Diagnostic value of the lateral femoral notch sign and kissing contusion in patients with anterior cruciate ligament injuries: a case-control study.

INTRODUCTION: The lateral femoral notch sign (LFNS) and the kissing contusion (KC) are two indirect signs of anterior cruciate ligament (ACL) injuries. They can be used to diagnose ACL injuries. MATERIALS AND METHODS: A total of 1000 patients were enrolled in this study, including 500 patients with ACL injuries who assigned to experimental group and 500 patients with meniscal tear (MT) who allocated to control group. All the patients underwent magnetic resonance imaging (MRI) preoperatively, and the diagnosis was confirmed with the aid of arthroscopy. The depth of LFNS and the presence of KC were determined on MRI findings. The relationship and characteristics between these two indicators was explored. RESULTS: The notch depth of lateral femoral condyle in the experimental group (0.99 ± 0.56 mm) was significantly greater than that in the control group (0.49 ± 0.28 mm) (P < 0.05). The positive rate of KC in the experimental group (183/500) was markedly higher than that in the control group (3/500) (P < 0.05). The values of notch depth in patients who had ACL rupture concomitant lateral MT injuries and medial collateral ligament (MCL) injuries were 1.12 ± 0.64 and 1.23 ± 0.74 mm, respectively, which were significantly higher than those in patients with only ACL injury (0.89 ± 0.49 mm) (P < 0.05). It also was revealed that when the optimal cut-off point of LFNS was 0.72 mm (area under the curve (AUC) = 81%), the values of specificity and sensitivity were 67% and 84%, respectively. For KC, the corresponding values were 36.6% and 99.4%, respectively. The diagnostic outcome of LFNS was not in agreement with that of KC, as there was a poor coincidence according to the Kappa coefficient (Kappa = 0.155 < 0.4, P = 0.035). CONCLUSION: The LFNS and KC have strong clinical significance in the diagnosis of ACL injuries. A deeper notch often indicates a more complex knee injury. Notch depth equal to 0.72 mm can be basically considered as the optimal cut-off point for LFNS in statistics.

Clinical Use of Platelet-Rich Plasma to Promote Tendon-Bone Healing and Graft Maturation in Anterior Cruciate Ligament Reconstruction-A Randomized Controlled Study.

Background: We investigated the effect of platelet-rich plasma (PRP) on tendon-bone healing and intra-articular graft (IAG) maturation after anterior cruciate ligament (ACL) reconstruction. Methods: In this prospective randomized controlled study, 60 patients with ruptured ACLs were divided one-to-one into two groups (study and control). Patients were treated using single-bundle autologous hamstring autografts. Only patients in the study group were administered PRP. Knee function (pre-operative and three-, six-, and 12-month post-operative Lysholm activity, Tegner and International Knee Documentation Committee scores, femoral tunnel (FT) and tibial tunnel (TT) diameters measured with computed tomography (post-operative follow-up at 4 days and at 12 months), and magnetic resonance imaging signal/noise quotients of the IAG and graft in the FT (at 12 months) were used to evaluate tendon-bone healing and graft maturation. Results: Patients' knee function scores improved after ACL reconstruction, but there were no significant differences between groups. At 12 months, FT (study, 8.88 ± 1.46 mm; control, 8.42 ± 2.75 mm) and TT (study, 9.50 ± 1.07 mm; control, 9.99 ± 1.91 mm) diameters were larger than FT (study, 6.91 ± 0.74 mm; control, 7.30 ± 1.17 mm) and TT (study, 9.31 ± 0.83 mm; control, 9.36 ± 0.88 mm) diameters at 4 days; however, differences between groups were not significant (FT, P = 0.67; TT, P = 0.52). There were no significant differences between groups for signal/noise quotients of the IAG (study, 1.38 ± 0.70; control, 2.01 ± 0.62; P = 0.06) and FT-portion of the graft (study, 2.39 ± 1.22; control, 2.46 ± 0.83; P = 0.89). Conclusion: PRP had no significant effect on reducing bone tunnel widening, accelerating tendon-bone healing, or improving knee function; however, PRP may improve IAG maturation. Trial registration: Our study was first registered at Clinicaltrials.gov with registration No. NCT04659447 on 12/09/2020.

Morphological Characteristics of Acromion and Acromioclavicular Joint in Patients with Shoulder Impingement Syndrome and Related Recommendations: A Three-Dimensional Analysis Based on Multiplanar Reconstruction of Computed Tomography Scans.

To find out which structure is crucial for the formation of shoulder impingement syndrome with the purpose of directing surgical procedures of subacromial decompression and discussing whether it is necessary to manage acromioclavicular joint during operation and how to do it properly. METHODS: This was a retrospective study. Clinical data and preoperative computed tomography (CT) images were collected from patients who were diagnosed with rotator cuff tears between January 2017 and August 2019 (sample size: 46) and those who were diagnosed without rotator cuff tears between March 2018 and August 2019 (sample size: 44) in our institution, respectively. Three-dimensional models of shoulders were established by multiplanar reconstruction of CT scans and measurements were performed on these models. The parameters such as the acromial length and width, the axial tilt, and the distance from acromial margin to glenoid plane were measured in an adjusted axial plane, and the critical shoulder angle and the spatial volume under acromioclavicular joint were measured in an adjusted coronal plane. The demographic characteristics, the acromial morphology and the spatial volume under acromioclavicular joint were compared to find significant differences between the two groups. The association between the axial tilt and the distance from acromial margin to glenoid plane was evaluated by an ordinary least squares linear regression. RESULTS: The patients with rotator cuff tears consisted of 16 males and 30 females, among which 30 right shoulders and 16 left shoulders were included. The patients without rotator cuff tears consisted of 28 males and 16 females, among which 15 right shoulders and 29 left shoulders were involved. Significant differences between the groups were found in the acromial width (3.332 cm vs 3.111 cm), the axial tilt (33.765° vs 23.829°), the critical shoulder angle (32.630° vs 30.363°), the distance from anterior 3 cm of lateral acromial margin (range, 2.476 cm-3.302 cm vs 1.993 cm-3.089 cm), and anterior 0.9 cm of medial acromial margin (range, 0.967 cm-2.369 cm vs 0.668 cm-1.993 cm) to glenoid plane, and the spatial volume under acromioclavicular joint (1.089 cm vs 1.446 cm) in the two groups. No significant differences were found in the age (60.0 years vs 58.3 years) or the acromial length (4.187 cm vs 4.184 cm). Significant association was revealed by linear regression analysis between the axial tilt and the distance from anterior two-thirds of lateral acromial margin to glenoid plane, and similar association was also found in the anterior half of medial margin. CONCLUSION: Anterior two-thirds of lateral acromial margin, anterior half of medial acromial margin, and inferior aspect of acromioclavicular joint are crucial structures and need to be fully decompressed when treating patients with rotator cuff tears.

The rs6427384 and rs6692977 Single Nucleotide Polymorphisms of the Fc Receptor-Like 5 (FCRL5) Gene and the Risk of Ankylosing Spondylitis: A Case Control Study in a Single Center in China.

BACKGROUND The study aimed to explore the genetic association of Fc receptor-like 5 (FCRL5) gene variants (rs6427384 and rs6692977) with ankylosing spondylitis risk in Chinese Han population. MATERIAL AND METHODS Genotyping for FCRL5 gene variations rs6427384 and rs6692977 was implemented among 130 ankylosing spondylitis cases and 135 healthy persons, through polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) method. Frequency dissimilarity for 2 polymorphisms was compared between 2 groups using chi-square test. The association strength of FCRL5 gene polymorphism with ankylosing spondylitis risk was estimated by odds ratios with 95% confidence intervals. RESULTS The frequencies of rs6427384 CC genotype and C allele were significantly lower in the case group than that in the control group (P<0.05), which suggested that C allele of rs6427384 polymorphism might offer protection against ankylosing spondylitis onset. Whereas only 2 genotypes of rs6692977 were detected in the control group, and no significant association was found with ankylosing spondylitis susceptibility. CONCLUSIONS FCRL5 gene polymorphism rs6427384 was correlated to ankylosing spondylitis occurrence among Chinese Han population, while rs6692977 was not.

RUNX3 Polymorphisms Affect the Risk of Ankylosing Spondylitis.

BACKGROUND We aimed to assess the potential association of runt-related transcription factor 3 (RUNX3) gene variants with ankylosing spondylitis (AS) susceptibility among Chinese Han people. MATERIAL AND METHODS Genotyping for RUNX3 variants was accomplished through polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in 115 AS patients and 102 healthy controls. Genotypes distributions of the polymorphisms in controls was assessed for their deviation from Hardy-Weinberg equilibrium (HWE). Moreover, odds ratio (OR) with 95% confidence interval (95%CI) was achieved using chi-square analysis to evaluate AS risk related to RUNX3 polymorphisms. Additionally, logistic regression analysis produced adjusted OR values. RESULTS Genotypes distribution of rs760805 and rs11249206 polymorphisms conformed to HWE in the control group (P>0.05). TT genotype of rs760805 appeared more frequently among AS cases than in controls (P=0.033), indicating its significant association with increased risk of AS onset (OR=2.309, 95%CI=1.069-4.892). The carriage of T allele in rs760805 also heightened AS incidence, in comparison to A allele (OR=1.578, 95%CI=1.075-2.316, P=0.020). Moreover, the carriage of AT+TT genotype in rs760805 and TT genotype in rs11249206 obviously increased risk of AS onset (OR=2.585, 95%CI=1.062-6.288). CONCLUSIONS RUNX3 rs760805 polymorphism can contribute to AS incidence in Chinese Han people. The interaction of the 2 polymorphisms may be a risk factor for AS.

MiR-596 inhibits osteoblastic differentiation and cell proliferation by targeting Smad3 in steroid-induced osteonecrosis of femoral head.

BACKGROUND: It is reported that miR-596 has a potential diagnostic value for non-traumatic osteonecrosis of the femoral head (NOFH), but its underlying mechanisms in NOFH is unclear. METHODS: The expression of miR-596 and Smad3 was detected by western blot and quantitative real-time PCR. The relationship between the two molecules was explored using Dual-Luciferase Reporter Assay. Glucocorticoid (GC)-dexamethasone, was used to induce bone marrow mesenchymal stem cell (BMSC) osteogenic differentiation, and the effects of miR-596 on BMSC osteogenic differentiation and proliferation were determined. RESULTS: MiR-596 expression was upregulated, while Smad3 expression was inhibited in the bone marrow samples of patients with steroid-induced osteonecrosis of femoral head (SANFH). Overexpression of miR-596 inhibited the proliferation and osteogenic differentiation of BMSCs induced by GC. Meanwhile, the opposite results were observed in the miR-596 inhibitor group. In addition, Smad3 was a target gene of miR-596, and negatively regulated by miR-596. The promotion effect of the miR-596 inhibitor on BMSC proliferation and osteogenic differentiation was reversed by si-Smad3. CONCLUSION: MiR-596 can suppress GC-BMSC osteoblastic differentiation and proliferation by regulating Smad3 expression.

Three-dimensional augmented reality surgical navigation with hybrid optical and electromagnetic tracking for distal intramedullary nail interlocking.

BACKGROUND: Intramedullary nail (IMN) fixation improves functional outcomes for the diaphyseal fractures of long bones. However, locking the distal holes of the IMN is challenging. Although several navigation methods have been proposed, an intuitive, radiation-free and accurate navigation method that does not suffer from problems of hand-eye coordination has not yet been described. METHODS: This paper proposes an augmented reality (AR) surgical navigation method with hybrid optical and electromagnetic (EM) tracking for distal IMN interlocking. Model experiments are designed to evaluate the AR-guided distal interlocking method. RESULTS: AR-guided drilling procedures were performed on 5 tibia models and a leg phantom. The accuracy (hit or miss) was evaluated using fluoroscopy. The experimental results demonstrated that all 18 drills successfully hit the distal holes at a rate of 100%. CONCLUSIONS: Our results indicate that the AR-guided distal interlocking method is feasible and has many potential applications in clinic after further evaluation.

Augmented reality surgical navigation with ultrasound-assisted registration for pedicle screw placement: a pilot study.

PURPOSE: We present a novel augmented reality (AR) surgical navigation system based on ultrasound-assisted registration for pedicle screw placement. This system provides the clinically desired targeting accuracy and reduces radiation exposure. METHODS: Ultrasound (US) is used to perform registration between preoperative computed tomography (CT) images and patient, and the registration is performed by least-squares fitting of these two three-dimensional (3D) point sets of anatomical landmarks taken from US and CT images. An integral videography overlay device is calibrated to accurately display naked-eye 3D images for surgical navigation. We use a 3.0-mm Kirschner wire (K-wire) instead of a pedicle screw in this study, and the K-wire is calibrated to obtain its orientation and tip location. Based on the above registration and calibration, naked-eye 3D images of the planning path and the spine are superimposed onto patient in situ using our AR navigation system. Simultaneously, a 3D image of the K-wire is overlaid accurately on the real one to guide the insertion procedure. The targeting accuracy is evaluated postoperatively by performing a CT scan. RESULTS: An agar phantom experiment was performed. Eight K-wires were inserted successfully after US-assisted registration, and the mean targeting error and angle error were 3.35 mm and [Formula: see text], respectively. Furthermore, an additional sheep cadaver experiment was performed. Four K-wires were inserted successfully. The mean targeting error was 3.79 mm and the mean angle error was [Formula: see text], and US-assisted registration yielded better targeting results than skin markers-based registration (targeting errors: 2.41 vs. 5.18 mm, angle errors: [Formula: see text] vs. [Formula: see text]. CONCLUSION: Experimental outcomes demonstrate that the proposed navigation system has acceptable targeting accuracy. In particular, the proposed navigation method reduces repeated radiation exposure to the patient and surgeons. Therefore, it has promising prospects for clinical use.

Therapeutic experience with primary liposarcoma from the sigmoid mesocolon accompanied with well-differentiated liposarcomas in the pelvis.

Multifocal liposarcoma with different histological types is rare, especially that originating from the mesentery. We herein report a case of primary myxoid liposarcoma from the sigmoid mesocolon that was accompanied with well-differentiated liposarcomas in the pelvis. The location, the fat signal and the relationship with adjacent organs of the liposarcomas were well shown in the axial, coronal and sagittal dimensions of MRI, giving a comprehensive and specific image before surgery. To alleviate the patient's symptoms and mental stress, a laparotomy was performed. The tumors were all completely excised with macroscopic free margins. The final histopathological report showed that the tumor in the sigmoid mesocolon was a pure myxoid liposarcoma, while the pelvic tumors were spindle cell liposarcomas, a special type of well-differentiated liposarcoma. According to the AJCC staging system, they were all stage IIB. No further adjuvant therapy was performed. Close follow-up after the surgery has been performed, and the patient has remained healthy without any evidence of recurrence or metastasis for 17 months after the surgery.