Coracohumeral index and coracoglenoid inclination as predictors for different types of degenerative subscapularis tendon tears.

PURPOSE: To define and compare the coracohumeral index (CHI) and coracoglenoid inclination (CGI) in patients with different types of the subscapularis tendon tears. METHODS: Patients were divided into two groups: articular-sided lesion group (group A) and bursal-sided lesion group (group B). All the patients were examined using a 3.0-T magnetic resonance imaging scanner pre-operatively. The morphometric parameters of the coracoids, including the coracohumeral distance (CHD), CHI, and CGI, were measured on MRI. RESULTS: There were 165 (70.2%) and 70 (29.8%) patients in groups A and B, respectively. There was no significant difference in the average CHD (7.98 ± 1.7 mm vs 7.82 ± 2.1 mm, respectively) and CGI (50.5° ± 16.6° vs 44.9° ± 17.4°, respectively; P = 0.427) between the two groups. Conversely, there was a significant difference in the CHI between them (0.32 ± 0.08 vs 0.57 ± 0.11, respectively; P = 0.0001). According to the CHI and CGI, the coracoid process was divided into three types, and nearly half of the patients (46.8%) had standard coracoids with a hook tip, which are vulnerable to injury on the articular side. However, with overlapping coracoids and hook tips, the patients (16.2%) tended to experience injury on the bursal side. There was a significant difference in the incidence of articular or bursal side tear between the two groups. CONCLUSIONS: The CHI and CGI are potential valuable predictors of the types of degenerative subscapularis tendon tears. With standard hook coracoids, the lesions tend to appear on the articular side initially; otherwise, with overlapping hook coracoids, the subscapularis tendon tears are commonly seen on the bursal side.

Arthroscopic debridement and synovium resection for inflammatory hip arthritis.

OBJECTIVE: To evaluate the efficacy of arthroscopic surgery in inflammatory hip arthritis. METHODS: A retrospective clinical study was conducted inspecting 40 hips in 36 patients of inflammatory arthritis. There were 17 cases of ankylosing spondylitis, 11 cases of rheumatoid arthritis, and 8 cases of psoriatic arthritis. The joints were irrigated and the inflamed tissues were debrided with anthroscopy. The patients were followed up with Harris hip score, Oxford hip score, Visual Analog Scale (VAS), and magnetic resonance imaging (MRI). Statistical analysis was performed using Student t test. RESULTS: All of the 36 cases were followed up for 46-103 months, averaging 67.2±8.4 months. Harris and Oxford scores increased from 66.9±12.1 and 69.4±16.4 before operation to 78.4±19.3 and 80.2±18.8 after operation, respectively (P<0.05). VAS score decreased from pre-operative 8.5±2.5 to post-operative 7.2±2.5 (P<0.05). All the patients showed improved joint range of motion. MRI revealed alleviation of hip synovitis. The results were classified as excellent in 8 patients, good in 17 patients, fair in 8 patient, and poor in 3 according to Harris hip score. Twenty-seven patients were satisfied with the operative outcomes as they regained normal daily activities. CONCLUSIONS: Arthroscopy-assisted joint debridement and synovium resection is an effective procedure for hip lesion in inflammatory arthritis. The inflammatory lesion might be thereby controlled and the symptoms be relieved.

[Treatment of adult congenital muscular torticollis with radiofrequency carbonation under arthroscope].

OBJECTIVE: To evaluate the efficacy of sternocleidomastoideus radiofrequency carbonation with local anesthesia under arthroscope for the treatment of congenital muscular torticollis in adults. METHODS: Twenty-six cases of congenital muscular torticollis were treated by radiofrequency carbonation with local anesthesia under arthroscope. The right side was in 14 patients and left in 12. There were 11 males and 15 females with an average age of 22 years old. Sternocleidomastoideus and clavicula were pre-operatively marked. Through an artificial lacuna, arthroscope and radiofrequency probe were inserted. RESULTS: The mean follow-up period was 25 months (range: 15 - 71). According to the motion deficits, craniofacial asymmetry, head tilt and subjective assessment, there were 19 excellent and 7 fair outcomes. Most patients showed a marked improvement in neck motion and head tilt with satisfactory functional and cosmetic outcomes. There was no nerve or vascular injury, no recurrence, infection and scar. The overall efficacy was satisfactory. CONCLUSION: The radiofrequency therapy for torticollis with local anesthesia under arthroscopy has a satisfactory efficacy. The advantages are minimal trauma, simple procedure, less pain and better cosmetics.

Arthroscopic Treatment for Femoroacetabular Impingement Syndrome with External Snapping Hip: A Comparison Study of Matched Case Series.

OBJECTIVE: To determine the effectiveness of hip arthroscopy combined with endoscopic iliotibial band (ITB) release in patients with both femoroacetabular impingement (FAI) syndrome and external snapping hip (ESH). METHODS: Retrospectively review the preoperative and minimum of 2-year follow-up data of patients with both FAI syndrome and ESH who underwent endoscopic ITB release during hip arthroscopy (FAI + ESH group) from January 2014 to December 2018. The same number of age- and gender-matched FAI syndrome patients without ESH undergoing hip arthroscopy were enrolled in the control group (FAI group). Patient-reported outcomes (PROs) including international Hip Outcome Tool (iHOT-33), modified Harris Hip Score (mHHS), visual analog scale for pain (VAS-pain), and abductive force of affected hip at 3 month and 2 years postoperatively were comparatively analyzed. The VAS-satisfaction score of two groups at 2 years postoperatively were also analyzed. RESULTS: The prevalence of ESH in FAI syndrome patients undergoing hip arthroscopy in our institution was 5.5% (39 of 715 hips), including nine males (10 hips) and 29 females (29 hips). The mean age at the time of surgery was 32.1 ± 6.9 years (range, 22-48 years). According to inclusion and exclusion criteria, 23 patients were enrolled in FAI + ITB group. Twenty-three age- and sex-matched FAI syndrome patients were enrolled in FAI group. At 24 months postoperatively, no patient still suffered ESH symptoms and painful palpation at lateral region in FAI + ITB group. The iHOT-33, mHHS, and VAS-pain score of patients in FAI + ESH group were significantly severer than patients in FAI group preoperatively (41.6 ± 7.5 vs 48.8 ± 7.2, 54.8 ± 7.2 vs 59.2 ± 6.9, 5.5 ± 0.9 vs 4.7 ± 1.0; P < 0.05), while there was no significant difference in these scores between the patients in FAI + ESH group and FAI group at 3-month and 24-month follow-up (73.6 ± 8.5 vs 76.1 ± 6.9, 85.3 ± 7.8 vs 84.2 ± 6.6, 0.8 ± 0.9 vs 0.6 ± 0.9; P > 0.05). At 3 months after surgery, the abductive force of operated hip was significantly smaller than that in FAI group (82.4 ± 12.4 N vs 91.9 ± 16.1 N, P < 0.05), whereas there was no significant difference at 24 months after surgery (101.6 ± 14.9 N vs 106.5 ± 13.7 N, P > 0.05). The VAS-satisfaction scores of patients in the two groups were at a similarly high level (90.5 ± 6.8 vs 88.8 ± 7.3, P > 0.05). There was no complication and no arthroscopic revision in either group until 2-year follow-up. CONCLUSION: Although abductive force recovery of the hip was delayed, hip arthroscopy combined with endoscopic ITB release addressed hip snapping in patients with both FAI syndrome and ESH, and could get similar functional improvement, pain relief, recovery speed, as well as patient satisfaction compared with the pure hip arthroscopy in FAI syndrome patients without ESH.

[Effect of arthroscopic debridement for adolescent ankylosing spondylitis with early hip-joint disease].

OBJECTIVE: To study the effect of arthroscopy debridement for adolescent ankylosing spondylitis (AS) with early hip-joint disease. METHODS: A total of 22 cases (26 hips) of adolescent AS were recruited. There were 15 males and 7 females. The distribution was as follows: left side (n = 10), right side (n = 8) and bilateral (n = 4). The average age was 16 (14 - 19) years old. The procedures included adhesion relief of hip joint, removal of hyperplasic synovial membrane, degenerated cartilage debris and repairing exfoliated debris or exposed subchondral bone on hip joint. RESULTS: All patients were followed up for an average of 26 (6 - 84) months. Most patients experienced pain relief, restored function and the range of motion. According to Harris hip joint score and VAS pain score evaluation system, the outcomes were excellent (n = 6) fair (n = 14) and poor (n = 2). There was no case of total hip replacement. CONCLUSION: Arthroscopic debridement for adolescent ankylosing spondylitis with early hip joint disease is effective to improve joint motion and relieve pain.

[Classification and arthroscopic surgery of chronic achilles tendinitis].

OBJECTIVE: To investigate the clinical classification of chronic achilles tendinitis and analyze the surgical technique and efficacy of arthroscopic surgery. METHODS: Twenty-two patients (16 males, 6 females) with chronic achilles tendinitis were recruited. The average age was 33.5 years old (range: 17 - 53). Sixteen cases were caused by sport injury while 6 cases had no definite etiological factor. The Achilles tendinopathy was divided into three types according to clinical characteristics and the results of X ray, CT scan and MRI examination of ankle: Type 1, hypertrophy (n = 10); Type 2, calcified tubercle (n = 5); Type 3, fiber tear (n = 7). All cases were treated with endoscopic debridement of ventral neovascularized area, peritendineum and Achilles tendon by shaver and radiofrequency (RF) probe. RESULTS: The patients were followed-up for a mean of 14 months (range: 9 - 15). Evaluated by our criteria and visual analogue scale, the post-operative efficacy was excellent in 12 cases, good in 8 and fair in 2. No postoperative complications, such as neurovascular injury, infection and rupture of Achilles tendon, was recorded. CONCLUSION: This scheme of classifying is helpful to the diagnosis and effective treatment of chronic Achilles tendonitis. With a high safety and a satisfactory efficacy, arthroscopic surgery has the advantages of minimally invasiveness.

Skeletal stem cell-mediated suppression on inflammatory osteoclastogenesis occurs via concerted action of cell adhesion molecules and osteoprotegerin.

In the current study, we investigated how skeletal stem cells (SSCs) modulate inflammatory osteoclast (OC) formation and bone resorption. Notably, we found that intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and osteoprotegerin (OPG) play a synergistic role in SSC-mediated suppression of inflammatory osteoclastogenesis. The effect of SSCs on inflammatory osteoclastogenesis was investigated using a lipopolysaccharide-induced mouse osteolysis model in vivo and human osteoarthritis synovial fluid (OASF) in vitro. OC formation was determined by tartrate-resistant acid phosphatase staining. Bone resorption was evaluated by microcomputerized tomography, serum C-terminal telopeptide assay, and pit formation assay. The expression of ICAM-1, VCAM-1, and OPG in SSCs and their contribution to the suppression of osteoclastogenesis were determined by flow cytometry or enzyme linked immunosorbent assay. Gene modification, neutralization antibodies, and tumor necrosis factor-α knockout mice were used to further explore the mechanism. The results demonstrated that SSCs remarkably inhibited inflammatory osteoclastogenesis in vivo and in vitro. Mechanistically, inflammatory OASF stimulated ICAM-1 and VCAM-1 expression as well as OPG secretion by SSCs. In addition, ICAM-1 and VCAM-1 recruited CD11b+ OC progenitors to proximity with SSCs, which strengthened the inhibitory effects of SSC-derived OPG on osteoclastogenesis. Furthermore, it was revealed that tumor necrosis factor α is closely involved in the suppressive effects. In summary, SSCs express a higher level of ICAM-1 and VCAM-1 and produce more OPG in inflammatory microenvironments, which are sufficient to inhibit osteoclastogenesis in a "capture and educate" manner. These results may represent a synergistic mechanism to prevent bone erosion during joint inflammation by SSCs.

SOCS1 Regulates the Immunomodulatory Roles of MSCs on B Cells.

BACKGROUND AND OBJECTIVES: The effective use of MSCs for the treatment of some B cell-mediated immune diseases is quite limited. The main reason is that the immunomodulatory effects of mesenchymal stem cells (MSCs) on B cells are unclear, and their underlying mechanisms have not been fully explored. METHODS AND RESULTS: By co-culturing B cells with MSCs without (MSC/CTLsh) or with suppressor of cytokine signaling 1 (SOCS1) knockdown (MSC/SOCS1sh), we found that MSCs inhibited B cell proliferation, activation and terminal differentiation. Remarkably, the highest inhibition of B cell proliferation was observed in MSC/SOCS1sh co-culture. Besides, MSC/SOCS1sh reversed the inhibitory effect of MSCs in the last stage of B cell differentiation. However, MSC/SOCS1sh had no effect on inhibiting B cell activation by MSCs. We also showed that IgA+ B cell production was significantly higher in MSC/SOCS1sh than in MSC/CTLsh, although no difference was observed when both MSCs co-cultures were compared to isolated B cells. In addition, MSCs increased PGE2 production after TNF-α/IFN-γ stimulation, with the highest increase observed in MSC/SOCS1sh co-culture. CONCLUSIONS: Our results highlighted the role of SOCS1 as an important new mediator in the regulation of B cell function by MSCs. Therefore, these data may help to develop new treatments for B cell-mediated immune diseases.

Biological potential alterations of migratory chondrogenic progenitor cells during knee osteoarthritic progression.

BACKGROUND: Although increasing studies have demonstrated that chondrogenic progenitor cells (CPCs) remain present in human osteoarthritic cartilage, the biological alterations of the CPCs from the less diseased lateral tibial condyle and the more diseased medial condyle of same patient remain to be investigated. METHODS: CPCs were isolated from paired grade 1-2 and grade 3-4 osteoarthritic cartilage by virtue of cell migratory capacities. The cell morphology, immunophenotype, self-renewal, multi-differentiation, and cell migration of these CPCs were evaluated. Additionally, the distributions of CD105+/CD271+ cells in OA osteochondral specimen were determined. Furthermore, a high-throughput mRNA sequencing was performed. RESULTS: Migratory CPCs (mCPCs) robustly outgrew from mildly collagenases-digested osteoarthritic cartilages. The mCPCs from grade 3-4 cartilages (mCPCs, grades 3-4) harbored morphological characteristics, cell proliferation, and colony formation capacity that were similar to those of the mCPCs from the grade 1-2 OA cartilages (mCPCs, grades 1-2). However, the mCPCs (grades 3-4) highly expressed CD271. In addition, the mCPCs (grades 3-4) showed enhanced osteo-adipogenic activities and decreased chondrogenic capacity. Furthermore, the mCPCs (grades 3-4) exhibited stronger cell migration in response to osteoarthritis synovial fluids. More CD105+/CD271+ cells resided in grade 3-4 articular cartilages. Moreover, the results of mRNA sequencing showed that mCPCs (grades 3-4) expressed higher migratory molecules. CONCLUSIONS: Our data suggest that more mCPCs (grades 3-4) migrate to injured articular cartilages but with enhanced osteo-adipogenic and decreased chondrogenic capacity, which might explain the pathological changes of mCPCs during the progression of OA from early to late stages. Thus, these dysfunctional mCPCs might be optional cell targets for OA therapies.

[Biomechanical evaluation of tendon graft fixation at the tibial site in anterior cruciate ligament reconstruction with Intrafix and bioabsorbable interference screw].

OBJECTIVE: The fixation strength of the hamstring tendon graft on the tibial side is considered the weak point in anterior cruciate ligament (ACL) reconstruction. This work tested the hypotheses that some of these devices will resist graft slippage under loads better than others, and that some will have higher ultimate strength than others. METHODS: Fourteen fresh frozen human cadaver knees underwent fixation of the hamstring tendon harvested from the knee to be used as graft material to reconstruct the ACL and were divided into two equal groups based on the fixation methods: bioabsorbable interference screw group and Intrafix group. A MTS 858 MiniBionix II testing machine was used to carry out tensile testing under an axial load parallel to the tibial tunnel with a velocity of 10 mm/min. Ultimate failure load, displacement of 100N, displacement of 400N, stiffness and mode of failure were recorded respectively. RESULTS: The maximum load for the Intrafix fixation group was (719.094+/-160.478) kgxmxs(-2), significantly higher than that of the bioabsorbable interference screw fixation group [(476.640+/-64.226) kgxmxs(-2), P<0.05]. The displacement levels of 100 kgxmxs(-2) and 400 kgxmxs(-2) for the Intrafix fixation group was (1.025+/-0.326) mm and (4.728+/-1.992) mm respectively, not significantly different from those of the bioabsorbable interference screw fixation [(1.335+/-0.539) mm and (7.564+/-4.307) mm respectively, t=0.2173, 0.0944, both P>0.05], and the stiffness of the Intrafix fixation group was (96.770+/-36.848) kgxm(-1)xs(-2) not significantly different from that of the bioabsorbable interference screw fixation group [(63.976+/-31.003 kgxm(-1)xs(-2)), t=0.0967, P>0.05]. After randomized t-test of significance, the displacement levels of 100N and 400N of these 2 groups were not significantly different. CONCLUSION: Both tibial site fixation with bioabsorbable interference screw and that with Intrafix in ACL reconstruction with 4-stranded hamstring tendon grafts can meet daily physiological demand. Tibial site fixation with Intrafix shows a higher failure load.

[RIGIDfix tibial and femur cross pin system used for hamstring grafted anterior cruciate ligament reconstruction].

OBJECTIVE: To evaluate the curative effect of RIGIDfix tibial and femur cross pin system used for hamstring grafted reconstruction of anterior cruciate ligament (ACL) in arthroscopy. METHODS: Thirty two cases with ACL ruptures were reconstructed arthroscopically with hamstring grafts and the grafts fixed with RIGIDfix cross-pin on both femoral and tibial sides. They included 18 males and 14 females with a mean age of 28 (20-45) years old; the mean time from injury to operation was 3.6 (2.5-6) months. And each knee was checked by MRI and X-ray preoperatively. Through arthroscopy, we found 19 ACL ruptured from femoral attachment point, 13 from tibial point, 3 cases combined with medial meniscus injury and 4 cases with articular cartilage injury of medial femoral condyle. After semitendinosus or gracilis harvesting, the hamstring grafts were pre-tensioned and woven, the diameter of 4 or 5 strands grafts was 7-8 mm. To position and drill tibial tunnel on ACL stump of tibial crest, and to drill femoral tunnel at 10:00 to 11 o'clock of femoral intercondylar fossa transtibial with knee flexed to 90 degree, the depth of femoral tunnel was 30 mm. The RIGIDfix guide was inserted through tibial tunnel up into the femoral tunnel to drill the sleeve and interlocking Trocar across the lateral femur and keep the two sleeves fixed to the lateral femur. Insert RIGIDfix guide into the tibial tunnel, keeping the top of guide 2-3 mm beneath the endostoma of tibial tunnel, drill the sleeve and interlocking Trocar across the lateral tibia and keep the two sleeve fixed to the lateral tibia. The graft was pulled into the tunnel (the 30 mm mark on the graft should be at the edge of femoral hole) to insert the RIGIDfix cross pins from femoral tunnel to tibial tunnel, while inserting the second, third, fourth cross pin, the graft should be kept under tension. Then a knot was tied through tibial bony bridge using the Enthibond thread switched to the end of tendon grafts. We finally observed the tension of tendon grafts and the impingement of fossa intercondylic under arthroscopy. RESULTS: With a 16-month follow-up evaluation, all of the patients' injured knees were stable and the average Lysholm knee score increased from 62.5 to 94.5. Rulermetr device values were less than 2 mm of sagittal displacement in 28 patients and 4 mm in 4. Postoperative Lachman was negative in 30 patients and weakly positive in 2. According to the IKDC scores, 30 patients reported normal function, 2 reported nearly normal function and none reported abnormal or severely abnormal function. CONCLUSION: The grafting method of fixing both femur and tibia sides with absorbable cross pins is feasible. In this way, the graft is stabilized to allow for reconstruction. A surgeon should refrain from dissecting the tendon and enlarging the tunnel so as to promote the healing of tendon and bone.

Arthroscopy combined with unicondylar knee arthroplasty for treatment of isolated unicompartmental knee arthritis: A long-term comparison.

BACKGROUND: Knee osteoarthritis is the most prevalent form of osteoarthritis and is becoming the main reason for progressive pain in knee joints. Arthroscopy combined with unicondylar knee arthroplasty (UKA) is one of the effective methods for the treatment of severe unicompartmental knee arthritis. This surgical approach gives us the capacity to explore all the articular cavities and plays a vital role in UKA patient selection. However, some scholars think that the surgical procedure is traumatic and may increase the rate of surgical infection, and its clinical efficacy needs further study. AIM: To compare the clinical effect of arthroscopy combined with UKA and UKA alone for patients suffering from unicompartmental osteoarthritis (OA). METHODS: A retrospective study was conducted on patients who were diagnosed with unicompartmental OA (Kellgren-Laurence grade ≥ III) and underwent UKA between October 2012 and November 2006. The patients were followed at 3, 6, and 12 mo and every 2 years thereafter. During each follow-up, the radiographic materials, the range of motion of knee and hospital for special surgery (HSS) score, knee society score and knee function score as recorded, and the modes and time of failure and revision details were collected as well. RESULTS: Data on 104 patients (118 knees), including 54 patients (60 knees) in the arthroscopy combined with UKA group (group A) and 51 (58 knees) in UKA alone group (group B) were collected during an average follow-up duration of 7.25 years, excluding the cases who were lost to follow-up. At the final follow-up, 3 (5.0%) of 60 knees in group A compared with 4 (6.9%) of 58 knees in group B failed and converted to total knee arthroplasty, with no statistically significant difference between the two groups (P = 0.933). The percentage of patients receiving blood transfusion was 40% in group A, significantly lower than that in group B (67.2%; P = 0.003). Total volume of blood transfusion in group A was also significantly lower than that of group B (P = 0.001). Both groups improved significantly after operation in clinical symptoms and functions. HSS score, knee society score, and knee function score increased significantly at the latest follow-up compared to pre-operation in group A, from 59.6 ± 10.9 to 82.7 ± 9.3 (mean difference [MD], 23.2; 95%CI: 19.3-27.0; P = 0.000), 47.3 ± 6.3 to 76.2 ± 13.1 (MD, 28.9; 95%CI: 25.1-32.7; P = 0.000), and 57.5 ± 6.3 to 75.1 ± 19.6 (MD, 17.5; 95% CI: 12.1-23.0; P = 0.000); and in group B, from 59.3 ± 15.6 to 84.3 ± 10.1 (MD, 23.7; 95%CI: 18.9-28.5; P = 0.000), 49.1 ± 9.2 to 75.1 ± 13.2 (MD, 24.7; 95%CI: 19.9-29.5; P = 0.000), and 59.3 ± 9.0 to 77.4 ± 13.8 (MD, 17.2; 95%CI: 12.8-21.6; P = 0.000). CONCLUSION: Arthroscopy combined with UKA and UKA alone both provide benefits in clinical symptom improvement and alignment correction. Arthroscopy combined with UKA does not increase the infection probability and surgical complications, and has an advantage in reducing the total volume of blood transfusion and the percentage of patients receiving blood transfusion.

Effect of medial meniscus extrusion on arthroscopic surgery outcome in the osteoarthritic knee associated with medial meniscus tear: a minimum 4-year follow-up.

BACKGROUND: The potential benefit of arthroscopic surgery for osteoarthritic knee associated with medial meniscus tear is controversial. This study was conducted to determine the effect of pre-operative medial meniscus extrusion (MME) on arthroscopic surgery outcomes in the osteoarthritic knee associated with medial meniscus tear during a minimum 4-year follow-up. METHODS: This was a retrospective review of a total of 131 patients diagnosed with osteoarthritic knee associated with medial symptomatic degenerative meniscus tear who underwent arthroscopic surgery from January 2012 to December 2014 and were observed for more than 4 years. Patients were classified into two groups: MME ≥3 mm (major MME group, n = 54) and MME <3 mm (non-major MME group, n = 77). Clinical assessments, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and radiographic assessments, including the Kellgren-Lawrence (K-L) grade and medial joint space width (JSW), were evaluated pre-operatively and at final follow-up. The longitudinal changes of clinical and radiographic parameters (WOMAC and the medial JSW change, K-L grade progression) were compared between groups unadjusted and adjusted for age, sex, and body mass index. Four-year survival rates (without progression to knee replacement [KR]) were also evaluated using a log-rank test and Cox proportional hazard regression model. RESULTS: Major MME was present in 41% of patients. After a minimum 4-year follow-up, the mean WOMAC total and pain scores improved significantly in both groups. However, the medial JSW and K-L grade worsened significantly. Patients with pre-operative major MME worsened more in WOMAC total (adjusted mean difference [MD] 3.800, 95% confidence interval [CI]: 0.900, 11.400; P = 0.037) and function (adjusted MD 3.100, 95% CI: 0.700, 6.300; P = 0.038) scores than patients with pre-operative non-major MME, and no significant difference was observed in WOMAC pain and stiffness score between groups. The group with major MME had significantly higher joint space narrowing (adjusted MD -0.630, 95% CI: -1.250, -0.100; P = 0.021) and K-L rate progression (adjusted mean relative risk [RR] 1.310, 95% CI: 1.100, 1.600; P = 0.038) than the group with non-major MME. There was a significantly more KR progression in patients with major MME compared with those with non-major MME (adjusted RR 3.100, 95% CI: 1.100, 9.200; P = 0.042 and adjusted hazard ratio 3.500, 95% CI 1.100, 9.500; P = 0.022). CONCLUSIONS: Osteoarthritic knee patients associated with medial meniscus tear with non-major MME are more responsive to arthroscopic surgery in terms of the clinical and radiologic outcomes and survival for at least 4-year follow-up; however, in terms of pain relief, arthroscopic surgery in patients with major MME is also beneficial as well as in patients with non-major MME.

[Impacted cancellous autograft for reconstructing bone defects of tibial plateau in total knee arthroplasty].

OBJECTIVE: To observe the effects of a newly developed technique to transform the dish-like bone defect into contained bone defect and adopt the cancellous bone obtained from bone cut to make parvula impacted bone graft to repair the bone defect of tibial plateau in total knee arthroplasty (TKA) for osteoarthritis (OA) patients with severe varus or valgus. METHODS: 54 OA patients (74 knees) with severe varus or valgus (> 25 degrees ) received TKA. The average depth of the bone defect at the tibial plateau measured in the operation was 18.23 mm and the average thickness of the bone cut was 9.97 mm. The average depth of the dish-like bone defect left after bone cutting was 8.78 mm and the defect occupied averagely 31.5% of the total section area. The sclerotic bone layer was removed to the depth of the cancellous bone by saw blade or reamer, which made the defect to be contained. Small holes were drilled in the contained bone defect. Fragments 5-8 mm in diameter were made from the cancellous bone osteotomized from the femur and tibia were impacted into the bone defect. The defect was finally covered by a bone slice to make a flat tibial section allowing the tibia prosthesis to be firmly seated on it by routine technique. Follow-up was conducted for 32.2 months on average. RESULTS: The tibial deformity was repaired effectively and reliable support for the prosthesis at the tibia side was provided. Subsequent X ray films showed that no bone defect was seen under the prosthesis and the position of the prosthesis was fine. No autograft resorption and complete radiolucency between the graft and the tibial host bone appeared during the follow-up. The average KSS score raised from 45.6 preoperatively up to 94.5 postoperatively. CONCLUSION: In comparison with other techniques, the impacted autografting technique more effectively reconstructs the bone defects of tibial plateau in TKA. The cancellous bone obtained from the bony end can be used fully, thus over-cutting can be avoided and the mechanical characteristics of the knee joint would not be disturbed.

[Experimental study of prostheses modified by three dimensions porous Ti combined bone morphogenetic proteins].

OBJECTIVE: To observe bone ingrowth of artificial femur which three dimensions (3-D) porous Ti combined bone morphogenetic proteins (BMPs) integrating on the prostheses surface in dogs. METHODS: The prostheses integrated 3-D porous Ti on the surface, which combined BMPs directly or through FG, were implanted canine. And fluorescent labeling was done at 2, 5 weeks after that, and then the prostheses with femurs were taken out in 3, 6 weeks after operation. These specimens were treated, then observed through microscopy. RESULTS: At 3 weeks, bone growing 1/2 of full thickness in 3-D porous Ti, but bone growing full thickness in 3-D porous Ti at 6 weeks. Bone formation was obviously higher at 6 weeks than at 3 weeks. CONCLUSION: The prostheses modified 3-D porous Ti can accelerate osteogenesis and improve bone formation so that mechanical interlock and integration can be come true.

[Arthroscopically assisted radiofrequency probe to treat achilles tendinitis].

OBJECTIVE: To evaluate the effectiveness of micro-tenotomy using a radiofrequency (RF) probe to treat chronicity achilles tendinitis. METHODS: Seventeen cases of chronicity achilles tendinitis were treated by RF probe. Eleven cases were male, and 6 female. The average age of the patients was 25 (17-48) years. Nine were athlete, 4 sports activity and 4 students. Seven were in left side, and 10 right side. Before receiving the RF therapy all patients had achilles tendinitis symptoms. The patients were treated with local anesthesia under arthroscopy by Arthrocare 2000 and TOPAZ. The operation were performed through a artificial lacuna under the subcutaneous tissue of achilles tend, insert arthroscope. The pathology test found the achilles tendon surface fibrous tissue hyperplasia and tear. The probe of RF to perforate just as meshwork, the space was 3-5 mm. RESULTS: Patients reported significantly reduced pain from 7 to 14 d postoperatively. The symptoms of pain was completely disappeared in 15, obviously relieve in 2. The functional outcome was assessed using the VAS score evaluation, perioperative 8.7 and postoperative 1.6. There were no perioperative and postoperative complications related to the procedure, as rupture of achilles tendon, blood vessel and nerve injury. No infection and recur was found in the cases. CONCLUSIONS: RF therapy for chronicity achilles tendinitis under the arthroscopy with minimum invasion is less pain and easy for early rehabilitation. The result is satisfactory.

[Arthroscope monitored solution of adult intramuscular injection associated gluteal muscle contracture by radiofrequency].

OBJECTIVES: To evaluate the result of releasing adult intramuscular injection associated gluteal muscle contracture under the monitor of arthroscope by radiofrequency probe. METHODS: From June 2001 to June 2005, 108 cases of bilateral gluteal muscle contracture were treated with radiofrequency colation under the arthroscope and solution with an average age of 24 years (from 18 to 40 years). There were 57 males and 51 females. Preoperatively, the course of the outline of the femur greater trochanter the sciatic nerve in buttocks and the area of gluteal muscle contracture were marked. With the patients firmly anchored in the straight lateral position, normal saline (which contains Adnephrin) was injected between the surface of contracted gluteus and subcutaneous fat to reduce bleeding in operation. The ports for the motorized shaver and radiofrequency probe were located at the edge of gluteal muscle contracture and were 5 mm superior to the greater trochanter. The 6 mm diameter port for the arthroscope was 3 cm inferior to the greater trochanter. Space was made between contracture bands and overlying subcutaneous tissue with a periosteal elevator by blunt dissection. After the anterior and posterior edge of the contracture bands were fully revealed, normal saline were filled in the space. With the monitor of arthroscope, the procedures were: removing fatty tissue from the surface of the contracture bands with motorized shaver, then cutting off the contracture bands curve and carefully probing and cutting off contracture bands which were mixed in gluteus maximus with radiofrequency probe, finally hemostasis by radiofrequency probe. In the operation flexion, adduction, internal rotation and straightening hip joint were repeated, until it got normal range of motion without snap and bleeding. Results One hundred and one patients were followed up with an average of 19 months. According to a comprehensive evaluating system, 91 cases were excellent, 7 were good, and 3 were fair. No infection, recurrence and neurovascular injury occurred. CONCLUSIONS: Gluteal muscle contracture could be effectively released with radiofrequency vaporization and solution. The technique has the advantage of easy to manipulate, minimally invasive, painless, safety and reliable curative effect, and is good for early functional exercises.

Subchondral bone derived mesenchymal stem cells display enhanced osteo-chondrogenic differentiation, self-renewal and proliferation potentials.

Rabbit mesenchymal stem cells (MSCs) are important seed cells in regenerative medicine research, particularly in translational research. In the current study, we showed that rabbit subchondral bone is a reliable source of MSCs. First, we harvested subchondral bone (SCB) from the rabbit knee-joint and initiated the MSC culture by cultivating enzyme-treated SCB. Adherent fibroblast-like cells that outgrew from SCB fulfill the common immuno-phenotypic criteria for defining MSCs, but with low contamination of CD45+ hematopoietic cells. Interestingly, differentiated SCB-MSCs expressed osteogenic and chondrogenic markers at significantly higher levels than those in bone marrow cell suspension-derived MSCs (BMS-MSCs) (P<0.05). No differences in the expression of adipogenic markers between SCB-MSC and BMS-MSC (P>0.05) were observed. Moreover, the results of the colony forming unit-fibroblast assay and sphere formation assay demonstrated that the SCB-MSCs had increased self-renewal potential. SCB-MSCs expressed higher levels of the stemness markers Nanog, OCT4, and Sox-2 compared to in BMS-MSCs (P<0.05). Furthermore, the results of both the CCK-8-based assay and CFSE dilution assay showed that SCB-MSCs exhibited enhanced proliferative capacity. In addition, SCB-MSCs exhibited higher phosphorylation of extracellular signal-related kinase/mitogen-activated protein kinase signaling, which is closely related to MSC proliferation. In conclusion, we identified SCB-MSCs as a novel stem cell population that met the requirements of MSCs; the unique properties of SCB-MSC are important for the potential treatment of tissue damage resulting from disease and trauma.

Radial shockwave treatment promotes human mesenchymal stem cell self-renewal and enhances cartilage healing.

BACKGROUND: Shockwaves and mesenchymal stem cells (MSCs) have been widely accepted as useful tools for many orthopedic applications. However, the modulatory effects of shockwaves on MSCs remain controversial. In this study, we explored the influence of radial shockwaves on human bone marrow MSCs using a floating model in vitro and evaluated the healing effects of these cells on cartilage defects in vivo using a rabbit model. METHODS: MSCs were cultured in vitro, harvested, resuspended, and treated with various doses of radial shockwaves in a floating system. Cell proliferation was evaluated by growth kinetics and Cell Counting Kit-8 (CCK-8) assay. In addition, the cell cycle and apoptotic activity were analyzed by fluorescence activated cell sorting. To explore the "stemness" of MSCs, cell colony-forming tests and multidifferentiation assays were performed. We also examined the MSC subcellular structure using transmission electron microscopy and examined the healing effects of these cells on cartilage defects by pathological analyses. RESULTS: The results of growth kinetics and CCK-8 assays showed that radial shockwave treatment significantly promoted MSC proliferation. Enhanced cell growth was also reflected by an increase in the numbers of cells in the S phase and a decrease in the numbers of cells arrested in the G0/G1 phase in shockwave-treated MSCs. Unexpectedly, shockwaves caused a slight increase in MSC apoptosis rates. Furthermore, radial shockwaves promoted self-replicating activity of MSCs. Transmission electron microscopy revealed that MSCs were metabolically activated by shockwave treatment. In addition, radial shockwaves favored MSC osteogenic differentiation but inhibited adipogenic activity. Most importantly, MSCs pretreated by radial shockwaves exhibited an enhanced healing effect on cartilage defects in vivo. Compared with control groups, shockwave-treated MSCs combined with bio-scaffolds significantly improved histological scores of injured rabbit knees. CONCLUSIONS: In the present study, we found that radial shockwaves significantly promoted the proliferation and self-renewal of MSCs in vitro and safely accelerated the cartilage repair process in vivo, indicating favorable clinical outcomes.

[Clinical evaluation of small diameter decompression and arthroscopy in the treatment of early avascular necrosis of femoral head].

OBJECTIVE: To investigate the therapeutic effect of small diameter, multiple porous, low drill velocity decompression and hip arthroscopy in treatment of early avascular necrosis of femoral head (ANFH). METHODS: 226 ANFH patients (383 hips), 169 males (296 hips) and 57 females (87 hips), aged 36.5 (14 - 64), underwent drilling decompression with 3.5 mm Steinmann pin at a low velocity under the C-arm X-ray monitoring, all the 383 hips were decompressed with Steinmann pin, small diameter, multiple porous, low drill velocity. Synovectomy and cartilage trimming were performed through hip arthroscopy at the same time on the 209 hips combined with hip arthrosynovitis or cartilage trauma. 164 cases were followed up for 35 months (3 - 60 months). RESULTS: The Harris score was increased from 68 (56 - 78) pre-operatively to 79 (58 - 92) post-operatively. Excellent curative effect was found in 198 of the 383 hips (69.5%) with a Harris score > 80, medium curative effect was found in 70 hips (24.5%) with a Harris score between 70 and 79; and bad effect found in 17 hips (6.0%) with a Harris score < 69. During the follow-up, these 17 hips presented progress in staging of clinical course and collapse of femoral head. 139 hips with hydrops articuli were treated with arthroscopy, and 87 of the 139 hips underwent hip MRI during the follow-up. It was found that the hydrops articuli decreased in 59 hips and increased in 10 hips. Complications were found in 10 cases and all of them were recovered after treatment. CONCLUSION: The effect of small diameter, multiple porous and low drill velocity decompression is equal to or surpasses traditional core decompression. Small diameter decompression has the advantage of less osseous destruction of femoral head, delaying femoral head collapse and improving blood circulation in the necrosis zone of femoral head. Hip arthroscopy can greatly improve the therapeutic effect of ANFH through scavenging pain-producing substance, removing the cartilage chips caused by isolation or undermining dissection, and correcting internal environment disorder.