after operation. We also evaluate clinical testing. International Knee Documentation Committee scores, and the Lysholm Knee score were also recorded. RESULTS: Pre-operative Lachman and anterior drawer tests were positive under anesthesia. Post-operative X-ray films showed that all fractures healed between 6 weeks to 3 months. Lachman and anterior drawer tests were negative after operation. At 1-year after surgery, the kneeling stress view showed no significant difference
between affected and unaffected knee. Lysholm knee score and IKDC also showed excellent in most people. CONCLUSION: Our study showed that arthroscopic transosseous equivalent fixation is an effective technique with several advantages, such as fracture healing, minimal invasive, and good fixation. Besides, there is no need to remove implant again. The most important is that this technology can even be used on adults and adolescents
without damage of physis.