Purpose: Surgical options for long head of the biceps tendon (LHBT) lesions include tenotomy and tenodesis. This study aims to determine the optimal surgical strategy for LHBT lesions with updated evidence from randomised controlled trials (RCTs). Methods: Literature was retrieved from PubMed, Cochrane Library, Embase and Web of Science on 12 January 2022. Randomised controlled trials (RCTs) comparing the clinical outcomes of tenotomy and tenodesis were pooled in the meta-analyses. Results: Ten RCTs with 787 cases met the inclusion criteria, and were included in the meta-analysis. Constant scores (MD, −1.24; p = 0.001), improvement of Constant scores (MD, −1.54; p = 0.04), Simple Shoulder Test (SST) scores (MD, −0.73; p = 0.03) and improvement of SST (p < 0.05) were significantly better in patients with tenodesis. Tenotomy was associated with higher rates of Popeye deformity (OR, 3.34; p < 0.001) and cramping pain (OR, 3.36; p = 0.008]. No significant differences were noticed between tenotomy and tenodesis regarding pain (p = 0.59), American Shoulder and Elbow Surgeons (ASES) score (p = 0.42) and its improvement (p = 0.91), elbow flexion strength (p = 0.38), forearm supination strength (p = 0.68) and range of motion of shoulder external rotation (p = 0.62). Subgroup analyses showed higher Constant scores in all tenodesis types and significantly larger improvement of Constant scores regarding intracuff tenodesis (MD, −5.87; p = 0.001). Conclusions: According to the analyses of RCTs, tenodesis better improves shoulder function in terms of Constant scores and SST scores, and reduces the risk of Popeye deformity and cramping bicipital pain. Intracuff tenodesis might offer the best shoulder function as measured with Constant scores. However, tenotomy and tenodesis provide similar satisfactory results for pain relief, ASES score, biceps strength and shoulder range of motion.

Objective: The Ligs Digital Arthrometer is a recently launched versatile arthrometer that can be used for the quantitative assessment of knee and ankle joint laxity. This study aimed to evaluate the validity of the Ligs Digital Arthrometer for the diagnosis of complete anterior cruciate ligament (ACL) ruptures at different loads.Materials and Methods: From March 2020 to February 2021, we included 114 normal subjects and 132 subjects diagnosed with complete ACL ruptures by magnetic resonance imaging (MRI) and eventually confirmed by arthroscopy in the study. Anterior knee laxity was independently measured by the same physical therapist using the Ligs Digital Arthrometer. Recorded anterior knee laxity and calculated the side-to-side difference (SSD) at 30, 60, 90, 120, and 150 N loads, respectively. The receiver operating characteristic (ROC) curve was used to determine the optimal laxity threshold, and the diagnostic value was evaluated by the area under the curve (AUC).Results: The demographic data of the subjects were comparable between the two groups (p &gt; 0.05). The mean values of anterior knee laxity measured by the Ligs Digital Arthrometer between the complete ACL ruptures group and the control group were significantly different at 30, 60, 90, 120, and 150 N loads (p &lt; 0.001 for all). According to the results of ROC curve analysis, the optimal laxity threshold for the diagnosis of complete ACL ruptures was 1.1 mm SSD (Se = 66.7%, Sp = 69.3%) at 30 N, 1.3 mm (Se = 74.2%, Sp = 82.5%) at 60 N, 1.6 mm (Se = 79.5%, Sp = 94.7%) at 90 N, 1.9 mm (Se = 84.1%, Sp = 92.1%) at 120 N and 2.1 mm (Se = 85.6%, Sp = 91.2%) at 150 N. The AUC order at different loads from high to low was 150 N (0.948 [0.923–0.973])&gt;120 N (0.933 [0.903–0.963])&gt;90 N (0.902 [0.862–0.943])&gt;60 N (0.846 [0.799–0.893])&gt;30 N (0.720 [0.657–0.783]).Conclusion: The Ligs Digital Arthrometer proved to be of high diagnostic value in complete ACL ruptures at 90 N, 120 N, and 150 N loads. The diagnostic value improved with the increase of load in a certain range. Based on the results of this study, as a portable, digital and versatile new arthrometer, the Ligs Digital Arthrometer was a valid and promising tool for diagnosing complete ACL ruptures.

Background Knee arthroscopic arthrolysis serves as an effective treatment for knee arthrofibrosis. However, hemarthrosis is the most common complication in arthroscopic surgery, which has potential adverse effects on postoperative rehabilitation. The purpose of this study was to evaluate the effects of topical tranexamic acid (TXA) in knee arthroscopic arthrolysis. Methods A total of 87 patients with knee arthrofibrosis who underwent arthroscopic arthrolysis from September 2019 to June 2021 were eligible for this retrospective review. Patients in the TXA group (n = 47) received topical administration of TXA (50 mL, 10 mg/mL) at the end of the surgery, and patients in the control group (n = 40) received no TXA. The postoperative drainage volumes, hematologic levels, inflammatory marker levels, knee range of motion (ROM), visual analog scale (VAS) pain scores, Lysholm knee scores and complications were compared between the two groups. The curative effect of each group was calculated according to Judet’s criteria. Results The mean drainage volumes on postoperative day (POD) 1 and POD 2, and total drainage volume were significantly lower in the TXA group than in the control group (P < 0.001 for all). The TXA group had significantly lower postoperative CRP and IL-6 levels on POD 1 and POD 2, and at postoperative week (POW) 1 and POW 2 than the control group. The VAS pain scores in the TXA group were significantly lower on POD 1 and POD 2, and at POW 1 and POW 2 than those in the control group (P < 0.001 for all). Patients in the TXA group showed better postoperative ROM and Lysholm knee scores at POW 1 and POW 2. No patient had any complications such as deep venous thrombosis (DVT) or infection. The excellent and good rates of knee arthroscopic arthrolysis were comparable between the two groups at the sixth postoperative month (P = 0.536). Conclusions Topical administration of TXA in knee arthroscopic arthrolysis can reduce postoperative blood loss and inflammatory response, alleviate early postoperative pain, increase early postoperative knee ROM, and improve early postoperative knee function without increased risks.

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