Tsung-Lin Lee

Aims: Bernese periacetabular osteotomy (PAO) is a well-established procedure for symptomatic hip dysplasia in adolescents and young adults. Its application in middle-aged patients remains debated due to concerns regarding complications and uncertain outcomes. This study evaluated the safety and effectiveness of PAO in middle-aged patients by comparing minimum two-year outcomes with those of younger cohorts. Methods: We conducted a retrospective cohort study of patients who underwent PAO between June 2015 and December 2021 with a minimum two-year follow-up. Patients with previous hip surgery or systemic conditions affecting outcomes were excluded. The final cohort comprised 27 hips in 16 adolescents (Group A, 11 to 19 years), 24 hips in 18 young adults (Group B, 20 to 39 years), and 17 hips in 14 middle-aged adults (Group C, 40 to 57 years). Radiological parameters, complications, and patient-reported outcomes (PROs), including visual analogue scale (VAS) pain scores, and modified Harris Hip Score (mHHS), were compared among groups. Results: All age groups demonstrated significant improvements in radiological parameters and PROs. Median mHHS improved from 84.7 (IQR 84.7 to 84.7) to 95.7 (IQR 95.7 to 100) in Group A, 81.4 (IQR 75.9 to 84.7) to 95.7 (95.7 to 100) in Group B, and 73.7 (66.0 to 75.9) to 95.7 (90.2 to 100) in Group C. No significant between-group differences in radiological parameters or PROs were observed at final follow-up. Complication rates were comparable across groups except for osteotomy site healing. The middle-aged group demonstrated longer osteotomy union times than the adolescent and young adult groups (median 13 months (IQR 10 to 14) vs six months (IQR 6 to 11) vs six months (IQR 5 to 7); (p < 0.001). Delayed union did not adversely affect functional outcomes or rehabilitation. Conclusion: Carefully selected middle-aged patients with hip dysplasia demonstrated favourable radiological and functional outcomes after PAO despite longer osteotomy union times, with complication rates comparable with younger cohorts. These findings support the safety and effectiveness of PAO in selected middle-aged patients with dysplasia-associated Tönnis grade I to II osteoarthritis. Cite this article: Bone Jt Open 2026;7(9):1204–1214.

Meniscal preservation is increasingly recognized as a critical determinant of long-term knee joint health, yet successful repair remains challenging due to the meniscus’s limited intrinsic healing capacity. The adult meniscus is characterized by restricted vascularity, low cellularity, a dense extracellular matrix, complex biomechanical loading, and a hostile post-injury intra-articular inflammatory environment—factors that collectively impair meniscus healing, particularly in the avascular zones. Over the past several decades, a wide range of biologic augmentation strategies have been explored to overcome these barriers, including synovial abrasion, fibrin clot implantation, marrow stimulation, platelet-derived biologics, cell-based therapies, scaffold coverage, and emerging biologic and biophysical interventions. This review summarizes the biological basis of meniscal healing, critically evaluates current and emerging biologic augmentation techniques, and integrates these approaches within a unified framework of vascular, cellular, matrix, biomechanical, and immunologic targets. Understanding and modulating the cellular and molecular mechanisms governing meniscal degeneration and repair may enable the development of more effective, mechanism-driven strategies to improve healing outcomes and reduce the risk of post-traumatic osteoarthritis.

Background: There are several possible links that have been used to claim that osteoporosis and peripheral artery disease (PAD) are associated; however, the solid evidence is not sufficient. This study aimed to use the Taiwan National Health Insurance Research Database (NHIRD) to determine if osteoporosis is associated with peripheral artery disease (PAD). Method: NHIRD records from 23 million patients were collected to recruit two matched cohort groups: 64,562 patients with and 64,562 patients without osteoporosis. To compare the crude hazard ratio (HR) and the incidence rate ratio between the two cohort groups for PAD, the Cox model was used. Result: With an adjusted HR of 1.18 (95% CI, 1.08–1.29), the osteoporosis cohort group had a significantly greater risk for PAD than the group without osteoporosis. The cumulative incidence of PAD in the cohort group was also statistically higher than it was in the group without osteoporosis (1.71% and 1.39%; p ≤ 0.0001, log-rank) over the 10-year follow-up period. In addition, the osteoporotic patients with ischemic stroke, chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF) had a significantly increased risk of PAD based on subgroup analysis. Conclusions: There was a positive association between osteoporosis and the development of PAD, as patients with osteoporosis had an increased incidence of PAD over time.