A Randomized Comparison Between Anterior Talofibular Ligament Repair Using Broström Operation with and without an Internal Brace.

The aim of the study was to compare the intermediate-term (>24 months) clinical outcomes between anterior talofibular ligament repair using Broström operation with and without an internal brace. Nineteen patients underwent surgery using an arthroscopic traditional Broström repair with an internal brace technique (IB) and Eighteen patients underwent surgery using an arthroscopic traditional Broström repair without an internal brace technique (TB) . All patients were evaluated clinically using the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). According to FAAM, sports activity scores of TB and IB groups were 83.33 ± 5.66 and 90.63 ± 6.21 at the final follow-up (p = .02). There were no significant differences in preoperative and postoperative stress radiographs between the two groups. Total medical expense was more in the IB group (p < .001). It also has a significant superiority in the terms of FAAM scores at sports activity. However, there was no difference during daily life.

Mid-term prognosis of endoscopic debridement combined with percutaneous cutaneo-fascial suture for the treatment of Morel-Lavallée lesion: a minimum 3-year follow-up study.

PURPOSE: Morel-Lavallée lesion (MLL) is a closed soft-tissue degloving injurie resulting from shear forces. With the advent of endoscopic technology and advancements in surgical techniques, innovative solutions are now available. However, there are few data on mid-term results after treatment of MLL, especially regarding arthroscopic method. The objective of this study is to evaluate the clinical outcomes of endoscopic debridement combined with percutaneous cutaneo-fascial suture in treating MLL. METHODS: A single-center retrospective study was conducted at a university teaching hospital investigating patients who underwent arthroscopic management of Morel-Lavallée lesion between 2014 and 2020.Patient demographics, postoperative recovery time, peri- and postoperative complications were investigated. Mid-term follow up clinical and radiological examinations were performed. RESULTS: The retrospective study included 38 patients aged between 11 and 90 years, with an average age of 50.9 ± 16.9 years. These patients waited an average of 36.6±23.5days to return to work after operation. The average time to follow-up was from 3 to 9 years, averaging 5.0 ± 1.8 years. At the end of follow-up, only one complication of superficial skin necrosis occurred, accounting for 2.6%. The imaging assessment at the final follow-up indicated improvement over the postoperative period for all 38patients. CONCLUSION: In mid-term experience, endoscopic debridement combined with percutaneous cutaneo-fascial suture for MLL management is a safe and effective option.

Functionally Tailored Metal-Organic Framework Coatings for Mediating Ti Implant Osseointegration.

Owing to their mechanical resilience and non-toxicity, titanium implants are widely applied as the major treatment modality for the clinical intervention against bone fractures. However, the intrinsic bioinertness of Ti and its alloys often impedes the effective osseointegration of the implants, leading to severe adverse complications including implant loosening, detachment, and secondary bone damage. Consequently, new Ti implant engineering strategies are urgently needed to improve their osseointegration after implantation. Remarkably, metalorganic frameworks (MOFs) are a class of novel synthetic material consisting of coordinated metal species and organic ligands, which have demonstrated a plethora of favorable properties for modulating the interfacial properties of Ti implants. This review comprehensively summarizes the recent progress in the development of MOF-coated Ti implants and highlights their potential utility for modulating the bio-implant interface to improve implant osseointegration, of which the discussions are outlined according to their physical traits, chemical composition, and drug delivery capacity. A perspective is also provided in this review regarding the current limitations and future opportunities of MOF-coated Ti implants for orthopedic applications. The insights in this review may facilitate the rational design of more advanced Ti implants with enhanced therapeutic performance and safety.

[Experimental study on improving stability of anchor by adding anchor].

OBJECTIVE: To explore whether anchor placement could improve holding force of anchors under the condition of osteoporosis, in order to solve the problem of clinical treatment for rotator cuff injury associated with osteoporosis. METHODS: Twenty one bone modules, which included 13 males and 8 females aged from 60 to 95 years old with an average of (77.6±10.3) years old, and were divided into three experimental groups named as group A, B and C, and 7 in each group. A single anchor was inserted in group A, two parallel anchors were screwed in group B, and a single anchor was screwed in group C, then after the anchor was pulled out, anchor was screwed back and another anchor was screwed in close to the anchor. X-ray examination was performed in all three groups to observe situation of anchor in osteoporosis module; the maximum axial pull-out force (Fmax) of the three groups was measured. RESULTS: Fmax of group A, B and C was (170.35±31.21) N, (314.47±23.47) N, and(292.74±25.36) N, respectively. Compared with group A, there were statistical difference of Fmax in group B and C(P<0.05), while no difference of Fmax between group B and C(P>0.05). CONCLUSION: In the case of loose anchors in the osteoporosis module, holding force of anchors could be improved by adding anchor, which provide a remedy for single anchor failure in clinical operation.

[Anatomical study on reconstruction of calcaneus fibula ligament].

OBJECTIVE: To measure anatomical data of calcaneofibular ligament (CFL), relevant data of CFL attachment to provide an anatomical basis for CFL reconstruction. METHODS: Twenty-seven adult ankle specimens were selected, including 11 males and 16 females, aged from 22 to 71 years old with an average of (41.6±17.2) years old;9 cases on the left side and 18 cases on the right side. The specimens reserved at least 20 cm above ankle joint and a complete foot, and exclude deformities, fractures, incomplete development and degenerative lesions. CFL was performed detailed anatomical observation, morphological parameters of CFL was measured, and coordinates of fibula side and calcaneal side of CFL in the coordinate axis were measured. The distance between fibula insertion of CFL and fibula tip, distance between calcaneal insertion of CFL and lateral calcaneal nodule, and Angle between CFL and long axis of fibula were also measured. RESULTS: In these 27 specimens, CFL cases were all single bundles and the length of CFL was (32.83 ± 8.19) mm. The center point of fibula attachment in CFL was(2.87± 1.21) mm proximal with a coefficient of variation of 42.16% and (2.08±1.34) mm anteriorly with a coefficient of variation of 64.42%. The center point of calcaneal attachment region of CFL was located on coordinate axis on the distal end (15.32±5.33) mm, with a coefficient of variation of 34.79%, and the posterior part (6.38±2.15) mm, with a coefficient of variation of 33.86%. The distance between center point of fibula attachment and fibula tip was (4.81±0.82) mm. The distance between center point of calcaneal attachment area of CFL and lateral calcaneal nodules was(17.25±3.12) mm. Angle between CFL and fibula axis is (43 ±18)° . CONCLUSION: According to anatomical studies, we could locate the fibula and calcaneal attachment of CFL by anatomical markers around ankle joint. However, the location of CFL attachment has a large variation, and the anatomical characteristics need to be considered in anatomical reconstruction.

Anatomical Study on the Reconstruction of the Anterior Talofibular Ligament.

The purpose of this study aimed to (1) identify the relationship between the fibula and the talus of the anterior talofibular ligament (ATFL); (2) collect detailed anatomical data and provide anatomical basis for ATFL anatomical reconstruction. We selected 27 ankle specimens of adult cadavers (9 left feet and 18 right feet in 11 males and 16 females; mean age 41.6 years) with the exception of ankle deformities, fractures, underdevelopment and degenerative diseases. In these 27 specimens,15 cases of ATFL were divided into two bundles and 12 cases of ATFL were single bundles. The average ATFL length was 20.31 ± 3.12mm. The center of the ATFL in 11 specimens was located in the calcaneofibular ligament (CFL) foot print area. The long axis of the fibula side stop point was 8.83±1.82 mm, and the short axis was 3.12±0.49 mm. The distance from the center of the ATFL fibula attachment area to the tip of the fibula was 14.22±2.87 mm, and the distance from the center of the CFL is 5.57±1.80mm. The distance from the center of the ATFL talar attachment area to the tibiotalar articular surface was (9.74±2.12) mm, and the distance from the anterior external cartilage surface of the talus was (4.87±1.82) mm. The angle between ATFL and the long axis of the fibula is 78°±12°. Our results suggest that in ATFL reconstruction, the anatomical attachment points around the ATFL or the angle between ATFL and the long axis of the fibula both can be used for bone canal positioning.

bFGF alleviates diabetes-associated endothelial impairment by downregulating inflammation via S-nitrosylation pathway.

Protein S-nitrosylation is a reversible protein modification implicated in both physiological and pathophysiological regulation of protein function. However, the relationship between dysregulated S-nitrosylation homeostasis and diabetic vascular complications remains incompletely understood. Here, we demonstrate that basic fibroblast growth factor (bFGF) is a key regulatory link between S-nitrosylation homeostasis and inflammation, and alleviated endothelial dysfunction and angiogenic defects in diabetes. Subjecting human umbilical vein endothelial cells (HUVECs) to hyperglycemia and hyperlipidemia significantly decreased endogenous S-nitrosylated proteins, including S-nitrosylation of inhibitor kappa B kinase ß (IKKßC179) and transcription factor p65 (p65C38), which was alleviated by bFGF co-treatment. Pretreatment with carboxy-PTIO (c-PTIO), a nitric oxide scavenger, abolished bFGF-mediated S-nitrosylation increase and endothelial protection. Meanwhile, nitrosylation-resistant IKKßC179S and p65C38S mutants exacerbated endothelial dysfunction in db/db mice, and in cultured HUVECs subjected to hyperglycemia and hyperlipidemia. Mechanistically, bFGF-mediated increase of S-nitrosylated IKKß and p65 was attributed to synergistic effects of increased endothelial nitric oxide synthase (eNOS) and thioredoxin (Trx) activity. Taken together, the endothelial protective effect of bFGF under hyperglycemia and hyperlipidemia can be partially attributed to its role in suppressing inflammation via the S-nitrosylation pathway.

MicroRNA-187 suppresses the proliferation migration and invasion of human osteosarcoma cells by targeting MAPK7.

PURPOSE: Osteosarcoma is one of the rare but fatal malignancies. The high metastatic rate, late diagnosis, emergence of drug resistance against drugs such as doxorubicin, and the lack of therapeutic targets obstructs the treatment of osteosarcoma. This study was undertaken to investigate the role and therapeutic potential of miR-187 in human osteosarcoma cells. METHODS: The WST-1 proliferation assay was used for investigation of cell viability. Transfections were carried out by Lipofectamine 2000 reagent. The qRT-PCR was used for expression analysis. DAPI, acridine orange (AO)/ethidium bromide (EB) and Annexin V/propidium iodide (PI) assay were used for apoptosis. Western blot analysis was used for the determination of protein expression. RESULTS: The expression of miR-187 was significantly downregulated in human osteosarcoma cells. Out of all osteosarcoma cell lines the SAOS-2 showed the lowest expression of miR-187 and therefore this cell line was selected for further studies. Overexpression of miR-187 caused significant inhibition in the proliferation of SAOS-2 osteosarcoma cells. The miR-187-triggered growth inhibition was found to be mainly due to induction of G2/M phase cell cycle arrest of the SAOS-2 cells. The G2/M cell cycle arrest was also accompanied by depletion of Cyclin-B1 expression. Additionally, miR-187 enhanced the chemosensitivity of the osteosarcoma cells to doxorubicin. The wound healing and transwell assay showed that miR-187 overexpression resulted in the suppression of migration and invasion of the SAOS-2 osteosarcoma cells. In silico analysis showed that miR-187 exerts its effects by inhibiting mitogen activated protein kinase 7 (MAPK7). The expression of MAPK7 was found to be significantly upregulated in osteosarcoma cells and overexpression of MAPK7 could nullify the effects of miR-187 on the proliferation of the osteosarcoma cells.

[Anatomical measurement of root attachments of the menisci].

OBJECTIVE: To measure anatomical data of anterior and posterior root attachments of the medial and lateral menisci for reconstruction of root tears. METHODS: Thirty cadaveric knee joints of human were chosen, including 16 males and 14 females, death age ranged from 35 to 68 years old with an average age of (55.6±7.8) years old. Structure of root attachments of the menisci was dissected and observed, then areas of the attachments and the distances from the centers of the attachments of each structure to specific landmarks were measured. These landmarks were medial tibial eminence apex, lateral tibial eminence apex, the anterior edge of posterior cruciate ligament (PCL), lateral margin of cartilage of medial tibial plateau, medial margin of cartilage of lateral tibial plateau. RESULTS: The attachment of posterior root of medial meniscus: the central point was located on posterior about (11.73±3.10) mm and lateral about (2.77±0.86) mm to the medial tibial eminence apex; anterior about (2.76±0.76) mm to the anterior edge of PCL; lateral about (3.92±0.22) mm to lateral margin of cartilage of medial tibial plateau; the area of the attachment was (31.29±5.18) mm2 . The central point of attachment of anterior root of medial meniscus was located on anterior about (25.40±5.27) mm and lateral about (3.01±0.86) mm to the medial tibial eminence apex, and the attachment area was (46.18±11.60) mm2. The attachment of posterior root of lateral meniscus: the central point was located on posterior about (4.51 ±1.35) mm and medial about (1.85±0.34) mm to lateral tibial eminence apex; anterior about (6.91± 1.11) mm to the anterior edge of PCL; medial about (3.16±0.96) mm to medial margin of cartilage of lateral tibial plateau; and the area of attachment was (44.10±6.23) mm2. The central point of attachment of anterior root of lateral meniscus was located on anterior about (12.97±2.92) mm and lateral about (1.31 ±0.22) mm to the lateral tibial eminence apex, and the attachment area was (60.84±14.98) mm2. CONCLUSION: The study quantitatively describes the area of the attachments of the anterior and posterior roots of the medial and lateral menisci as well as the relationship between central points and corresponding landmarks, which could provide some anatomical reference for clinical repair of roots injury of menisci.

[A comparative study of the curative effect of proximal fibular osteotomy and single condylar replacement for the treatment of knee osteoarthritis of different severity].

OBJECTIVE: To compare the clinical effect of proximal fibular osteotomy (PFO) and single condyle replacement (UKA) in the treatment of knee osteoarthritis of different severity. METHODS: From June 2015 to September 2017, 53 patients with knee osteoarthritis were analyzed retrospectively. According to the operation mode, they were divided into PFO group (26 cases) and UKA group (27 cases) . According to Kellygren-Lawrence imaging classification standard：PFO group, 5 cases of gradeⅡ, 11 cases of grade Ⅲ, 10 cases of grade Ⅳ; UKA group, 7 cases of gradeⅡ, 9 cases of grade Ⅲ, 11 cases of grade Ⅳ. The amount of intraoperative bleeding, operation time and postoperative hospital stay were compared between the two groups. The patients were followed up regularly in the outpatient clinic before operation, 3 months after operation and 1 year after operation. The WOMAC score and the angle of tibiofemoral angle at each time point in the same group were compared, and the OMAC score and the angle of tibiofemoral angle at each time between the two groups were compared. RESULTS: Fifty-three patients were followed up for 12 to 24 (16.6±4.8) months. Compared with UKA group, PFO group had less intraoperative bleeding, shorter operative time and shorter postoperative hospital stay (P<0.05) . The scores of pain, stiffness and body function in UKA group were better than those in PFO group (P<0.05) . After 3 months and 1 year, the WOMAC index in PFO group was significantly improved (P<0.05) ; after 3 months and 1 year, the WOMAC index in UKA group was significantly better than that in PFO group (P<0.05) ; after 3 months, the WOMAC index in PFO group was significantly better than that in UKA group (P<0.05) . The tibiofemoral angle of gradeⅡand Ⅲ patients in both groups decreased gradually (P<0.05) ; the tibiofemoral angle of grade Ⅳ patients in UKA group was smaller than that of grade Ⅳ patients in PFO group (P<0.05) . CONCLUSION: Compared with UKA, PFO has the advantages of small trauma, fast recovery and low cost. The curative effect of PFO is equal to or more than UKA in the patients with gradeⅡand Ⅲ knee osteoarthritis. It is an alternative surgical method for the treatment of knee osteoarthritis.

[Effect of perioperative dexamethasone on nausea, vomiting and pain after total knee arthroplasty].

OBJECTIVE: To investigate the effect of perioperative dexamethasone on nausea, vomiting and pain after unilateral total knee arthroplasty and to evaluate its safety. METHODS: From February 2014 to June 2016, 100 patients with unilateral advanced osteoarthritis treated by total knee arthroplasty were divided into two groups: 50 patients in dexamethasone group including 27 males and 23 females, aged (72.30±7.02) years, were given intravenous drip of dexamethasone 10 mg before operation; 50 patients in saline group, including 26 males and 24 females, aged (71.30±6.08) years, were given the same amount of saline at the corresponding time. The VAS scores of pain at rest and at 45 degrees of knee flexion were recorded at 2, 4, 6, 8, 12, 24, 36 and 48 h after operation. Vomiting, antiemetic drugs and opioids were recorded at 0 to 24 h and 24 to 48 h after operation. The side effects and complications were recorded. RESULTS: All the 100 patients were followed up for an average of 14.5 months. VAS score of pain at rest in dexamethasone group was lower than that in saline group at 8, 24 and 48 h after operation (P<0.05); VAS score of dexamethasone group at 45 degrees after knee flexion was lower than that of saline group at 8 and 48 h after operation(P<0.05); VAS score of dexamethasone group at rest and 45 degrees after knee flexion was lower than that of saline group(P<0.05). The dosage of opioids and total opioids in dexamethasone group was lower than that in saline group at 0 to 24 h, 24 to 48 h after operation (P<0.05). The proportion of nausea and vomiting occurred at 0 to 24 h and 24 to 48 h after operation, and the proportion of antiemetic required at 0 to 24 h after operation had statistical significance between two groups(P<0.05). The total antiemetic dosage of dexamethasone group was less than that of saline group(P<0.05). As of the last follow-up, no complications such as infection, gastrointestinal ulcer and bleeding occurred in the two groups. CONCLUSIONS: Preoperative systemic application of dexamethasone can effectively reduce pain and nausea and vomiting after TKA without increasing postoperative complications.

[Finite element analysis of anterior ring injuries in unstable pelvic fractures treated by different methods].

OBJECTIVE: To compare the biomechanical stability of different fixation methods for anterior ring injury of unstable pelvic fractures, and to provide reference for clinical treatment. METHODS: An unstable pelvic fracture model (Tile C) with one side of the sacroiliac joint dislocation and the pubic rami fracture was constructed via three-dimensional finite element analysis. Five different fixation methods were used in the front, and the rear was fixed with sacroiliac screws. The von Mises stress and strain distributions of different combinations of fixation methods were analyzed under mimicking standing conditions. RESULTS: After being loaded with 500 N vertically, the maximum stress in the anterior fracture was 3.56 MPa in anterior pelvic external fixation (AEF) group, the total displacement and the vertical displacement of the Y axis at the sacroiliac joint and the fracture were not more than 1.5 mm. The maximum stress at fixation, the front of the fracture and sacroiliac joints in the anterior pelvic subcutaneous approach(APA) group and AEF, was significantly higher than anterior modified Stoppa approach(ASA) group, anterior pelvic Ilioinguinal approach (AIA) group, and canulated screw fixation(CSF) group. The total displacement and the vertical displacement of the Y axis at the sacroiliac joint and the fracture in APA group and AEF group were also greater than the other three groups. CONCLUSIONS: Anterior ring injury of unstable pelvic fractures can be significantly improved after the fixation of the implants in the five combined methods. However, overall biomechanical properties of ASA, AIA and CSF group are superior to APA and AEF group.

[Treatment for posterior root tear of lateral meniscus through bone tunnel suture under arthroscopy].

OBJECTIVE: To evaluate clinical effects of posterior root tear of lateral meniscus through bone tunnel suture under arthroscopy. METHODS: From January 2012 to December 2014, 23 patients with posterior root tear of lateral meniscus repaired through bone tunnel suture under arthroscopy, including 15 males and 8 females, aged from 19 to 48 years old with an average age of (25.0±4.7) years old; 10 knees on the left side and 13 knees on the right side. Complications were observed, Lysholm score before and after operation at 12 months were used to evaluate clinical results, and VAS score was applied to assess pain relief. MRI was used to check recovery outcomes of lateral meniscus injury. RESULTS: All patients were followed up from 13 to 24 months with an average of (17.0±4.3) months. No injury of vessels, nerve and incision infection occurred. Motion of knee joint of 19 patients reached normal, 4 patients manifested limited activity of knee joint at12 months after operation. Postoperative Lysholm score 88.52±6.48 at 12 months was higher than that of before operation 46.12±7.35; Postoperative VAS score 0.8±0.7 at 12 months was lower than that of before operation 4.3±1.6. CONCLUSIONS: Bone tunnel suture under arthroscopy for the treatment of posterior root tear of lateral meniscus could relieve pain, decrease postoperative complications and obtain good clinical efficacy.

[Treating intractable lateral epicondylitis by extracurricular arthroscopic operation based on pressure point].

OBJECTIVE: To evaluate clinical efficaly of intractable lateral epicondylitis by extracurricular arthroscopic operation based on pressure point. METHODS: From October 2015 to September 2017, 19 patients with intractable lateral epicondylitis were treated with extraarticylar arthroscopic operation based in pressure point. Among patients, including 7 males and 12 females, aged from 33 to 62 years old with an average of(43.16±8.12) years old, The courses of conservative treatment ranged from 7 to 41 months, with an average of(15.47±7.08) months. Postoperative complications were observed, VAS score and Mayo score before and after operation at 3 months were observed and compared. RESULTS: All patients were followed up from 6 to 26 months, with an average (17.16±5.25) months. No infection, skin necrosis and nerve injury occurred. No group weakness occurred within six months after operation. VAS score decreased from 4.42±1.17 before operation to 0.53±0.61 after operation at 3 months. Mago was improved from 62.63±7.88 before operation to 93.42±5.28 after operation at 3 months. According to Mayo score, 17 cases got excellent results, and 2 cases were good. CONCLUSIONS: Intractable lateral epicondylitis by arthroscopic extracurricular operation based on pressure point, which deal with main extracurricular root cause, could anatomical level is understand easily, field of vision is good and diseased tissue is cleaned up thoroughly, and has obvious curative effect.

[Treatment of obstinate tennis elbow by debridement and repair under elbow arthroscopy combined with small incision].

OBJECTIVE: To evaluate the effectivity and the improvement of elbow arthroscopic techniques of treating obstinate tennis elbow using debridement and repair under elbow arthroscopy combined with small incision. METHODS: From March 2014 to February 2017, 36 patients(total 36 elbows) with obstinate tennis elbow were treated consecutively using debridement and repair under elbow arthroscopy combined with small incision open, the two methods alternate. In key process, the first 18 cases [group A including 8 males and 12 females with an average age of (43.89±9.71) years old, the treatment time was(17.39±10.53) months] used direct-looking operation and arthroscopic verification, the latter 18 cases[group B including 7 males and 11 females with an averave age of (44.28±8.04) years old, the treatment time was(15.50±9.18) months] used arthroscopic operation and direct-looking verification. The arthroscopic and gross pathological findings were observed during the operation. After operation serious neurovascular complications were observed. The operation time was compared between two groups. MEPS (Mayo Elbow Performance Score) and VAS scores were recorded preoperatively and postoperatively. RESULTS: All patients were followed up for an average of (17.22±8.47) months in group A and (17.83±8.83) months in group B. There was 1 case of nerve injury without infection. VAS score was improved from preoperative 4.33±1.24 to postoperative 0.61±0.70 in group A, and from 4.50±1.47 to postoperative 0.67±0.69 in group B. MEPS of group A was improved from preoperative 62.22±7.90 to postoperative 93.06±5.18 in group A, and from preoperative 61.94±8.93 to postoperative 92.22±5.21 in group B. There were no statistical differences between two groups in MEPS and VAS score. The operation time in group B(54.06±8.43) min was less than that in group A(73.39±12.78) min. Thirty-two cases were satisfied greatly with treatment results, 3 cases satisfied, 1 case unsatisfied. The main reasons that results in dissatisfaction were nerve injury. CONCLUSIONS: Treating obstinate tennis elbow using debridement and repair under elbow arthroscopy combined with small incision have open and arthroscopic surgery advantages, with thorough therapeutic effect. The procedure is suitable to try to explore and improve the elbow arthroscopic technique.

[Biomechanical stability study on different internal fixation for acetabular fracture].

OBJECTIVE: To investigate the biomechanical stability of the acetabular fracture with three different internal fixation methods. METHODS: Sixteen both-column acetabular fracture models were randomly divided into three groups:The specimens of 16 hip joints were randomly divided into 4 groups. Among them, 1 group of complete acetabulum were used as normal control group, and the other 3 groups simulated two column fracture models and were fixed in the following methods, respectively: anterior wall with screw and posterior with plate(SP), anterior wall with plate and posterior wall with screw(PS) and both wall with plate (PP). The degree of fracture displacement and the contact characteristics of the acetabulum were recorded by continuous vertical loading. RESULTS: The mean longitudinal displacement under the load 800 N of SP, PS and PP three groups were (1.92±0.81), (2.09±1.13) and (3.44±0.75) mm, there was significant difference between SP and PP group (P=0.033). And the mean horizontal displacement of SP, PS and PP three groups were(0.63±0.33), (0.77±0.45) and (1.44±0.56) mm, there was significant difference between SP and PP group(P=0.047).Compared with normal control group in the acetabular area under the loading 800 N, the contact area of SP, PS and PP groups were increased by 6%, 9% and 27%, there was significant difference between PP and normal control group (P=0.027). Meanwhile, the mean stress of SP, PS and PP groups were increased by 4%, 29% and 39%, there was significant difference between PP and intact acetabulum group (P=0.003). CONCLUSIONS: Anterior column screw combined with posterior column plate has better biomechanical stability and contact characteristics than other two methods.

A Novel Surgical Technique for treatment of Morel-Lavallée Lesion: Endoscopic debridement combined with percutaneous cutaneo-fascial suture.

Morel-Lavallée lesions are rare, closed degloving soft tissue injuries in which the skin and subcutaneous tissues are traumatic separated from the underlying fascia. There is lack of consensus regarding optimal management of these lesions. After failure of conservative management, operative intervention is imperative. The purpose of this manuscript is to describe a minimally invasive endoscopic method for treatment of Morel-Lavallée Lesions, which achieves the goal of an open surgical debridement.

[Diagnostic value of MRI for posterior root tear of medial and lateral meniscus].

OBJECTIVE: To explore diagnostic value of MRI on posterior root tear of medial and lateral meniscus. METHODS: From January 2012 to January 2016, clinical data of 43 patients with meniscal posterior root tear confirmed by arthroscopy were retrospective analyzed, including 25 males and 18 females, aged from 27 to 69 years old with an average age of(42.5±8.3)years old;27 cases on the right side and 16 cases on the left side. MRI examinations of 43 patients with tear of posterior meniscus root confirmed by knee arthroscopies were retrospectively reviewed. MRI images were double-blinded, independently, retrospectively scored by two imaging physicians. Sensitivity, specificity and accuracy of MRI diagnosis of lateral and medial meniscus posterior root tear were calculated, and knee ligament injury and meniscal dislocation were calculated. RESULTS: Forty-three of 143 patients were diagnosed with meniscus posterior root tears by arthroscopy, including 19 patients with lateral tears and 24 patients with medial tears. The sensitivity, specificity and accuracy in diagnosis of posterior medial meniscus root tears for doctor A were 91.67%, 86.6% and 83.9% respectively, and for doctor B were 87.5%, 87.4% and 87.4%, 19 patients with medial meniscal protrusion and 2 patients with anterior cruciate ligament tear. The sensitivity, specificity and accuracy in diagnosis of posterior lateral meniscus root tears for doctor A were 73.7%, 79.9% and 79% respectively, and for doctor B were 78.9%, 82.3% and 82.5%, 4 patients with lateral meniscus herniation and 16 patients with cruciate ligament tear. Kappa statistics for posterior medial meniscus root tears and posterior lateral meniscus root tears were 0.84 and 0.72. CONCLUSIONS: MRI could effectively demonstrate imaging features of medial and lateral meniscal root tear and its accompanying signs. It could provide the basis for preoperative diagnosis of clinicians, and be worthy to be popularized.

Femoral tunnel positioning using an anteromedial technique for ACL reconstruction: A radiographic study with a cadaveric model.

BACKGROUND: We studied the anatomic positioning of the femoral tunnel during simulated anterior cruciate ligament reconstruction using an anteromedial portal approach in cadaveric models. METHODS: In thirty cadaveric human knee specimens, simulation of an arthroscopic anterior cruciate ligament reconstruction was performed and the femoral tunnel was drilled using an anteromedial portal. A Kirschner wire was passed into the tunnel and radiographs were obtained. These radiographs were then evaluated in the coronal and sagittal planes. Angles between the axis of the femoral tunnel and the joint line in the coronal plane (alpha, α) or the femoral long axis in the sagittal plane (beta, ß) were calculated for each specimen. The external aperture of the femoral tunnel was defined as the point of exit of the Kirschner wire from the lateral femoral cortex. This was evaluated relative to a prescribed rectangle and coordinate axis, with the radiographic quadrant method of Bernard, to assess the accuracy of femoral tunnel placement. RESULTS: The mean α in the coronal plane was 48.53∘, the mean ß in the sagittal plane was 32.23∘. All of the femoral tunnel external apertures were located outside of the rectangleCONCLUSION: We evaluated the positioning of the femoral tunnel and the external aperture of the femoral tunnel with the anteromedial portal technique. This study provides a reference standard to assess accurately femoral tunnel positioning on postoperative radiographs.