Mid-term outcomes of microfragmented adipose tissue plus arthroscopic surgery for knee osteoarthritis: A randomized, active-control, multicenter clinical trial.

BACKGROUND: Osteoarthritis (OA) is the most prevalent form of degenerative whole-joint disease. Before the final option of knee replacement, arthroscopic surgery was the most widely used joint-preserving surgical treatment. Emerging regenerative therapies, such as those involving platelet-rich plasma, mesenchymal stem cells, and microfragmented adipose tissue (MFAT), have been pushed to the forefront of treatment to prevent the progression of OA. Currently, MFAT has been successfully applied to treat different types of orthopedic diseases. AIM: To assess the efficacy and safety of MFAT with arthroscopic surgery in patients with knee OA (KOA). METHODS: A randomized, multicenter study was conducted between June 2017 and November 2022 in 10 hospitals in Zhejiang, China. Overall, 302 patients diagnosed with KOA (Kellgren-Lawrence grades 2-3) were randomized to the MFAT group (n = 151, were administered MFAT following arthroscopic surgery), or the control group (n = 151, were administered hyaluronic acid following arthroscopic surgery). The study outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, the visual analog scale (VAS) score, the Lequesne index score, the Whole-Organ Magnetic Resonance Imaging Score (WORMS), and safety over a 24-mo period from baseline. RESULTS: The changes in the WOMAC score (including the three subscale scores), VAS pain score, and Lequesne index score at the 24-mo mark were significantly different in the MFAT and control groups, as well as when comparing values at the posttreatment visit and those at baseline (P < 0.001). The MFAT group consistently demonstrated significant decreases in the WOMAC pain scores and VAS scores at all follow-ups compared to the control group (P < 0.05). Furthermore, the WOMAC stiffness score, WOMAC function score, and Lequesne index score differed significantly between the groups at 12 and 24 mo (P < 0.05). However, no significant between-group differences were observed in the WORMS at 24 mo (P = 0.367). No serious adverse events occurred in both groups. CONCLUSION: The MFAT injection combined with arthroscopic surgery treatment group showed better mid-term clinical outcomes compared to the control group, suggesting its efficacy as a therapeutic approach for patients with KOA.

[Clinical application of acromion radiological classification in diagnosis and treatment of rotator cuff injury].

OBJECTIVE: To develop a new classification of acromion based on the subacromial impingement theory and the Rockwood tilt view. And explore the application value of the new classification in the diagnosis and treatment of rotator cuff tear. METHODS: The clinical data of 101 patients underwent shoulder arthroscopic surgery for impingement syndrome or rotator cuff tear from January to December 2017 were retrospectively analyzed. There were 34 males and 67 females, aged from 34 to 76 years with an average of (56.31±9.63) years old, course of disease from 2 to 12 months with average of 6 months. Preoperative radiographs of the routine anteroposterior view, Rockwood tilt view and the supraspinatus outlet view were obtained. Based on the subacromial impingement theory and Rockwood radiographs, the morphology of the acromion can be divided into three types:typeⅠ(flat type), typeⅡ(bump type), and type Ⅲ (impingement type). Two observers classified 101 shoulder Rockwood radiographs according to the new classification method and the supraspinatus Outlet radiographs according to the traditional acromial morphological classification method. Supraspinatus tendon injuries were classified into no tear, partial-thickness tear, and full-thickness tear according to the arthroscopic findings. Concordance test (Kappa value) between the inter-observer and intra-observer was carried out for the new classification method and the traditional classification method respectively. The rank sum test was used to compare the mean acromiohumeral distance(AHD) of the three acromion forms in the new acromion classification method. Spearman rank correlation test and Gamma method were used to analyze the correlation between the new acromion classification method and the degree of supraspinatus tendon tear. RESULTS: The inter-observer consistency analysis of the new classification system was significantly better than that of the traditional classification (0.827 vs 0.278), the intra-observer consistency analysis of the new classification system were also significantly better than that of the traditional classification (0.921 vs 0.448, 0.890 vs 0.539). There was no statistical significance in the AHD among three types of the new classification(H=2.186, P>0.05). In all 101 patients, the highest proportion of impingement type acromion was 45.5% (46 cases), followed by bump type acromion was 36.6% (37 cases), and flat type acromion was 17.8% (18 cases). The incidence of supraspinatus tendon tear in the patients with impingement type acromion was significantly higher than that of the other two types of acromion, there was a spearman rank correlation between the new acromion type and the degree of the supraspinatus tendon tear(rs=0.719, P<0.001). CONCLUSION: Rockwood radiographs of the shoulder can well display the anterolateral osteophytes of the acromion. The new acromion classification method based on Rockwood radiographs has high reliability and good reproducibility, in which impingement type of acromion is closely related to supraspinatus tendon tear. Compared with the traditional classification and AHD, the new classification method has more diagnostic value than for rotator cuff injury.

[Arthroscopic treatment for the calcific tendinitis at soft tissues around hip].

OBJECTIVE: To explore the feasibility and clinical effects of arthroscopic treatment for the calcific tendinitis at soft tissues around hip. METHODS: A total of 16 patients diagnosed as the calcific tendinitis at soft tissues around hip from May 2013 to July 2018 were retrospectively analyzed. All the 16 patients received arthroscopic procedures. There were 10 males and 6 females with an average age of 35 to 63 (44.50±6.67) years old and 9 left hips, 6 right hips were involved. The course of disease were 1 to 8(3.18±1.97) days. Clinical effects were evaluated with visual analogue scale(VAS), modified Harris hip scores (HHS), nonarthritic hip score (NAHS) and imaging examinations before operation, 1 day after operation and the final follow-up. RESULTS: All 16 patients successfully finished the arthroscopic procedures in 0.5 to 1.2 (0.75±0.21) hours. Primary healing of incision were obtained without any complications of infection, wound hematocele and neurovascular injury. All 16 patients received an average postoperative follow-up of 6 to 12 (9.6±2.3) months. Before operation, the VAS were 7.88±0.72, modified HHS were 29.25±3.23, NAHS were 27.42±3.08. The 1st day postoperative VAS were 2.19±0.66, modified HHS were 82.56± 5.64, NAHS were 82.11±2.94, all the difference were statistically significant between before and 1 day after operation (P< 0.05). At the final follow-up, the VAS were 0.38±0.50, modified HHS were 94.31±2.82, NAHS were 94.84±2.85, all the scores were improved significantly compared to that before operation (P<0.05). At final follow-up, there was no recurrence and the calcification disappeared in all patients, there was one patient feel sourness around the hip. CONCLUSION: Arthroscopic treatment for the calcific tendinitis at soft tissues around hip is effective.It has advantages of minimal invasive, rapid pain relief, rapid hip joint function recovery and definite clinical effects.

[Prospective cases-control study on arthroscopic for the treatment of ischial tuberosity cyst].

OBJECTIVE: To compare technique and clinical effect of arthroscopic and conventional sectional therapy for the treatment of ischial tuberosity cyst. METHODS: From May 2014 and September 2016, 49 patients with symptomatic ischial tuberosity cyst were randomized divided into arthroscopic group and conventional section group by envelope method. There were 24 patients in arthroscopic group, including 16 males and 8 females aged from 42 to 81years old with an average age of (64.1±9.3) years old;the courses of disease ranged from 2 to 36 months with an average of (17.0±9.1) months;treated with removing cyst wall under arthroscopic and build artificial lacuna around cyst. There were 25 patients in conventional section group, including 11 males and 14 females aged from 47 to 79 years old with an average of (61.2±10.6) years old; the courses of disease ranged from 4 to 36 months with an average of (17.5±8.5) months;treated with cutting off lump with transverse incision. Operative time, blood loss, fluid volume, hospital stays and postoperative complication were observed and compared, VAS score were applied to evaluate pain degree. RESULTS: Forty-nine patients were followed up from 6 to 18 months with an average of (11.3±3.3) months. In conventional group, 2 patients occurred incision infection, 1 case reoccurred. All patients in arthroscopic group were healed at stage I. Operative time, blood loss, fluid volume, and hospital stays in arthroscopic group were (54.7±7.7) min, (20.8±3.5) ml, (20.3±5.6) ml, (2.8±0.6) d respectively and better than that of conventional group(71.8±8.8) min, (67.3±12.0) ml, (103.6±20.3) ml, (7.8±2.9) d. Postoperative VAS score in arthroscopic group on the first day, seventh days and first month were 2.6±0.7, 0.5±0.6, 0.3±0.5, and significantly lower than that of conventional group 6.0±0.7, 3.0±1.0, 1.1±1.0 respectively(P<0.05). There were no statistical difference in postoperative complications between two groups(P>0.05). CONCLUSIONS: Compared with conventional group, arthroscopic for ischial tuberosity cyst has advantages of minimal invasive, less blood loss during perioperative period, less pain degree after surgery, safety and rapid recovery. But arthroscopic skills are needed for surgeons. It should be recommended in clinical practice.

Lycium barbarum polysaccharide arbitrates palmitate-induced apoptosis in MC3T3­E1 cells through decreasing the activation of ERS­mediated apoptosis pathway.

Palmitate (PA) has been identified to induce cell apoptosis in osteoblasts. The c­Jun NH2­teminal kinase (JNK) signaling pathway and endoplasmic reticulum stress (ERS) were found to be important contributors. Therefore, natural or synthetic agents may antagonize PA­induced apoptosis in osteoblasts, and demonstrate the potential application to reverse osteoporosis. The present study demonstrated that the Lycium barbarum polysaccharide (LBP) is as a major active ingredient of Lycium barbarum and that it can reduce the fatty acid toxicity of PA. Furthermore, this study attempted to elucidate the underlying molecular mechanisms of LBP. Firstly, it was demonstrated via a Cell Counting Kit­8 assay, that LBP could significantly increase the viability of MC3T3­E1 cells in a dose­dependent manner. Flow cytometric analysis indicated that LBP inhibits PA­induced apoptosis in osteoblastic cells. Reverse transcription­quantitative polymerase chain reaction and western blotting results showed that the expression levels of glucose­regulated protein 78, C/EBP homologous protein and cysteinyl asparate specific proteinase­3/­9/­12, were increased in MC3T3­E1 cells following PA treatment. The treatment of the cells with PA resulted in an activation of the ERS and the JNK signaling pathway. These pathways were effectively suppressed by co­incubation with LBP. Taken together, PA may cause ERS, in cell apoptosis, and it may further activate the JNK signaling pathway. LBP reversed PA­induced apoptosis in MC3T3­E1 cells through inhibition of the activation of the ERS­mediated JNK signaling pathway.

[Replacement of humeral head prosthesis for four-part proximal humeral fractures or fracture-dislocations].

OBJECTIVE: To evaluate the short-term results of humeral head replacement for the treatment of four-part proximal humeral fractures or fracture-dislocations. METHODS: Twenty-five patients (11 male and 14 female)with four-part proximal humeral fractures or fracture-dislocations underwent humeral head replacement. The average age was 68.2 years (ranging from 56 to 77 years). All cases were followed up and evaluated the clinical results including pain, function and range of motion of shoulder with Neer scoring system. RESULTS: The follow-up ranged from 12 to 40 months with an average time of 29.3 months. No prosthesis loosening, prosthesis dislocation, postoperative infection, nerve injury or periprosthesis fractures occurred. The results were excellent in 8 cases, good in 11 cases and fair in 6 cases. The excellent and good rate was 76% according to Neer scoring system. CONCLUSION: Replacement of humeral head prosthesis could attain good short-term results for four-part proximal humeral fractures or fracture-dislocations. The key to improve the postoperative results is meticulous surgical techniques and appropriate correct consecutive physical therapy.