Systematic evaluation of the incidence of the knee donor area after autobone cartilage mosaic xentoplasty / 中国骨伤

OBJECTIVE@#To provide an overview of the incidence of knee donor -site morbidity after autologous osteochondral mosaicplasty.@*METHODS@#A comprehensive search was conducted in PubMed, EMbase, Wanfang Medical Network, and CNKI databases from January 2010 to April 20, 2021. Relevant literature was selected based on predefined inclusion and exclusion criteria, and data were evaluated and extracted. The correlation between the number and size of transplanted osteochondral columns and donor-site morbidity was analyzed.@*RESULTS@#A total of 13 literatures were included, comprising a total of 661 patients. Statistical analysis revealed an incidence of knee donor-site morbidity at 8.6% (57/661), with knee pain being the most common complaint, accounting for 4.2%(28/661). There was no significant correlation between the number of osteochondral columns and postoperative donor-site incidence (P=0.424, N=10), nor between the diameter size of osteochondral columns and postoperative donor-site incidence(P=0.699, N=7).@*CONCLUSION@#Autologous osteochondral mosaicplasty is associated with a considerable incidence of knee donor-site morbidity, with knee pain being the most frequent complaint. There is no apparent correlation between donor-site incidence and the number and size of transplanted osteochondral columns. Donors should be informed about the potential risks.

Clinical effects of arthroscopy-assisted anterior cruciate ligament tibial eminence avulsion fracture compared with traditional open surgery:a Meta-analysis / 中国骨伤

OBJECTIVE@#To systematically evaluate the clinical efficacy of arthroscopy and traditional incision in the treatment of tibial avulsion fracture of anterior cruciate ligament (ACL).@*METHODS@#From July 2010 to July 2020, clinical comparative trial about arthroscopy and traditional incision in the treatment of ACL tibial avulsion fracture was conducted by using computer-based databases, including Embase, Pubmed, Central, Cinahl, PQDT, CNKI, Weipu, Wanfang, Cochrane Library, CBM. Literature screening and data extraction were carried out according to the inclusion and exclusion criteria, and the quality of the included literature was evaluated by improved Jadad score and Ottawa Newcastle scale (NOS). The operation time, hospital stay, fracture healing time, knee range of motion, postoperative excellent and good rate, complication rate, Lysholm score, International Knee Documentation Committee (IKDC) score and Tegner score were statistically analyzed by Review Manager 5.3 software.@*RESULTS@#Finally, 16 literatures were included, including 1 randomized controlled trial and 15 non randomized controlled trials, with a total of 822 patients (405 in arthroscopy group and 417 in traditional incision group). Meta analysis showed that the operation time [MD=-9.03, 95% CI(-14.36, -3.70), P<0.001], hospital stay [MD=-5.81, 95%CI(-9.32, -2.31), P=0.001] and fracture healing time [MD=-14.61, 95% CI(-17.93, -11.28), P<0.001] in the arthroscopy group were better than those in the traditional incision group. The incidence of complications in arthroscopy group was lower than that in traditional incision group[OR=0.15, 95%CI(0.07, 0.33), P<0.001]. The postoperative excellent and good rate[OR=4.39, 95%CI (1.96, 9.82), P<0.001], knee mobility[MD=6.78, 95%CI(2.79, 10.77), P<0.001], Lysholm score[MD=11.63, 95%CI(4.91, 18.36), P<0.001], IKDC score[MD=7.83, 95%CI(6.09, 9.57), P<0.001] and Tegner score[MD=0.60, 95%CI(0.31, 0.89), P<0.001] in the arthroscopic group were higher than those in the traditional incision group.@*CONCLUSION@#Compared with the traditional open reduction and internal fixation, arthroscopic surgery in patients with ACL tibial avulsion fracture can shorten the operation time, hospital stay and fracture healing time, reduce the incidence of postoperative complications, and obtain good postoperative knee function. It can be recommended as one of the first choice for patients with ACL tibial avulsion fracture.

A short term clinical study of fibular osteotomy for knee osteoarthritis / 中国骨伤

<p><b>OBJECTIVE</b>To study clinical effects of fibular osteotomy for the treatment of knee osteoarthritis.</p><p><b>METHODS</b>From January 2015, 12 patients (15 knees) with knee osteoarthritis were treated with fibular osteotomy. The main symptom was interval inside pain. All the patients were female with an average age of 61.3 years old. Early postoperative ambulation of joints was carried out after surgery, and the corresponding radiographic assessment before and after operations were performed with record. Finally, the following indicators were analyzed:VAS, KSS, HSS, respectively before, 2 days and 2 months after the operation.</p><p><b>RESULTS</b>The average hospitalization time was (6.0±2.4) days, and the time of unilateral operation was (33.3±8.4) minutes without significant bleeding. There were no obvious complications such as wound infection, delayed healing and nerve damage. All the patients could walk around 1 day after operations with a chief complaint of the obvious reduction or disappear of the interval medial knee pain. The VAS score, HSS score and KSS clinical score were significantly improved 2 days after surgery compared to the scores before operation. These above scores and functional score were significantly improved 2 months after operation compared to the scores before operation. X ray films of the weight bearing knees were taken 2 days after surgery, showing increased height of medial joint space to some extent compared to that before operation.</p><p><b>CONCLUSIONS</b>A fibular osteotomy has been proved to significantly reduce the postoperative pain and facilitate the good recovery of joint function with the advantages of simple surgical procedures and slighttrauma. Therefore, it is an effective method for the treatment of knee osteoarthritis with varus deformity.</p>

Research on pericellular matrix properties for chondrcytes / 中国骨伤

Pericellular matrix (PCM) is a narrow tissue region surrounding chondrocytes, which "chondron" with its enclosed cells. A number of studies suggested that PCM is rich in proteoglycans, collagen and fibronectin, and plays an important role in regulating microenvironment of chondrocytes. Direct measures of PCM properties through micropipette aspiration technique showed that PCM was different from mechanical property of chondrocytes and nature extracellular matrix. However, the function of PCM is not clear, and need further study.

Normal age-related viscoelastic properties of chondrons and chondrocytes isolated from rabbit knee / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The mechanical microenvironment of the chondrocytes plays an important role in cartilage homeostasis and in the health of the joint. The pericellular matrix, cellular membrane of the chondrocytes, and their cytoskeletal structures are key elements in the mechanical environment. The aims of this study are to measure the viscoelastic properties of isolated chondrons and chondrocytes from rabbit knee cartilage using micropipette aspiration and to determine the effect of aging on these properties.</p><p><b>METHODS</b>Three age groups of rabbit knees were evaluated: (1) young (2 months, n = 10); (2) adult (8 months, n = 10); and (3) old (31 months, n = 10). Chondrocytes were isolated from the right knee cartilage and chondrons were isolated from left knees using enzymatic methods. Micropipette aspiration combined with a standard linear viscoelastic solid model was used to quantify changes in the viscoelastic properties of chondrons and chondrocytes within 2 hours of isolation. The morphology and structure of isolated chondrons were evaluated by optical microscope using hematoxylin and eosin staining and collagen-6 immunofluorescence staining.</p><p><b>RESULTS</b>In response to an applied constant 0.3 - 0.4 kPa of negative pressure, all chondrocytes exhibited standard linear viscoelastic solid properties. Model predictions of the creep data showed that the average equilibrium modulus (E(∞)), instantaneous modulus (E(0)), and apparent viscosity (m) of old chondrocytes was significantly lower than the young and adult chondrocytes (P < 0.001); however, no difference was found between young and adult chondrocytes (P > 0.05). The adult and old chondrons generally possessed a thicker pericellular matrix (PCM) with more enclosed cells. The young and adult chondrons exhibited the same viscoelastic creep behavior under a greater applied pressure (1.0 - 1.1 kPa) without the deformation seen in the old chondrons. The viscoelastic properties (E(∞), E(0), and m) of young and adult chondrons were significantly greater than that observed in young and adult cells, respectively (P < 0.001). The adult chondrons were stiffer than the young chondrons under micropipette aspiration (P < 0.001).</p><p><b>CONCLUSIONS</b>Our findings provide a theoretical model to measure the viscoelastic properties of the chondrons as a whole unit by micropipette aspiration, and further suggest that the properties of the chondrocytes and PCM have an important influence on the biomechanical microenvironment of the knee joint cartilage degeneration that occurs with aging.</p>

Case-control study on the relationship between body mass index and lower limb alignment of patients with knee osteoarthritis / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the relationship between body mass index and lower limb alignment of patients with knee osteoarthritis.</p><p><b>METHODS</b>From July 2008 to June 2010, 78 patients who suffered from severe knee osteoarthritis were treated with total knee replacement, including 17 males and 61 females, ranging from 41 to 85 years old, with an average age of 68.1 years. The Chinese average adult body mass index (BMI) classification standard was used to classify the patients into three groups: normal group, BMI<24.0, including 3 males and 11 females, totalized 14 patients (28 knees), with the mean age of (69.5 +/- 4.7); overweight group, 24.0 < or = BMI<28.0, including 4 males and 25 females, totalized 29 patients (58 knees), with the mean age of (66.4 +/- 7.9) years; and obese group, BMI > or = 28.0, including 10 males and 25 females, totalized 35 patients(70 knees), with the mean age of (69.1 +/- 8.3) years. The limb X-ray film measuring system was used to measure the lower limb alignment at the supine and weight-bearing position.</p><p><b>RESULTS</b>There were no statistical significances between the normal group and the overweight group in the knee varus angle at the supine and weight-bearing position (P>0.05). However, keen varus angle of the overweight group increased compared with the other two groups at the supine position,and the angle of the weight-bearing position increased nearly 2 degrees, but no statistical significance. There was no statistical significance between supine and weight-bearing position in the three groups of BMI, but the knee varus angle at the supine position was more than the weight -bearing position in the three groups.</p><p><b>CONCLUSION</b>The knee varus angle of obese patients with osteoarthritis in the weight-bearing position increases obviously. It indicates that obesity is an important factor increasing the angle of lower limb alignment.</p>