Preparation and characterization of bone marrow mesenchymal stem cell-derived extracellular matrix scaffolds.

The aim of this study was to assess the feasibility of creating extracellular matrix (ECM) scaffolds from mesenchymal stem cells. Bone marrow mesenchymal stem cell (BMSC)-derived ECM (BMSC-dECM) scaffolds were fabricated by lyophilization after crosslinking, without using a decellularization process. Acellular porcine chondrocyte-derived ECM (AC-dECM) scaffolds were used as a control. The surface morphology, internal structure, water uptake ratio, mechanical properties, and biocompatibility of the scaffolds, as well as the in vitro behavior of cells grown on the scaffolds were examined and compared between the two scaffold types. For the BMSC-dECM scaffolds, the average pore size was 304.4 ± 108.2 µm, average porosity was 93.3% ± 4.5%, average compressive modulus was 6.8 ± 1.5 kPa, and average water uptake ratio exceeded 20. The BMSC-dECM scaffolds supported the in vitro attachment and proliferation of cells, with these aspects likely being comparable to those of the AC-dECM scaffolds. The findings of this preliminary study highlight the potential utility of BMSC-derived ECM scaffolds for future cartilage tissue-engineering applications.

[Application of monitoring phosphocreatine kinase continuously and dynamically in early diagnosis of compartment syndrome].

OBJECTIVE: To determine the efficacy of phosphocreatine kinase in the early diagnosis of compartment syndrome. METHODS: Forty patients with compartment syndrome of limbs were reviewed from 2005 to 2008 including 34 males and 6 females with an average age of (37.03 +/- 13.02) years. Monitoring phosphocreatine kinase continuously and dynamically after injured 2, 24 hours, 1, 2, 3 and 4 weeks later. The concentration of CK were measured by using Japanese Olympus automatic biochemistry analysator. The muscle preparations from affected extremity were taken after operation and 1, 2, 3 weeks later for biopsy. RESULTS: Two hours later after injury, the contents of CK increased sharply and the contents of CK were about 20 times more than the nomal. Twenty-four hours later, the contents of CK reached its maximum,the contents of CK were about 42 times more than the nomal. One week later, the contents of CK recovered to normal level. Pathological changes of muscle were irreversible. CONCLUSION: The change of the contents of CK can reflect the progression of disease objectively. If it increased sharply, the chance of compartment syndrome was high. Monitored it dynamicly and continuously can provide assistant for early diagnosis of compartment syndrome and evaluating pathogenetic condition.

[Arthroscopic release to treat subtalar stiffness after calcaneal fracture].

OBJECTIVE: To report the results of arthroscopic release to treat subtalar stiffness after calcaneal fractures. METHODS: From September 2004 to December 2006, 10 cases of subtalar stiffness were treated. There were 8 male and 2 female cases, with an average age of 36 years old (ranging from 18 to 48). All, but 2 cases, had single subtalar involvement. The routine triple portals (lateral, anterolateral, posterolateral portals) were applied with the patient placed in the lateral decubitus position. The anterior capsule, lateral gap, calcaneofibular ligament, posterior capsule together with the posteromedial corner of the subtalar joint were released step by step under arthroscopic control. Finally, manual release was performed. RESULTS: All cases were followed-up for 12 to 36 months (mean, 24.5 months). According to the AOFAS hindfoot activity rating scale, 10 cases were rated as Grade III, 2 as Grade II before the surgery. Nine cases were improved to Grade I, 3 to Grade II at the last follow-up after the surgery. AOFAS hindfoot scores were significantly improved from 71.4 before the surgery to 90.6 at the last follow-up (P < 0.01). All cases returned to the previous work at an average of 1.8 months (range, 1 to 3 months) after the surgery. CONCLUSION: Arthroscopic release to treat subtalar stiffness after calcaneal fracture has such advantages as minimally-invasiveness, simplicity and effectiveness.

[Surface-replacement total hip arthroplasty in the treatment of the femoral head osteonecrosis].

OBJECTIVE: To evaluate the outcome and indication of surface-replacement total hip arthroplasty in the treatment of the femoral head osteonecrosis. METHODS: The clinical data of 17 patients (21 hips) with femoral head osteonecrosis were reviewed. Among which, 10 cases were male and 7 cases were female, the average age was 36 years old (ranging from 25 to 51 years). There were 8 hips at Ficat stage III and 10 hips at Ficat stage IV. The 17 patients (21 hips) underwent surface-replacement total hip arthroplasty. Gibson posterolateral incision was used and non-cemented prosthesis was implanted. For prosthetic femoral head fixation, a guide pin was inserted into the capital center. After hollow boring hit drilling, a guide pole was inserted, and redundancy of femoral head was rasped off with cutterbar. The bone cement was painted on the femoral head and prosthesis, and the prosthesis was planted into the central axis hole of neck of femur until bone cement solidification. The therapeutic effects were evaluated by Harris hip score and statistical analysis was made. The X-ray was rechecked regularly. RESULTS: The mean duration of follow-up was 32 months (18 to 42 months). The average Harris hip score was improved significantly from preoperative 35.30 +/- 5.23 to postoperative 90.47 +/- 3.14, and the excellent and good rate was 90.5%. There were high statistical differences between preoperative and postoperative Harris score (P < 0.01). The X-ray showed radiolucent line around acetabular prostheses in two patients but without prostheses loosening. CONCLUSION: Surface-replacement total hip arthroplasty is a satisfactory way for the treatment of femoral head osteonecrosis in the middle-late phase, which can help reconstructing normal joint biomechanics and load transmission,improving joint stability and postponing THA without affecting later rebuilding, as well as some advantages such as decreasing surgical wound, convenient and low infection rate. Its indication is Ficat stage III and part Ficat stage IV femur head necrosis with less destroyed neck of femur,especially for young patients having a large amount of activity.

[Computer assisted imaging guided total knee arthroplasty: preliminary clinical study of 46 cases].

OBJECTIVE: To discuss the approach and curative effect of total knee arthroplasty by intraoperative digital 3D bone mode. METHODS: 28 patients with bone arthritis, 7 with rheumatoid arthritis, 7 with ankylosing spondylitis, totally 46 patients with 54 knees affected, 29 males and 17 females, aged 48 (31 - 76), underwent total knee arthroplasty by digital 3D bone mode, including osteotomy, adjustment of soft tissue, and rotational positioning of prostheses. The operative time, hemorrhage and drainage 48 h after operation, and complication were observed. The pre-postoperative knee function was evaluated by HISS scoring system. The pre-postoperative range of motion of knee joint, and angle of KNA, variance of angle in exterior and interior stress and separation of joint space in tensile force, and postoperative rotational angle of tibia-femur prostheses were measured. X-ray tangential projection photography of patella was used to evaluate the apposition of patellofemoral joint. The postoperative curative effect was observed for 3 months. RESULTS: No complication as injury of nerves and blood vessel, bone fracture, fat embolism and so on was observed. The operative time was 80 +/- 15 min per knee. The hemorrhage and drainage in 48 h was 550 +/- 60 ml per knee. The Hand Injury Severity Score (HISS) 2 weeks after the operation was (92 +/- 4), significantly higher than that before operation [(46 +/- 6), P < 0.01]. There were statistically significant differences in the KNA angle, variance of angle under exterior stress, interior stress, and separation of joint space in tensile force pre- and postoperatively (all P < 0.01). The postoperative rotational angle of tibia-femur prostheses was (4.2 +/- 0.4) degrees. The X-ray tangential projection photograph of patella showed excellent apposition of patellofemoral joint, and no dislocation and unsteadiness. The postoperative range of motion of knee joint was 120 degrees +/- 9 degrees 3 months after operation. No joint laxity was found. CONCLUSION: Computer assisted imaging guidance actually and dynamically observe the changes of line of force of the lower limbs, knee joint rotational apposition and ligament balance, provides geometrical and morphological data and rebuild the knee joint bio-mechanically and anatomically, thus elevating the reproducibility of total knee arthroplasty and ensuring the safety of the system.

[Virtual image-guided minimal incision sugary unicondylar knee arthroplasty].

OBJECTIVE: To investigate the curative effect of virtual image-guided minimal incision sugary unicondylar knee arthroplasty (MIS-UKA). METHODS: Twenty-six patients of knee osteoarthritis (with 26 knees) received virtual image-guided MIS-UKA and followed up for (8.2 +/- 2.4) months. The incision length, operative time, hemorrhage, and 48 h drainage were calculated. The patients were evaluated by hand injury severity score (HISS) system knee score. X-ray film of the whole lower limb was taken to observe the line of force and range of motion of knee. RESULTS: MIS-UKA was successfully performed on the 26 knees with the average incision length of 7.4 +/- 0.6 cm, the average operative time of 78 +/- 12 min, the average hemorrhage of 114 +/- 18 ml, and the 48 h drainage of 122 +/- 13 ml. Two weeks after the operation, the average HISS hip score was 98, higher than that before the operation (72), the hip-knee-ankle angle was 0.8 degree +/- 0.6 degree, larger than that before the operation (7.6 degrees +/- 1.8 degrees), the flexion contraction angle was 1.8 degrees +/- 1.1 degrees, smaller than that before the operation (6.8 degrees +/- 1.6 degrees), and the joint range of motion of knee was 132.6 degrees +/- 3.5 degrees, larger than that before the operation (107.5 degrees +/- 6.2 degrees). No infection, prosthesis cacothesis, and patellofemoral joint pain were found. CONCLUSION: The surgical navigation system surmounts the disadvantage of small visual field, observes the line of force of the lower limbs, knee joint rotational apposition, and ligament balance dynamically with digital 3D bone mode, provide geometry and morphology data, and rebuilds knee joint vitodynamically and anatomically, and heightens the accuracy of prostheses replacement, thus having important clinic value in MIS-UKA.

[Experimental study about the dorsal approach to arthroscopic lateral release in hallux valgus surgery].

OBJECTIVE: To study the availability and method of the dorsal approach to arthroscopic lateral release in hallux valgus (HAV) surgery. METHODS: Ten fresh foot specimens with ankle preserved were included. Lateral capsule and the oblique head of hallucis adductus muscle were released using blade under arthroscopic visualization. Inspection was made for the relationship of the dorsal portals and the surrounding nerves, vessels and tendons. The ranges of release were also recorded. Five cases underwent the dorsal approach to arthroscopic lateral release in hallux valgus surgery. All patients were female, and the average age was 30 years old. The average hallux valgus angle was 30 degrees. RESULTS: The proximal portal was in close proximity to the extensor hallucis brevis tendon at a distance of 0 - 3 mm (average 1.5 mm) and was at a distance of 1 - 4 mm to the extensor hallucis longus tendon (average 2.4 mm). The distal portal was in close proximity to the first dorsal digital artery and nerve which were vulnerable to injury due to the short distance of 1 - 3 mm (average 1.4 mm). Among the 6 normal feet, metatarsal sesamoid ligament (MSL) was totally released in 1 specimens, and was partially released (70%) in 1 specimen, while in the other 4 HAV feet, 2 specimens had MSL totally released, 1 specimen partially released (50%). The 5 patients were all followed up with the average of 9 months. And the angle of hallux valgus was improved to 7 degrees (range from 4 degrees - 9 degrees). CONCLUSIONS: Dorsal approach to do arthroscopic lateral release in HAV is available. The advantages are small incisions, clear arthroscopic visualization, higher flexibility to release the lateral structures, less possibility of avascular necrosis of the metatarsal head as a result of no vessel injury.

[Establishment of arthroscopic trans-septal approach and its clinical application].

OBJECTIVE: To investigate the method and result of arthroscopic trans-septal approach (ATS). METHODS: Ten fresh cadaveric knees were prepared for anatomical study about the posterior septum, and 65 posterior compartment arthroscopy of the knees were performed to view the structure of the posterior septum. The initial diagnosis included: rheumatoid arthritis, pigmented villonodular synovitis, osteoarthritis, loose body or foreign body in the posterior compartment, posterior cruciate ligament (PCL) injury or avulsion fracture, posterior horn tear of meniscus, undiagnosed swollen knee with pain and effusion, osteochondritis dissecans, pyogenic arthritis, gout. From January 2002 to June 2005, 22 cases of ATS were applied. Anterolateral portal was initially created, followed by posterolateral portal under the viewing of arthroscopy which was located at the anterolateral portal. Anteromedial and posteromedial portals were also created using the same technique. Arthroscopy was then transferred to the posteromedial portal, and blade was introduced from the anteromedial portal to gradually remove the synovium covering PCL. Arthroscopy was relocated to the anteromedial portal, Wissinger rod was introduced from the posteromedial portal and pointed to the posterior septum adjacent to the posterior edge of the midportion of PCL. The Wissinger rod was pushed carefully to pierce through the posterior septum under the sight of arthroscopy which was located at the posterolateral portal. ATS was finally created. RESULTS: The posterior septum was in the middle of posterior compartment of the knee, which was film screen-like at the sagittal plane and sandwich-like at the transverse plane. The synovium covered the posterior septum at arthroscopic inspection. Twenty-two cases of ATS were successfully created, amounting to 34% (22/65) of all cases at the same period which had received the arthroscopy of posterior compartments of the knees. Synovectomy of the posterior compartments of the knees was performed in 7 cases, loose body removal was in 6 cases, PCL reconstruction was in 4 cases, reduction and fixation of PCL avulsion fracture was in 2 cases. Chondroplasty, inflammatory synovectomy, and meniscectomy were performed accordingly in 6 osteoarthritis cases. No vascular or nervous injury was encountered. At an average of 20 months follow-up (range, 4 to 45 months), 9 cases still had mild knee pain or swelling, 2 cases had severe pain and were recommended for total knee replacement, the other 11 cases had no recurrence of knee pain or swelling. CONCLUSIONS: ATS has no blind area under arthroscopic vision and facilitate trans-septal operation. It is a safe and effective method to treat the diseases of the posterior compartment of the knee. The direction of inside to outside to create ATS is comparatively reliable, and PCL could be identified as an interior landmark during the passage of Wissinger rod through posterior septum to create ATS.

[Sagittal mobility study on the first tarsometatarsal joint in hallux valgus patients and its clinical values].

OBJECTIVE: To study sagittal mobility about the FTJ (first tarsometatarsal joint) and its relationship with the pathophysiology and treatment of hallux valgus patients. METHODS: According to Lee's method, FTJ sagittal mobility of 300 normal feet and 200 hallux valgus was measured, and its correlative factors were statistically analysed. RESULTS: FTJ sagittal mobility of 300 normal feet was 8.4 degrees +/- 2.3 degrees , and that of 200 hallux valgus was 11.7 degrees +/- 3.2 degrees , the difference was significant. The normal range of FTJ sagittal mobility was less than 13 degrees . The sagittal overmotion of FTJ had relation to the anatomical configuration of FTJ (P < 0.05), intercuneiform splitting (P < 0.01), transferred pain under the second metatarsal head (P < 0.01), and FTJ osteoarthritis (P < 0.01) had no relation to HVA (hallux valgus angle), IMA (intermetatarsal angle), second metatarsus medial diaphyseal cortex hypertrophy (P > 0.05). CONCLUSION: Lee's method is convenient and accurate. Both HVA and IMA can not represent the sagittal mobility measurement of FTJ, which should be routinely evaluated, especially for hallux valgus patients with type I FTJ. Lapidus procedure should be considered for patients with larger FTJ in combination with transferred pain under the second metatarsal head, intercuneiform splitting, FTJ osteoarthritis.

[Anatomical study about the posterior coaxial portals via posterior tibial tendon sheath for ankle arthroscopy].

OBJECTIVE: To conduct the anatomical study about the posterior coaxial portals via posterior tibial tendon (PTT) sheath for ankle arthroscopy. METHODS: Coaxial portals were established in 20 ankles by K-wires which were left in place for distance measurement between them and the posterior nerves, tendons and vessels. Ankle arthroscopy was performed in 5 fresh ankles using 2.7 mm 300 arthroscopy with the same portals as mentioned above. The maximum visible scope were recorded and the distance between the arthroscopy and the posterior nerves, tendons and vessels was also measured. RESULTS: The medial portal was located 5 - 12 mm (average, 8 mm) above the tip of medial malleolus, and the lateral portal was located 8 - 24 mm (average, 15 mm) above the tip of lateral malleolus. The coaxial portals, which traversed the PTT sheath and passed posterior to the fibular, not only separated the arthroscopy and instrument from the posterior nerves, tendons and vessels by posterior capsule but also enlarged their distance. The medial and lateral malleolus articular gap, the posterior capsule could be viewed by these portals with as much as 1/2 - 2/3 posterior articular surface of talus. Not only the tibiotalar articular gap but also the dynamic movement between the mortise and the talus were clearly observed. Arthroscopic operation could be performed by instrument through the posterolateral portal. CONCLUSIONS: The posterior coaxial portals via PTT sheath for ankle arthroscopy have such advantages as easy maneuverability, superior safety, clear vision and larger operation field under arthroscopy.