Giant cell tumor of bone at distal radius suffered more soft tissue recurrence and ultrasonography is effective to detect the soft tissue recurrence.

BACKGROUND: Soft tissue recurrence of giant cell tumor of bone (GCTB) is rare. This study aims to provide its prevalence, recurrent locations, risk factors, effective detection methods and a modified classification for this recurrence. METHODS: Patients with soft tissue recurrence after primary surgery for GCTB were screened from January 2003 to December 2022. General data, recurrence frequency, types according to an original classification (type-I: peripheral ossification; type-II: central ossification; type-III: without ossification), a modified classification with more detailed subtypes (type I-1: ≤ 1/2 peripheral ossification; type I-2: ≥ 1/2 peripheral ossification; type II-1: ≤ 1/2 central ossification; type II-2: ≥ 1/2 central ossification; type III: without ossification), locations, detection methods such as ultrasonography, X-ray, CT or MRI, Musculoskeletal Tumor Society (MSTS) scores were recorded. Multivariate regression analysis was conducted to identify risk factors for recurrence frequency. RESULTS: A total of 558 recurrent cases were identified from 2009 patients with GCTB. Among them, 32 were soft tissue recurrence. The total recurrence rate was 27.78% (558/2009). Soft tissue recurrence rate was 5.73% among 558 recurrent cases, and 1.59% among 2009 GCTB patients, respectively. After excluding one patient lost to follow-up, 10 males and 21 females with the mean age of 28.52 ± 9.93 (16-57) years were included. The definitive diagnosis of all recurrences was confirmed by postoperative pathology. The interval from primary surgery to the first recurrence was 23.23 ± 26.12 (2-27) months. Eight recurrences occurred from primary GCTB located at distal radius, followed by distal femur (6 cases). Recurrence occurred twice in 12 patients and 3 times in 7 patients. Twenty-seven recurrences were firstly detected by ultrasonography, followed by CT or X-ray (10 cases in each). Types at the first recurrence were 5 cases in type-I, 8 in type-II and 18 in type-III. According to the modified classification, 3 patients in type I-1, 2 in type I-2, 1 in type II-1, 7 in type II-2, and 18 in type III. The mean MSTS score was 26.62 ± 4.21 (14-30). Neither Campanacci grade nor recurrence type, modified classification and other characters, were identified as risk factors. CONCLUSIONS: Soft tissue recurrence of GCTB may recur for more than once and distal radius was the most common location of primary GCTB that would suffer a soft tissue recurrence. Ultrasonography was a useful method to detect the recurrence. Since no risk factors were discovered, a careful follow-up with ultrasonography was recommended.

[Effectiveness validation of a novel comprehensive classification for intertrochanteric fractures].

Objective: To validate the effectiveness of a novel comprehensive classification for intertrochanteric fracture (ITF). Methods: The study included 616 patients with ITF, including 279 males (45.29%) and 337 females (54.71%); the age ranged from 23 to 100 years, with an average of 72.5 years. Two orthopaedic residents (observers Ⅰ and Ⅱ) and two senior orthopaedic surgeons (observers Ⅲ and Ⅳ) were selected to classify the CT imaging data of 616 patients in a random order by using the AO/Orthopaedic Trauma Association (AO/OTA) classification of 1996/2007 edition, the AO/OTA classification of 2018 edition, and the novel comprehensive classification method at an interval of 1 month. Kappa consistency test was used to evaluate the intra-observer and inter-observer consistency of the three ITF classification systems. Results: The inter-observer consistency of the three classification systems evaluated by 4 observers twice showed that the 3 classification systems had strong inter-observer consistency. Among them, the κ value of the novel comprehensive classification was higher than that of the AO/OTA classification of 1996/2007 edition and 2018 edition, and the experience of observers had a certain impact on the classification results, and the inter-observer consistency of orthopaedic residents was slightly better than that of senior orthopaedic surgeons. The intra-observer consistency of two evaluations of three classification systems by 4 observers showed that the consistency of the novel comprehensive classification was better for the other 3 observers, except that the consistency of observer Ⅳ in the AO/OTA classification of 2018 version was slightly higher than that of the novel comprehensive classification. The results showed that the novel comprehensive classification has higher repeatability, and the intra-observer consistency of senior orthopaedic surgeons was better than that of orthopaedic residents. Conclusion: The novel comprehensive classification system has good intra- and inter-observer consistency, and has high validity in the classification of CT images of ITF patients; the experience of observers has a certain impact on the results of the three classification systems, and those with more experiences have higher intra-observer consistency.

Leucine rich repeat containing 32 accelerates tenogenic differentiation of tendon-derived stem cells and promotes Achilles tendon repair in rats.

Although many surgical or non-operative therapies have been developed to treat Achilles tendon injuries, the prognosis of which is often unsatisfactory. Recently, biologic approaches using multipotent stem cells like tendon-derived stem cells (TDSCs) pose a possible treatment option. To evaluate whether the Leucine rich repeat containing 32 (Lrrc32) affects the tenogenic differentiation of TDSCs and thus promotes Achilles tendon healing. TDSCs were infected with the recombinant Lrrc32-overexpressing lentivirus (LV-Lrrc32) and then locally injected into the injured site of rat. Four weeks after surgery, the Achilles tendon tissue (~0.5 cm) around the injured area was harvested for analysis. Pathological results showed that Lrrc32-overexpressing TDSCs significantly improved the morphological changes of the injured tendons. Specifically, the increased collagen-I expression and hydroxyproline content in extracellular matrix, and more orderly arrangement of the regenerated collagen fibers were observed in the Lrrc32 overexpression group. Moreover, 4 weeks after injection of Lrrc32-overexpressing TDSCs, the expression of tenocyte-related genes such as tenomodulin (Tnmd), scleraxis (Scx) and decorin (Dcn) were upregulated in the area of the healing tendon. These findings indicated that Lrrc32 promoted the tenogenic differentiation of TDSCs in vivo. Additionally, Lrrc32 overexpression also increased the expression of TGF-ß1 and p-SMAD2/3, suggesting that the beneficial effects of Lrrc32 on tendon repair might be associated with the expression of TGF-ß1 and p-SMAD2/3. Our findings collectively revealed that Lrrc32-overexpressed TDSCs promoted tendon healing more effectively than TDSCs alone.

Kartogenin Combined Platelet-Rich Plasma (PRP) Promoted Tendon-Bone Healing for Anterior Cruciate Ligament (ACL) Reconstruction by Suppressing Inflammatory Response Via targeting AKT/PI3K/NF-κB.

Anterior cruciate ligament (ACL) rupture is the most common sports injuries and PRP has the potential to be a kartogenin (KGN) carrier to promote collagen fibril organization and cartilage regenerative in the tendon-bone interface. This paper aimed to investigate co-injection of KGN-PRP into the bone tunnels of ACL reconstructions which could enhance tendon-bone healing graft osteointegration effectively. HPLC was used to measured release rate of KGN from KGN-PRP gel. Then, an ACL injury reconstruction model in rabbits was established and the rabbits received saline, PRP, and KGN-PRP injection onto the tendon-bone interface after reconstruction. The tissue was harvested from the tendon-bone interface at 4 weeks and 8 weeks post-surgery, and the sections were stained with Safranin O/fast green to detected tendon-bone healing. Immunochemistry staining was used to analyze VEGF, collagen I, and HIF-1α expression, and ELISA assay was used for detecting IL-6, TNF-α, and COX-2 concentrations. The expression levels of AKT/PI3K/NF-κB-related protein and mRNA were presented by Western blot and qPCR. The release rate of KGN was high within 4 h of KGN-PRP gel and followed by a slow release until 7 days. The Safranin O/fast green staining results indicated that tendon-bone interface in sham and mock group existed gap and tissue disorganization. The KGN + PRP group showed the positive color of the healing interface was more obvious and cartilage tissue began to be generated in large amounts at this interface. The maximum tensile force of KGN-PRP injection tendon-bone healing site was significantly higher than that of PRP group, and KGN-PRP effectively promoted fibro chondrogenesis and tendon-bone healing. The expression of collagen I, VEGF, and HIF-1α in regenerated tissues at the healing interface was significantly increased by KGN-PRP treatment compared with the mock and sham groups. The expressions of IL-6, TNF-α, and COX-2 after KGN-PRP treatment were significantly decreased in tendon-bone interface compared to the mock group. WB and qPCR results showed KGN-PRP treatment effectively inhibits AKT/PI3K/NF-κB activation of inflammatory pathways, thereby reducing the level of inflammation to promote wound healing. PRP is an effective carrier for KGN with the sustained release of KGN. After ACL reconstruction, injection of KGN-PRP gel significantly reduced the inflammatory response and inhibited AKT/PI3K/NF-κB activation in cartilage tissue, which promoted tendon-bone healing.

Upregulation of Runt related transcription factor 1 (RUNX1) contributes to tendon-bone healing after anterior cruciate ligament reconstruction using bone mesenchymal stem cells.

BACKGROUND: Anterior cruciate ligament (ACL) injury could lead to functional impairment along with disabilities. ACL reconstruction often fails owing to the regeneration failure of tendon-bone interface. Herein, we aimed to investigate the effects of Runt related transcription factor 1 (RUNX1) on tendon-bone healing after ACL reconstruction using bone mesenchymal stem cells (BMSCs). METHODS: BMSCs were isolated from the marrow cavity of rat femur, followed by the modification of RUNX1 with lentiviral system. Then, an ACL reconstruction model of rats was established with autografts. RESULTS: Results of flow cytometry exhibited positive-antigen CD44 and CD90, as well as negative-antigen CD34 and CD45 of the BMSCs. Then, we found that RUNX1-upregulated BMSCs elevated the decreased biomechanical strength of the tendon grafts after ACL reconstruction. Moreover, based on the histological observation, upregulation of RUNX1 was linked with better recovery around the bone tunnel, a tighter tendon-bone interface, and more collagen fibers compared to the group of BMSCs infected with LV-NC. Next, RUNX1-upregulated BMSCs promoted osteogenesis after ACL reconstruction, as evidenced by the mitigation of severe loss and erosion of the cartilage and bone in the tibial and femur area, as well as the increased number of osteoblasts identified by the upregulation of alkaline phosphatase, osteocalcin, and osteopontin in the tendon-bone interface. CONCLUSION: Elevated expression of RUNX1 contributed to tendon-bone healing after ACL reconstruction using BMSCs.

A Sagittal Patellar Angle Linear Equation Reflecting Patellofemoral Kinematics: Evaluation of Patellar Height at any Degree of Knee Flexion Angle.

OBJECTIVE: To confirm whether a novel sagittal patellar angle linear equation used for evaluating patellar height by calculating expected sagittal patellar angle (SPA) at any degree of knee flexion angle is suitable for patients older than 17 years and its reliability compared with other commonly used methods. METHODS: From September 2016 to September 2019, a total number of 202 consecutive outpatients' knee lateral X-ray radiographs were retrospectively measured and evaluated using a recently proposed linear equation Y = 1.94 + 0.74 × knee flexion(KF) angle. Patients were divided by ages into ayounger group, whose ages were between 17-49 years, and an older group, whose ages were older than 49 years, which has not been validated in the original study. Parameters such as KF, SPA, patella and patella tendon length and so on were measured on computer with picture archiving and communication system by two independent observers at an interval of 1 month. Insall-Salvati (IS) index, Caton-Deschamps (CD) index and Y value, correlation coefficients were calculated and compared using SPSS 22.0 software. RESULTS: In the younger group, 143 patients (165 knees) were included, ages were 17-49 (31.62 ± 11.38) years, males/females were 70 (48.95%)/73 (51.05%), left knees/right knees were 83 (50.30%)/82 (49.70%), mean value of Y was 31.50° ± 10.07°, and SPA was 34.38° ± 12.38°, mean value of IS was 1.06 ± 0.17, mean value of CD was 1.04 ± 0.18. While in older group, 59 patients (78 knees) were included, ages were 50-60 (mean 54.61 ± 2.99) years, there were 32 males (54.24%) and 27 females (45.76%), 42 knees were left (53.85%) and 36 knees were right (46.15%), mean values of Y and SPA were 25.90° ± 11.55° and 29.36° ± 14.22°, mean IS index in older group was 1.06 ± 0.18, mean CD index was 1.00 ± 0.16. Intra- and inter-observer reliabilities of Y in younger and older groups were 0.999, 0.999, 1.000 and 0.999, meaning high reliability and reproducibility, but low Pearson's correlation coefficients with IS and CD index were showed as -0.213 and - 0.216 in younger group and - 0.113 and - 0.316 in older group. CONCLUSIONS: In patients older than 17 years, the linear equation Y = 1.94 + 0.74 × KF is a reliable and practical method to evaluate SPA regardless of age and knee flexion angle, but has weak correlation coefficients with the IS and CD index.

A Retrospective Study of the Risk Factors for Postoperative Foot or Ankle Pain in 90 Patients with Varus Osteoarthritis of the Knee who Underwent Total Knee Arthroplasty.

BACKGROUND The reasons for foot and ankle pain following total knee arthroplasty (TKA) for knee varus osteoarthritis are unknown. This retrospective study aimed to investigate the risk factors for postoperative foot and ankle pain in patients with varus osteoarthritis of the knee who underwent TKA. MATERIAL AND METHODS We enrolled 90 patients who underwent TKA for varus knee osteoarthritis. The visual analog scale (VAS) was used to evaluate patients' foot or ankle pain before and after surgery. The correlation between independent variables (eg, age, sex, body mass index [BMI], ankle osteoarthritis, and varus angle) and foot and ankle pain in patients with osteoarthritis of the knee was measured. Moreover, radiological changes were compared between the groups with and without worsened pain. RESULTS No significant difference in VAS was found between patients <60 and ≥60 years of age (P>0.05). Male sex and BMI <30 kg/m² were weakly correlated with preoperative foot or ankle pain. However, patients with varus of ≥6° and preexisting ankle osteoarthritis had a higher incidence of foot or ankle pain before surgery. Moreover, no significant differences in radiological changes were found between the groups with and without worsened foot or ankle pain after surgery (P>0.05). CONCLUSIONS In male patients with osteoarthritis of the knee, a BMI <30 kg/m², varus of <6°, and no preexisting ankle osteoarthritis were protective factors for foot and ankle pain. TKA corrected knee and ankle malalignment. Therefore, postoperative foot and ankle pain was not associated only with TKA surgery.

[CLINICAL OBSERVATION OF IMPROVING AXIAL OFFSET BY USING Ilizarov BONE TRANSPORT TECHNOLOGY].

OBJECTIVE: To explore the effectiveness of Ilizarov technique in improving bone transport axial offset. METHODS: Between January 2010 and December 2014, 14 patients with tibial fracture were treated by using Ilizarov technique. Of 14 cases, 11 were male and 3 were female, aged 18-70 years (mean, 38.8 years); there were 10 cases of infective bone defect and 4 cases of non-infective bone defect. According to Paley typing, 7 cases were rated as type B1(bone defect without shortening) and 7 cases as type B3(bone defect with shortening). The injury to operation time was 1 to 72 months (mean, 11.9 months). Ilizarov fixation was used for type architecture and adjusting fixed bone removal of half the distance between the needle and the ring, changing the auadrilateral edges, adjusting the convolution relationship between the bone removal section and bone segment involution, and adjusting the two force lines of bone segment involution end so as to make the limb lines of force satisfactory. RESULTS: The patients were followed up 9-31 months (mean, 19.1 months). Four cases achieved natural bone healing at last follow-up, bone healing was obtained in 10 cases after bone graft. At 1 week after operation, X-ray films showed angulation in the coronal plane in 10 cases (3-12°, 4.9° on average) and in the sagittal plane in 9 cases (2-12°, 3.8° on average); axial offset was observed in 6 cases (43%), which was corrected in 5 cases except 1 case. At last followup, angulation in the coronal plane was observed in 5 cases (2-4°, 2.6° on average), angulation in the sagittal plane in 6 cases (2-6°, 4.1° on average), and axial offset in 1 case (7%), which were significantly improved when compared with ones at 1 week. According to Paley evaluation criteria, the osseous results were excellent in 12 cases and good in 2 cases; the functional results were excellent in 12 cases and good in 2 cases at last follow-up. CONCLUSIONS: Axial offset in the Ilizarov bone transport relatively common. By adjusting fixed bone removal of half the distance between the needle and the ring, the axial offset can be improved.