Weihong Zhu

Tissue regeneration is an energy‐demanding process that requires adequate ATP production to support cellular proliferation, biosynthesis, and tissue remodeling. Under pathological and age‐related conditions, bioenergetic deficits impair intrinsic regenerative capacity by disrupting mitochondrial function, redox homeostasis, and anabolic signaling. Although conventional scaffold‐ and cell‐based bioengineering strategies have advanced regenerative medicine, they generally do not directly address the metabolic dysfunction that limits tissue repair. Recently, bioenergetic materials (BEMs) have emerged as a novel class of biomaterials engineered to modulate cellular metabolism in situ. By supplying tricarboxylic acid (TCA) cycle intermediates, delivering metabolic enzymes, or incorporating oxygen‐releasing and energy‐harvesting components, BEMs replenish cellular ATP, restore redox balance, and activate anabolic signaling pathways that support tissue regeneration. In this review, we classify BEMs according to their principal mechanisms of action and summarize recent advances in their application to bone, cartilage, skin, and neural tissue repair. We further discuss the major challenges to clinical translation and highlight future opportunities for integrating metabolic modulation with advanced fabrication techniques and smart, feedback‐regulated biomaterial systems. By reshaping the local metabolic microenvironments, BEMs represent a promising strategy to enhance tissue regeneration in pathological settings characterized by mitochondrial dysfunction, redox imbalance, inflammation, and insufficient energy supply.

Tunnel enlargement is a common challenge in revision anterior cruciate ligament reconstruction and compromises graft fixation and biological integration. Traditional 2‐stage revision procedures prolong treatment duration and increase patient morbidity. We describe a technique using autologous cancellous bone harvested from the ipsilateral iliac crest to restore femoral and tibial tunnel bone stock after anterior cruciate ligament reconstruction failure. This technique focuses on managing tunnel enlargement and prepares the tunnels for subsequent anterior cruciate ligament revision. Arthroscopic impaction of autologous bone restores tunnel geometry and provides a favorable biological environment for fixation. In selected patients, this approach may shorten rehabilitation time and eliminate the need for staged surgery.

Recurrent patellar dislocation is a common condition in young and active individuals, with medial patellofemoral ligament (MPFL) injury being the primary pathological factor in most cases. Anatomic double‐bundle MPFL reconstruction has been established as an effective treatment for patellar instability; however, the optimal fixation method remains a matter of debate. Conventional techniques often employ suture anchors and interference screws for patellar and femoral fixation, which may require larger medial incisions, compromise the extensor mechanism, and increase the risk of bone tunnel fracture or graft laceration because of screw divergence. To overcome these limitations, we describe an MPFL reconstruction technique using dual adjustable‐loop cortical button fixation on both the femoral and patellar sides. This approach provides suspensory fixation with a minimal implant, preserves bone stock and soft‐tissue integrity, and enables controlled graft tensioning under arthroscopic visualization. This technique represents an alternative to traditional anchor‐ or screw‐based MPFL reconstruction methods.

Posterior shoulder dislocation is often accompanied by a reverse Hill‐Sachs lesion that may engage the posterior glenoid rim and drive recurrent instability. Lesions involving >25% of the humeral articular surface frequently require surgery. We describe an all‐arthroscopic, joint‐preserving technique that combines humeral reconstruction with posterior stabilization. A curved iliac‐crest corticocancellous bone block is inlaid to restore the humeral defect and fixed with suture anchors using a double‐pulley compression construct. Anterior capsular soft‐tissue compression is added extra‐articularly to augment stability. In the same setting, the posterior labrum‐capsuloligamentous complex is repaired with suture anchors to re‐establish glenoid containment. This single‐stage approach addresses both bony and soft‐tissue pathology to prevent engagement and preserve native joint function.

Charcot arthropathy of the shoulder is a rare destructive joint disorder that is most commonly secondary to syringomyelia and often leads to osteolysis of the shoulder joint and severe upper limb dysfunction. The diagnostic and therapeutic challenges of this condition lie not merely in identifying joint destruction, but in the nonspecific nature of its early clinical manifestations, which may mimic infection, tumor, or inflammatory arthropathy. In addition, the extent of bone destruction in the glenoid and humeral head may vary considerably, making conventional imaging descriptions insufficient for preoperative assessment and treatment decision-making. The neuropathic gleno-humeral degeneration (NGH) classification independently evaluates the degenerative changes of the glenoid and humeral head on imaging. This classification helps reduce ambiguity in radiographic descriptions and provides a reference for clinical surgical decision-making. Current evidence suggests that the management of Charcot arthropathy of the shoulder should be based on comprehensive assessment: Radiography may be used for initial diagnosis with assistance from the NGH classification; magnetic resonance imaging can evaluate soft tissue conditions and related abnormalities; and computed tomography with three-dimensional reconstruction is useful for quantifying bone defects and planning prosthetic implantation. In patients with swelling, joint effusion, elevated inflammatory markers, or planned surgery, joint aspiration and biopsy should be considered to exclude infection, tumor, and inflammatory joint diseases. For patients whose joint destruction has entered a quiescent phase, shoulder arthroplasty and other surgical procedures may be considered. In the future, multi-center and prospective cohort studies, and long-term follow-up are still needed to further validate the clinical value of NGH classification and clarify the long-term efficacy of shoulder replacement surgery.

Avulsion fracture of the ischial tuberosity is an uncommon injury caused by a sudden, forceful eccentric contraction of the hamstrings that avulses the unfused secondary ossification center from the pelvis. Although open reduction and internal fixation are recommended when fragment displacement exceeds 2 cm, reports describing minimally invasive solutions are still lacking. In addition, for those patients who are engaged in high‐intensity sports or physical activities, conservative treatment can compromise hamstring power, delay return to sport, and occasionally result in chronic ischial pain. To address these limitations, we describe an arthroscopic “double‐pulley” suture anchor fixation technique for avulsion fracture of the ischial tuberosity with 6‐mm displacement. This approach reduces soft tissue trauma through minimally invasive access and avoids secondary surgeries for implant removal, potentially reducing recovery time and improving patient outcomes. Technique Video: video See video under supplementary data.

Acromioclavicular joint separation is a common shoulder injury that interferes with normal shoulder function. There are various surgical treatment methods for acromioclavicular joint separation; however, no consensus on the gold‐standard technique has been established. Therefore, we describe an all‐arthroscopic technique using double adjustable loops and triple‐button fixation. This method achieves anatomic reconstruction of the coracoclavicular ligament complex to provide a reliable surgical option for the treatment of acromioclavicular joint separation. Technique Video: video See video under supplementary data.

Patellar tendon rupture is an uncommon injury that usually requires surgical repair, but no consensus exists regarding the ideal repair technique. Suture anchor repair and the transosseous suture method have be widely used, but the suture anchor technique may cause anchor pull-out, while the transosseous suture method may result in insufficient suture strength. Therefore, we propose and evaluate the efficacy of combined repair technique with two suture anchors and three transosseous sutures for patellar tendon repairs. We conducted a retrospective cohort study of patients who received surgery for acute patellar tendon rupture at the inferior pole of the patella between January 2016 and December 2020. All patients underwent a standardized integrated knee extensor mechanism combined repair technique by the same surgeon with 2 suture anchors and 3 transosseous sutures. Radiology, complications, and patient-reported outcomes were recorded. Clinical outcomes were measured using range of motion (ROM), patient satisfaction, Visual Analog Scale (VAS) pain scores, Knee Society Function Score (KSS-F), International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner score. Totally 40 patients were enrolled with an average age of 33.95 years. Mean follow-up duration was 60 months (range: 36 to 72 months). The risk of complications was 7.5% (3/40). Mean ROM improved from 45.65 ± 10.66 preoperatively to 127.25 ± 3.99 postoperatively (mean ± SD, p < 0.001). Mean postoperative VAS pain score, KSS-F score, IKDC score, Lysholm score and Tegner score significantly improved (p < 0.001). The Caton Deschamps Index (CDI) significantly decreased from 1.74 ± 0.19 preoperatively to 1.11 ± 0.06 postoperatively (p < 0.001). Postoperative MRI revealed evident healing between the patellar tendon and the inferior pole of the patella. The combined repair technique demonstrated reliable mid-term outcomes with satisfactory functional recovery, radiological healing, and a low complication rate. This technique may serve as a practical and effective option for proximal patellar tendon ruptures.

Background: Posterior cruciate ligament (PCL) injury is a relatively common musculoskeletal condition. However, there is currently a lack of consensus on decision-making, treatment and postoperative management for such injuries. Objectives: To use the modified Delphi method to reach expert consensus on the management of PCL injury. Methods: A literature search of PubMed, Cochrane Library, Embase, and Web of Science for articles up to 17 October 2024, to support the development of recommendation statements. An Expert Panel of 90 experienced clinicians from orthopedics and sports medicine participated in a two-round Delphi process. Each statement was evaluated in two parts: the first part assessed content appropriateness (score of 7–9 indicating appropriateness and 4–6 indicating possible appropriateness), while the second part assessed agreement (score of 5–9 indicating agreement). Results: The panel members developed 11 statements using the Delphi process, addressing the following topics: (1) clinical decision-making, (2) treatment, and (3) postoperative management about PCL injuries. The final consensus was reached on 11 statements and we eventually translated these statements into a corresponding table of expert recommendations. Conclusion: Consensus was reached on 11 statements regarding three aspects of PCL injury management. These findings provide a foundation for developing evidence-based guidelines that can enhance clinical decision-making, improve treatment strategies, and optimize postoperative care for patients with PCL injuries.