Factors influencing functional outcome of fractures of the anterior process of the calcaneus.

INTRODUCTION: Fractures of the anterior process of the calcaneus (APC) are easily overlooked in clinical practice. Most patients have good to excellent clinical outcome after conservative treatment, while some patients may have persisting symptoms and unfavorable functional outcomes. The aim of this study was to identify the risk factors associated with unfavorable functional outcome after conservative treatment in APC fractures. METHODS: All patients presenting with APC fractures and receiving conservative treatment from April 2019 to April 2020 were retrospectively assessed. The primary outcome measurement was the ankle joint function assessed using Karlsson Scoring System at 2 years post-injury. The risk factors associated with unfavorable functional outcomes (Karlsson score ≤ 80) were evaluated by logistic regression analysis. RESULTS: In total, 84 patients were included with a mean age of 40 years. 26 (31%) patients presented with unfavorable functional outcome at 2 years post-injury. In multivariate logistic regression, concomitant fractures of talonavicular (TN) joints and older age were significantly associated with unfavorable functional outcome (p<0.05). Patients with concomitant fractures of TN joints had an odds ratio of 3.623 for unfavorable functional outcome. The optimal cutoff age for an unfavorable outcome was ≥ 47.5 years, with an odds ratio of 5.010. CONCLUSION: Most patients with APC fractures achieved good to excellent results when treated conservatively. Attention should be paid to those with concomitant fractures of TN joints and with age ≥ 47.5 years, which might lead to unfavorable functional recovery. LEVEL OF EVIDENCE: IV; case series.

Fracture of the lateral process of the talus with associated deltoid ligament injury: a report of 2 cases.

BACKGROUND: Fractures of the lateral process of the talus (LTPF) are rare and only rarely are associated ligamentous injuries. The injury mechanism is commonly considered to be similar with ankle sprains, where excessive varus of the hindfoot leads to avulsion fractures of the lateral process of the talus. However, previous cadaveric studies have suggested that LTPF was more likely to be caused by eversion or external rotation force with dorsiflexion of the ankle. But no clinical evidence has been provided. CASE PRESENTATION: Two patients presented to the emergency department with ankle pain after ankle eversion or external rotation. Physical examination revealed tenderness and swelling on both medial and lateral sides of the ankles. Plain radiographs and computed tomography revealed LTPF and medial soft tissue swelling, and magnetic resonance imaging confirmed a discontinuity of the deltoid ligament in Case 1. Surgical exploration revealed rupture of the superficial layer of the deltoid ligaments with intact deep layer in both patients. Treatment included fixation of the lateral process of the talus with headless compression screws and repair of deltoid ligaments. Both patients achieved excellent clinical outcomes 1 year post injury. CONCLUSION: There are many possibilities of the injury mechanism of LTPF. These two cases provided clinical evidence that eversion or external rotation force, in addition to inversion, was also an important mechanism of LTPF.

Injectable stress relaxation gelatin-based hydrogels with positive surface charge for adsorption of aggrecan and facile cartilage tissue regeneration.

BACKGROUND: Cartilage injury and pathological degeneration are reported in millions of patients globally. Cartilages such as articular hyaline cartilage are characterized by poor self-regeneration ability due to lack of vascular tissue. Current treatment methods adopt foreign cartilage analogue implants or microfracture surgery to accelerate tissue repair and regeneration. These methods are invasive and are associated with the formation of fibrocartilage, which warrants further exploration of new cartilage repair materials. The present study aims to develop an injectable modified gelatin hydrogel. METHOD: The hydrogel effectively adsorbed proteoglycans secreted by chondrocytes adjacent to the cartilage tissue in situ, and rapidly formed suitable chondrocyte survival microenvironment modified by ε-poly-L-lysine (EPL). Besides, dynamic covalent bonds were introduced between glucose and phenylboronic acids (PBA). These bonds formed reversible covalent interactions between the cis-diol groups on polyols and the ionic boronate state of PBA. PBA-modified hydrogel induced significant stress relaxation, which improved chondrocyte viability and cartilage differentiation of stem cells. Further, we explored the ability of these hydrogels to promote chondrocyte viability and cartilage differentiation of stem cells through chemical and mechanical modifications. RESULTS: In vivo and in vitro results demonstrated that the hydrogels exhibited efficient biocompatibility. EPL and PBA modified GelMA hydrogel (Gel-EPL/B) showed stronger activity on chondrocytes compared to the GelMA control group. The Gel-EPL/B group induced the secretion of more extracellular matrix and improved the chondrogenic differentiation potential of stem cells. Finally, thus hydrogel promoted the tissue repair of cartilage defects. CONCLUSION: Modified hydrogel is effective in cartilage tissue repair.

Teres minor muscle hypertrophy is a negative predictor of outcomes after reverse total shoulder arthroplasty: an evaluation of preoperative magnetic resonance imaging and postoperative implant position.

BACKGROUND: Predictors of outcomes after reverse total shoulder arthroplasty (rTSA) remain unclear. The purpose of this study was to analyze the impact of preoperative muscle quality and postoperative implant positioning on patient-reported outcomes following rTSA. METHODS: We evaluated 88 shoulders treated with rTSA in which preoperative magnetic resonance imaging was available. Preoperative muscle quality was evaluated, including fatty infiltration, rotator cuff muscle volume, and total tear size. Postoperative implant position was determined radiographically. The correlation between imaging parameters and the 2-year postoperative American Shoulder and Elbow Surgeons (ASES) score was examined. Multivariate analyses were performed to adjust for confounding factors including patient demographic characteristics and implant position. RESULTS: Univariate analysis showed that the ASES score was significantly lower in patients with teres minor muscle hypertrophy relative to those with normal muscle (73.3 ± 22.8 vs. 84.2 ± 16.9, P = .02). The functional subscore was significantly lower in patients with grade 2 fatty infiltration of the deltoid muscle relative to those with grade 0 fatty infiltration (26.1 ± 14.6 vs. 34.8 ± 11.6, P = .03). Older age was associated with a higher pain subscore (ρ = 0.32, P = .002). Multivariate analysis demonstrated that teres minor muscle hypertrophy remained a significant independent predictor of the ASES score (ß coefficient = 91.3, P = .03). CONCLUSION: Teres minor muscle hypertrophy is an independent negative predictor of patient-reported outcomes after rTSA.

Do glenoid retroversion and humeral subluxation affect outcomes following total shoulder arthroplasty?

BACKGROUND: Glenoid retroversion and humeral head subluxation have been suggested to lead to inferior outcomes after total shoulder arthroplasty (TSA). There are limited data to support this suggestion. We investigated whether preoperative glenoid retroversion and humeral head subluxation are associated with inferior outcomes after TSA and whether change of retroversion influences outcomes after TSA. METHODS: Patients undergoing TSA with minimum 2-year follow-up were included from a prospectively collected institutional shoulder arthroplasty database. Retroversion and humeral head subluxation before and after surgery were measured on axillary radiographs. Postoperative radiographs were -evaluated for glenoid component loosening and compared between groups. Spearman correlations were determined between retroversion measurements and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores. Patients were analyzed in groups based on retroversion and humeral head subluxation. RESULTS: There were 113 patients (50% follow-up rate) evaluated at 4.2 years postoperatively. The mean preoperative retroversion (15.3° ± 7.7°) was significantly higher than postoperative retroversion (10.0° ± 6.8°; P < .0001). There was no correlation between postoperative glenoid version or humeral head subluxation and ASES scores. For patients with preoperative retroversion of >15°, there was no difference in outcome scores based on postoperative retroversion. There were no differences in preoperative or postoperative version for patients with or without glenoid lucencies. DISCUSSION: We observed no significant relationship between postoperative glenoid retroversion or humeral head subluxation and clinical outcomes in patients following TSA. For patients with preoperative retroversion >15°, change of retroversion during TSA had no impact on their clinical outcomes at short-term follow-up.

Quantitative imaging of anterior cruciate ligament (ACL) graft demonstrates longitudinal compositional changes and relationships with clinical outcomes at 2 years after ACL reconstruction.

T1 ρ and T2 magnetic resonance imaging (MRI) may allow for a noninvasive assessment of ligamentization after anterior cruciate ligament (ACL) reconstruction. We hypothesized that ACL graft T1 ρ and T2 relaxation times would decrease over time, that T1 ρ and T2 relaxation times would be inversely correlated with Knee Osteoarthritis Outcome Scores (KOOS), and that T1 ρ and T2 values would be lower for autograft relative to allograft reconstruction. Thirty-nine patients (age: 30.5 ± 8.2 years) were followed prospectively after ACL reconstruction with hamstring autograft (N = 27) or soft-tissue allograft (N = 12). Magnetic resonance (MR) imaging and KOOS surveys were completed at 6, 12, 24, and 36 months after surgery. ACL graft was segmented to define T1 ρ and T2 relaxation times. Relaxation times were compared between time points with ANOVA tests. Log-transformed autograft and allograft relaxation times were compared with the Student t tests. The relationship between KOOS and relaxation times at 24 months was investigated with Spearman's rank correlation. ACL graft T1 ρ relaxation times were significantly higher at 6 months relative to 12 months (P = .042), 24 months (P < .001), and 36 months (P < .001). ACL graft T2 relaxation times were significantly higher at 6 months relative to 12 months (P = .036), 24 months (P < .001), and 36 months (P < .001). T1 ρ and T2 relaxation times were significantly lower for autograft reconstruction vs allograft reconstruction at 24 months postreconstruction. Two-year KOOS Sports, Pain, and Symptoms were significantly inversely correlated with T1 ρ and T2 relaxation times. T1 ρ and T2 sequences may offer a noninvasive method for monitoring ACL graft maturation that correlates with patient-reported knee function after ACL reconstruction.

Do Preoperative and Postoperative Glenoid Retroversion Influence Outcomes After Reverse Total Shoulder Arthroplasty?

BACKGROUND: There are limited data on the effect of glenoid retroversion in clinical outcomes following reverse total shoulder arthroplasty (RTSA). The purpose of this study was to evaluate if surgical correction of retroversion affects outcomes following RTSA. METHODS: An institutional database was utilized to identify 177 patients (mean age: 68.2 ± 10.1 years) with minimum 2-year follow-up after primary RTSA. Glenoid version was measured on preoperative and postoperative radiographs. American Shoulder and Elbow Surgeons (ASES) scores and range of motion were collected before and after RTSA. Change in retroversion was determined by comparing preoperative and postoperative glenoid retroversion on radiographs using paired Wilcoxon signed-rank test. Spearman's rank correlation was used to investigate relationships between ASES scores and glenoid retroversion. RESULTS: The mean postoperative ASES composite score (75.5 ± 22.7) was significantly higher than preoperative (36.8 ± 19.2; P < .0001). The mean preoperative glenoid retroversion was 9.1 ± 6.7° compared to 6.5 ± 5.1° postoperatively (P < .0001). There was no correlation between postoperative ASES scores and preoperative retroversion (r = .014, P = .85) or postoperative retroversion (r = -.043, P = .57). There was no statistical relationship between postoperative retroversion and range of motion, though there is a risk of inadequate power given the sample size. CONCLUSIONS: Patient-reported outcomes and range of motion measurements following RTSA at short-term follow-up appear to be independent of either preoperative or postoperative glenoid retroversion.

Pain Management Using Perioperative Administration of Parecoxib for Total Hip Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial.

BACKGROUND: Controlling postoperative pain and improving outcomes after total hip arthroplasty (THA) remain an important challenge, which affects the functional recovery of the hip. OBJECTIVES: To assess the effect of preemptive administration of the selective cyclooxygenase-2 inhibitor parecoxib sodium (PS) after THA. STUDY DESIGN: A prospective, randomized, double-blinded clinical trial. SETTING: An academic medical center. METHODS: This randomized double-blind clinical trial compared postoperative analgesia intervention for unilateral primary THA. Patients were assigned in a 1:1 ratio to the PS group and the control group. The PS group received 40 mg dose of PS 30 minutes before incision, 12 hours after THA, and every 12 hours for 2 days postoperatively, and the control group received normal saline solution at the same time point. In addition, both groups received patient-controlled intravenous analgesia of morphine. Perioperative visual analog scale (VAS) scores, cumulative morphine consumption, functional recovery, perioperative bleeding risk, and the selected indicators of the inflammatory response were compared between the PS group and the control group. RESULTS: From October 2014 to June 2015, 180 patients undergoing unilateral primary THA were screened for this prospective clinical trial. A total of 141 patients were enrolled and randomly assigned into the PS group (n = 69) and the control group (n = 72). Compared with the control group, VAS scores at rest were significantly lower in the PS group at 4, 12, and 24 hours after surgery, and VAS scores during movement were also lower in the PS group at 4, 12, 24, 36, and 48 hours after surgery (all P < 0.001). Both the cumulative morphine consumption and its associated nausea and vomiting were reduced in the PS group (P < 0.001 and P = 0.021, respectively). The length of hospitalization in the PS group was shorter than the control group (PS group 5.91 ± 1.15 days, control group 6.41 ± 1.49 days; P = 0.019). The PS group had lower body temperature than the control group at postoperative day (POD) 1 (P = 0.003) and POD 3 (P = 0.001), and the levels of high-sensitivity C-reactive protein in the PS group at POD 3 (P = 0.016) and POD 6 (P = 0.006) were also lower than those in the control group. The concentration of interleukin (IL)-6 and IL-10 were significantly different between the 2 groups (IL-6, P = 0.007; IL-10, P = 0.006) on the first day postoperatively. The PS group was not significantly different from the control group with respect to any outcomes: blood loss, postoperative blood drainage and blood transfusion, and number of days needed to accomplish straight-leg raising and off-bed exercise. LIMITATIONS: PS was used only until POD 2, and there was no long-term follow-up. CONCLUSIONS: Perioperative administration of PS is an effective addition to a multimodal regimen that alleviates postoperative pain, reduces the cumulative morphine consumption, length of hospitalization, and perioperative inflammatory response, without increasing perioperative bleeding risk. KEY WORDS: Parecoxib sodium, multimodal analgesia, total hip arthroplasty, inflammatory response.

Functional workspace and patient-reported outcomes improve after reverse and total shoulder arthroplasty.

BACKGROUND: Low-cost motion analysis systems (LCMASs) have emerged as easy and practical methods to measure the functional workspace (FWS). Thus, we ventured to apply an LCMAS, the Kinect2 gaming camera, to evaluate the FWS in patients with shoulder osteoarthritis (OA) and patients who underwent total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA). METHODS: A cross-sectional study of participants with OA (n = 53), TSA (n = 70), and RTSA (n = 34) was performed. The FWS as measured by an LCMAS, the American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form score, and the Patient-Reported Outcomes Measurement Information System (PROMIS) score were collected. For participants who underwent TSA or RTSA, the FWS was evaluated at 6, 12, and 24 months postoperatively. The correlation of the FWS with the ASES score and PROMIS score was determined. Significance was set at P < .05. RESULTS: Patients who underwent TSA or RTSA had a significantly higher FWS than patients with shoulder OA at almost all time points. Patients who underwent TSA had a significantly higher FWS than patients who underwent RTSA at 24 months after surgery. PROMIS and ASES scores showed strong correlations with the FWS in patients who underwent TSA (R = 0.75 [P < .001] and R = 0.83 [P < .001], respectively) and RTSA (R = 0.84 [P < .001] and R = 0.73 [P < .001], respectively). CONCLUSION: The FWS measured by an LCMAS is an easy and low-cost method to quantify the reachable space of the hand in patients and shows strong correlations with patient-reported outcome measures. This may be a useful tool to assess upper-extremity range of motion before and after shoulder arthroplasty.

Paclitaxel Induce Apoptosis of Giant Cells Tumor of Bone via TP53INP1 Signaling.

OBJECTIVE: To evaluate the antitumor capability and to investigate the underlying molecular mechanism of paclitaxel. METHODS: First, cck-8 and apoptosis assays were used to determine survival and apoptotic effects of HS 737.T cells under treatment of paclitaxel. Next, RNA-seq and bioinformatics were used to determine the differentially expressed genes and to analyze the pathway involved. Quantitative real-time polymerase chain reaction was used to verify the accuracy of some differentially expressed genes (DEG). ClueGO was used to decode and visualize functionally grouped GO terms of differentially expressed genes, and to map the DEG protein-protein interactions (PPI) network. Western blotting was used to check the expression of target genes, the cleavage of Caspase-3 and PARP1, and the phosphorylation level of p53. Finally, transcriptomics, bioinformatics, and RNAi were used to estimate the antitumor capability and to identify the underlying mechanisms of paclitaxel in GCTB. RESULTS: Our data revealed that paclitaxel had significant time-dependent effects on the viability and induced apoptosis of HS 737.T cells. RNA-seq and bioinformatics analysis showed that apoptosis, death receptor signaling pathway, TNF signaling pathway, and TP53 regulated transcription of cell death genes pathway were closely associated with paclitaxel in the treatment of GCTB. Western bolt results revealed that paclitaxel induced cleavage of Caspase-3 and PARP1, and increased the phosphorylation level of p53 in HS 737.T cells. RNAi results showed that the expression level of TP53INP1 was significantly decreased in HS737.T cells (the decrease was more than 70%). In addition, we found that the inhibitory ratios of paclitaxel on HS737.T cells deficient in TP53INP1 were less than in HS737.T cells with empty vector (19.88 and 40.60%, respectively). Hence, our data revealed that TP53INP1 regulated paclitaxel-driven apoptosis in HS737.T cells. CONCLUSION: Paclitaxel can significantly repress cell proliferation and induce apoptosis of HS 737.T cells through activating Caspase-3, PARP1, p53, and TP53INP1. Paclitaxel may be an effective drug in the management of GCTB.

18F-fluorodeoxyglucose uptake predicts PKM2 expression in lung adenocarcinoma.

Positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG) is widely used in the management of lung adenocarcinoma. Pyruvate kinase M2 (PKM2) plays a key role in glycolysis. We therefore investigated whether PKM2 expression affects 18F-FDG uptake in a retrospective analysis of 76 patients who underwent 18F-FDG PET/computed tomography (CT) scans for staging before surgical resection. We found that PKM2 expression was higher in tumors than peritumoral tissue (p < 0.05). Patients with high PKM2 expression had reduced overall (p < 0.05) and disease-free (p < 0.05) survival as compared to those with low PKM2 expression. Comparison of the primary tumor maximum standardized uptake value (SUVmax) between patients with high and low PKM2 expression revealed that the SUVmax was higher in primary tumors with high PKM2 expression than low PKM2 expression (p < 0.05). Multivariate analysis confirmed the association between SUVmax and PKM2 expression (p < 0.05). PKM2 status was predicted with 81.6% accuracy when the SUVmax cutoff value of 6.4. Thus,18F-FDG PET/CT is predictive of the PKM2 status in lung adenocarcinoma patients and could aid in determining therapeutic strategies.