Exercise-induced Musclin determines the fate of fibro-adipogenic progenitors to control muscle homeostasis.

The effects of exercise on fibro-adipogenic progenitors (FAPs) are unclear, and the direct molecular link is still unknown. In this study, we reveal that exercise reduces the frequency of FAPs and attenuates collagen deposition and adipose formation in injured or disused muscles through Musclin. Mechanistically, Musclin inhibits FAP proliferation and promotes apoptosis in FAPs by upregulating FILIP1L. Chromatin immunoprecipitation (ChIP)-qPCR confirms that FoxO3a is the transcription factor of FILIP1L. In addition, the Musclin/FILIP1L pathway facilitates the phagocytosis of apoptotic FAPs by macrophages through downregulating the expression of CD47. Genetic ablation of FILIP1L in FAPs abolishes the effects of exercise or Musclin on FAPs and the benefits on the reduction of fibrosis and fatty infiltration. Overall, exercise forms a microenvironment of myokines in muscle and prevents the abnormal accumulation of FAPs in a Musclin/FILIP1L-dependent manner. The administration of exogenous Musclin exerts a therapeutic effect, demonstrating a potential therapeutic approach for muscle atrophy or acute muscle injury.

A novel and efficient murine model for investigating tendon-to-bone healing.

BACKGROUND: Tendon-to-bone healing is a critical challenge in sports medicine, with its cellular and molecular mechanisms yet to be explored. An efficient murine model could significantly advance our understanding of this process. However, most existing murine animal models face limitations, including a propensity for bleeding, restricted operational space, and a steep learning curve. Thus, the need for a novel and efficient murine animal model to investigate the cellular and molecular mechanisms of tendon-to-bone healing is becoming increasingly evident. METHODS: In our study, forty-four 9-week-old male C57/BL6 mice underwent transection and reattachment of the Achilles tendon insertion to investigate tendon-to-bone healing. At 2 and 4 weeks postoperatively, mice were killed for histological, Micro-CT, biomechanical, and real-time polymerase chain reaction tests. RESULTS: Histological staining revealed that the original tissue structure was disrupted and replaced by a fibrovascular scar. Although glycosaminoglycan deposition was present in the cartilage area, the native structure had been destroyed. Biomechanical tests showed that the failure force constituted approximately 44.2% and 77.5% of that in intact tissues, and the ultimate tensile strength increased from 2 to 4 weeks postoperatively. Micro-CT imaging demonstrated a gradual healing process in the bone tunnel from 2 to 4 weeks postoperatively. The expression levels of ACAN, SOX9, Collagen I, and MMPs were detected, with all genes being overexpressed compared to the control group and maintaining high levels at 2 and 4 weeks postoperatively. CONCLUSIONS: Our results demonstrate that the healing process in our model is aligned with the natural healing process, suggesting the potential for creating a new, efficient, and reproducible mouse animal model to investigate the cellular and molecular mechanisms of tendon-to-bone healing.

PPP1R3A inhibits osteogenesis and negatively regulates intracellular calcium levels in calcific tendinopathy.

Calcific tendinopathy (CT) is defined by the progressive accumulation of calcium crystals in tendonic regions that results in severe pain in patients. The etiology of CT is not fully elucidated. In this study, we elucidate the role of PPP1R3A in CT. A significant decrease in PPP1R3A expression was observed in CT patient tissues, which was further confirmed in tissues from a CT-induced rat model. Overexpression of PPP1R3A ex vivo reduced the expression of osteo/chondrogenic markers OCN and Sox9, improved tendon tissue architecture, and reduced intracellular Ca2+ levels. Overexpression of SERCA2 and knockdown of Piezo1 decreased expression of osteo/chondrogenic markers and intracellular calcium in PPP1R3A-knockdown tendon cells. Lastly, PPP1R3A expression was regulated at the posttranscriptional level by binding of HuR. Collectively, the present study indicates that PPP1R3A plays an important role in regulating calcium homeostasis in tendon cells via Piezo1/SERCA2, rendering it a promising target for therapeutic interventions of CT.

Supraspinatus Tendon Reconstruction Using Fascia Lata Autograft for Irreparable Posterosuperior Massive Rotator Cuff Tears.

Superior capsule reconstruction has shown good long-term clinical efficacy in treating irreparable posterosuperior massive rotator cuff tears. However, conventional superior capsule reconstruction did not treat the medial supraspinatus tendons. Therefore, dynamic function of the posterosuperior rotator cuff does not restore effectively, especially the function of active abduction and external rotation. We describe a supraspinatus tendon reconstruction technique that presents a stepwise approach to accomplish the dual goals of stable anatomic reconstruction and restoring the dynamic function of the supraspinatus tendon.

Comparison of Suture Button and Syndesmotic Screw for Ankle Syndesmotic Injuries: A Meta-analysis of Randomized Controlled Trials.

Background: The syndesmotic screw (SS) and suture button (SB) fixation methods are both widely used for the reduction of ankle syndesmotic injury, with varying outcomes. Purpose: To review recently published randomized controlled trials (RCTs) to assess the outcomes between SS and SB fixation for ankle syndesmotic injury. Study Design: Systematic review; Level of evidence, 1. Methods: The PubMed, Embase, ClinicalTrials.gov, and Cochrane databases were searched for relevant RCTs published between 1966 and 2021 according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Eligible studies were RCTs comparing SS and SB fixation for ankle syndesmotic injury. The risk of bias was evaluated using the Cochrane Risk of Bias tool. Primary outcomes included complications, malreduction, and unplanned reoperation, and secondary outcomes were the American Orthopaedic Foot & Ankle Society (AOFAS) score, Olerud-Molander ankle score (OMAS), and EuroQol-5 Domain (EQ-5D) score. The mean difference (MD) and risk ratio (RR) were calculated for continuous and dichotomous outcomes, respectively. Random- or fixed-effects model was applied according to heterogeneity. Results: Of 389 studies, 8 RCTs involving 512 patients were included. Overall, 257 patients received SS fixation and 255 patients received SB fixation. The 2 groups did not differ significantly in malreduction (RR, -0.06; 95% CI, -0.18 to 0.07) or EQ-5D (MD, 0.01; 95% CI, -0.01 to 0.03). However, the SB group showed significant advantages over the SS group in complications (RR, 0.42; 95% CI, 0.26 to 0.66), unplanned reoperation (RR, 0.62; 95% CI, 0.43 to 0.89), AOFAS score (MD, 3.04; 95% CI, 1.77 to 4.31), and OMAS (MD, 4.51; 95% CI, 1.54 to 7.48). The risk of bias of the included studies was acceptable. Conclusion: The results showed that there were no significant differences between the SS and SB groups in malreduction and EQ-5D scores. However, the SB group had significantly better local irritation rates, unplanned reoperation rates, AOFAS scores, and OMASs.

Revascularization character of autologous fascia lata graft following shoulder superior capsule reconstruction by enhanced magnetic resonance imaging.

BACKGROUND: Fascia lata has been used for arthroscopic superior capsule reconstruction (ASCR) and verified to achieve a good clinical outcome. However, it is still not known about revascularization character of the fascia lata after ASCR. This study was performed to evaluate the revascularization of autologous fascia lata grafts after ASCR by enhanced magnetic resonance imaging (MRI). METHODS: A prospective study of 19 patients with irreparable rotator cuff tears underwent ASCR with autologous fascia lata grafts from September 2019 to April 2021. Radiography examinations and clinical evaluations were performed preoperatively and postoperatively at 6 weeks and 3, 6, and 12 months. The signal-to-noise quotient (SNQ) value and enhancement index (EI) of autologous fascia lata grafts in the great tubercle insertion (GTI), midpoint of the graft (MG), and glenoid insertion (GI) were compared for radiography examination. Clinical evaluation included the American Shoulder and Elbow Surgeons (ASES) score, University of California Los Angeles (UCLA) shoulder score, and Visual Analog Scale (VAS) score. RESULTS: The SNQ values in T1WI enhancement at GI and GTI were significantly higher than those at the plain MRI scan at all postoperative observation timepoints; however, the SNQ values in T1WI enhancement at MG did not show a significant difference until 3 months postoperation. EI values at GTI and GI were significantly higher than those at MG at 6 weeks and 3 months postoperation, while there was no significant difference in the EI value between GTI and GI. At 6 months postoperation, the EI value at GI was significantly higher than those at MG. At 12 months postoperation, the EI value at GI was significantly higher than those at MG and GTI; however, there was no significant difference between GTI and MG. The EI values at GTI and MG peaked at 3 months and 6 months postoperation, respectively, and then plateaued at 12 months postoperation. However, there was no significant difference in the EI value among the different postoperative timepoints at GI. The EI value did not correlate with the VAS and ASES, UCLA scores at any time point or any postoperative observation location. CONCLUSION: Revascularization of the fascia lata was dependent on the location of the fascia lata and plateaus at 12 months postoperation. The EI value did not correlate with the VAS and ASES, UCLA scores during12 months postoperation.

Silkworm spinning inspired 3D printing toward a high strength scaffold for bone regeneration.

Inspired by the silkworm spinning process for production of tough cocoons, a gradient printing-assembly technique with silk fibroin (SF) and hydroxyapatite (HA) to achieve high strength scaffolds for bone regeneration is developed. A coaxial extrude-nozzle is employed to provide gathered thickening and shearing for aligned assembly. The aligned SF-HA assembles into the compacted nanostructure, which performs a maximum compressive strength of 166 MPa and bending strength of 40 MPa. Scaffolds with various morphologies could be arbitrarily constructed via extruded 3D printing for the regeneration of cortical bone or cancellous bone. The hemolysis quantification of red blood cells (RBCs), proliferation and flow cytometry of bone marrow stem cells (BMSCs) have proved the excellent biocompatibility of the printed scaffolds. Osteogenic induced differentiation assay in vitro and surgical intervention for rat femoral defect repairing have verified the successful osteogenesis with high mechanical strength and remarkable stability in the physiological environment. The silkworm spinning inspired 3D printing offers a facile approach for the fabrication of implantable scaffolds with high strength and excellent biocompatibility, which is highly desired for the applications of bone tissue engineering.

Application of 3 dimension-printed injection-molded polyether ether ketone lunate prosthesis in the treatment of stage III Kienböck's disease: A case report.

BACKGROUND: Polyether ether ketone (PEEK) is a high-performance medical polymer, and there are some clinical cases of PEEK prosthesis implantation. However, application of 3D-printed injection-molded PEEK lunate prosthesis for treatment of stage III Kienböck's disease has not been reported. This study's purpose was to analyze the clinical efficacy of 3D-printed injection-molded PEEK lunate prosthesis in the treatment of stage III Kienböck's disease and thus provide a good therapeutic choice for Kienböck's disease. CASE SUMMARY: We report a patient with stage III Kienböck's disease. With the healthy lunate bone as reference, 3D lunate reconstruction was performed using a mirroring technique. A PEEK lunate prosthesis was prepared by 3D printing and injection molding, and then it was inserted into the original anatomical position after removing the necrotic lunate bone. Wrist pain and function, anatomical suitability of the lunate prosthesis, and complications were evaluated and analyzed postoperatively. At the last visit (one year after surgery), the range of motion, grasp force, visual analog scale score and Cooney score of the affected wrist were significantly improved, and postoperative X-ray examination indicated that the lunate prosthesis had good anatomical suitability for adjacent bony structures. CONCLUSION: The 3D-printed injection-molded PEEK lunate prosthesis demonstrated definite efficacy in treating stage III Kienböck's disease.

Histologic and biomechanical evaluation of the thoracolumbar fascia graft for massive rotator cuff tears in a rat model.

BACKGROUND: Fascial autografts, which are easily available grafts, have provided a promising option in patients with massive rotator cuff tears. However, no fascial autografts other than the fascia lata have been reported, and the exact healing process of the fascia-to-bone interface is not well understood. The objective of this study is to histologically and biomechanically evaluate the effect of the thoracolumbar fascia (TLF) on fascia-to-bone healing. METHODS: A total of 88 rats were used in this study. Eight rats were killed at the beginning to form an intact control group, and the other rats were divided randomly into 2 groups (40 rats per group): the TLF augmentation group (TLF group) and the repair group (R group). The right supraspinatus was detached, and a 3 × 5 mm defect of the supraspinatus was created. The TLF was used to augment the torn supraspinatus in the TLF group, whereas in the R group, the torn supraspinatus was repaired in only a transosseous manner. Histology and biomechanics were assessed at 1, 2, 4, 8, and 16 weeks postoperatively. RESULTS: The modified tendon maturation score of the TLF group was higher than that of the R group at 8 weeks (23.00 ± 0.71 vs. 24.40 ± 0.89, P = .025) and 16 weeks (24.60 ± 0.55 vs. 26.40 ± 0.55, P ≤ .001). The TLF group showed a rapid vascular reaction, and the peak value appeared at 1 week. Later, the capillary density decreased, and almost no angiogenesis was observed at 8 weeks postoperatively. Immunohistochemistry results demonstrated a significantly higher percentage of collagen I in the TLF group at 4, 8, and 16 weeks (24.78% ± 2.76% vs. 20.67% ± 2.11% at 4 weeks, P = .046; 25.46% ± 1.77% vs. 21.49% ± 2.33% at 8 weeks, P = .026; 34.77% ± 2.25% vs. 30.01% ± 3.17% at 16 weeks, P = .040) postoperatively. Biomechanical tests revealed that the ultimate failure force in the TLF group was significantly higher than that in the R group at the final evaluation (29.13 ± 2.49 N vs. 23.10 ± 3.47 N, P = .022). CONCLUSIONS: The TLF autograft can promote a faster biological healing process and a better fixation strength. It could be used as an alternative reinforcement or bridging patch when the fascia lata is not appropriate or available for superior capsule reconstruction (SCR).

Adipogenic differentiation was inhibited by downregulation of PPARγ signaling pathway in aging tendon stem/progenitor cells.

BACKGROUND: Tendon stem/progenitor cells (TSPCs) play a vital role in tendon repair and regeneration. Previously we found more adipocytes accumulated in the patellar tendon injury sites in aging rats compared with the young ones, of which the mechanism is still unknown. Here, we want to identify whether erroneous differentiation of TSPCs by aging accounts for the adipocyte accumulation. METHODS: TSPCs from young and aging rats were isolated and propagated. Both young and aging TSPCs were induced to differentiate into adipocytes, and Oil red O staining, quantitative real-time polymerase chain reaction (qRT-PCR), western-blot and immunofluorescent staining were used to evaluate the capability of TSPCs. RNA sequencing was utilized to screen out different genes and signaling pathways related to adipogenesis between young and aging TSPCs. RESULTS: The Oil red O staining showed there were more adipocytes formed in young TSPCs. Besides, adipogenic markers perilipin, peroxisome proliferator-activated receptor γ (PPARγ), CCAAT/enhancer-binding proteins alpha (C/EBPα) and Fatty acid-binding protein 4 (FABP4) were elevated both at gene and protein level. PPARγ signaling pathway was selected as our target via RNA sequencing. After adding the signaling activators, Rosiglitazone maleate (RM), inhibited adipogenesis of aging TSCs was reversed. CONCLUSIONS: In conclusion, aging inhibited adipogenesis of TSPCs by down-regulating PPARγ signaling. It is not likely that the adipocyte accumulation in aging tendon during repair was due to the aging of TSPCs. This may provide new targets for curing aging tendon injuries or tendinopathies.

Structural Engineering of Hollow Microflower-like CuS@C Hybrids as Versatile Electrochemical Sensing Platform for Highly Sensitive Hydrogen Peroxide and Hydrazine Detection.

Designing metal sulfides with unique configurations and exploring their electrochemical activities for hydrogen peroxide (H2O2) and hydrazine (N2H4) is challenging and desirable for various fields. Herein, hollow microflower-like CuS@C hybrids were successfully assembled and further exploited as a versatile electrochemical sensing platform for H2O2 reduction and N2H4 oxidation, of which the elaborate strategies make the perfect formation of hollow architecture, providing considerable electrocatalytic sites and fast charge transfer rate, while the appropriate introduction polydopamine-derived carbon skeleton facilitates the electronic conductivity and boosts structural robustness, thus generating wide linear range (0.05-14 and 0.01-10 mM), low detection limit (0.22 µM and 0.07 µM), and a rather low overpotential (-0.15 and -0.05 V) toward H2O2 and N2H4, as well as good selectivity, excellent reproducibility, and admirable long-term stability. It should be highlighted that the operating potentials can compare favorably with those of some reported H2O2 and N2H4 sensors based on noble metals. In addition, good recoveries and acceptable relative standard deviations (RSDs) attained in serum and water samples fully verify the accuracy and anti-interference capability of our proposed sensor systems. These results not only elucidate an effective structural nanoengineering strategy for electroanalytical science but also advance the rational utilization of H2O2 and N2H4 in practicability.

Three-dimensional printed talar prosthesis with biological function for giant cell tumor of the talus: A case report and review of the literature.

BACKGROUND: Giant cell tumors (GCT) are most commonly seen in the distal femur. These tumors are uncommon in the small bones of the hand and feet, and a very few cases have been reported. A giant cell tumor of the talus is rarely seen clinically and could be a challenge to physicians. CASE SUMMARY: We report a rare case of GCT of the talus in one patient who underwent a new reconstructive surgery technique using a three-dimensional (3D) printing talar prosthesis. The prosthesis shape was designed by tomographic image processing and segmentation using technology to match the intact side by mirror symmetry with 3D post-processing technologies. The patient recovered nearly full range of motion of the ankle after 6 mo. The visual analogue scale and American Orthopaedic Foot and Ankle Society scores were 1 and 89 points, respectively. CONCLUSION: We demonstrated that 3D printing of a talar prosthesis is a beneficial option for GCT of the talus.

Three dimension printing talar prostheses for total replacement in talar necrosis and collapse.

BACKGROUND: Reconstructing bone structures and stabilizing adjacent joints are clinical challenges in treating talar necrosis and collapse (TNC). 3D printing technology has been demonstrated to improve the accuracy of talar replacement. This study aimed to evaluate anatomical talar replacement and the clinical results. METHODS: Nine patients with TNC were enrolled between 2016 and 2020. The prosthetic shape and size were designed by CT post-processing and mirror symmetry technology. The clinical outcomes included radiographic parameters of the forefoot, hindfoot, and ankle alignment, ankle activity, recurrent pain, and peri-operative complications. RESULTS: After a mean follow-up of 23.17 ± 6.65 months, degenerative arthritis and prosthetic dislocation and other complications were not observed on plain radiographs. Each 3D-printed talar prosthesis was placed in the original anatomical position. The parameters which have significant changes pre-operative and post-operative are as follows: talar height, 27.59 ± 5.99 mm and 34.56 ± 3.54 mm (95% CI - 13.05 to - 0.87, t = 2.94, P = 0.032) and Meary's angle, 11.73 ± 4.79° and 4.45 ± 1.82° (95% CI 1.29~22.44, t = 2.89, P = 0.034). The AOFAS hindfoot score improved from 26.33 ± 6.62 to 79.67 ± 3.14 at the final follow-up (95% CI 43.36~63.30, t = 13.75, P = 0.000). The VAS score decreased from 6.33 ± 1.03 to 0.83 ± 0.75 (95% CI 4.40~6.60, t = 12.84, P = 0.000). The post-operative satisfaction scores regarding pain relief, activities of daily living, and return to recreational activities were good to excellent, and the change of activity range was statistically significant. CONCLUSIONS: The 3D printing patient-specific total talar prostheses allowed anatomical reconstruction in TNC. This novel treatment with 3D-printed prostheses could serve as a reliable patient-specific alternative in TNC.

Analysis of the stress distribution of the subtalar joint and fusion efficacy after double-screw insertion.

BACKGROUND: Screw fixation is a typical technique for the isolated subtalar joint. However, no consensus has been reached on how to select the most suitable insertion position and direction. This study aims to find the ideal screw insertion and then explore its influence on the clinical efficacy of subtalar fusion by analyzing the effects of different cannulated screw insertions on the stress distribution, anti-rotary strength, and anti-inversion/eversion strength of the subtalar joint. METHODS: In this study, we investigated three cannulated screw insertions for subtalar fusion: screw insertion with the most uniform stress distribution (group A), lateral-medial parallel screw insertion (group B), and traditional longitudinally parallel screw insertion (group C). The effects of these three insertions on the loading stress of the subtalar joint (including stress distribution, anti-inversion/eversion strength, and anti-rotary strength) were comparatively analyzed with the three-dimensional finite element method to screen the ideal screw insertion. Moreover, a prospective study was conducted to analyze the influence of the ideal screw insertion on subtalar fusion, including the fusion rate, fusion time, and clinical efficacy (VAS score, AOFAS score, and complications). RESULTS: Group B was worse than group A with respect to the stress distribution uniformity, but slightly better than group C, and better than both groups A and C in terms of the anti-rotary strength and anti-inversion/eversion strength. The screw insertion based on the most uniform stress distribution is not feasible in surgery. Therefore, the lateral-medial antiparallel screw insertion is the ideal insertion. From January 2012 to June 2016, 48 cases were treated by subtalar fusion with the ideal screw insertion, and then followed up for 30.6 months (12-48 months). The fusion was proved in all 48 cases with a fusion rate of 100% by X-ray or CT scan. The mean time of fusion was 12.8 weeks (12-16 weeks). The VAS score decreased from 6.00 before operation to 1.03 on the last visit (P < 0.05), and the AOFAS score increased from 57.0 to 85.6 (P < 0.05), with a good and excellent rate of 95.8%. CONCLUSIONS: The lateral-medial parallel screw insertion not only demonstrates a good stress distribution profile of the subtalar joint but also has advantages such as easy localization and operation during surgery, as well as a high fusion rate and few complications after surgery. Therefore, it is a safe, accurate, and effective fixation mode that is worthy of being popularized clinically.

Interleukin-15 facilitates muscle regeneration through modulation of fibro/adipogenic progenitors.

BACKGROUND: Chronic muscle injury is characteristics of fatty infiltration and fibrosis. Recently, fibro/adipogenic progenitors (FAPs) were found to be indispensable for muscular regeneration while were also responsible for fibrosis and fatty infiltration in muscle injury. Many myokines have been proven to regulate the adipose or cell proliferation. Because the fate of FAPs is largely dependent on microenvironment and the regulation of myokines on FAPs is still unclear. We screened the potential myokines and found Interleukin-15 (IL-15) may regulate the fatty infiltration in muscle injury. In this study, we investigated how IL-15 regulated FAPs in muscle injury and the effect on muscle regeneration. METHODS: Cell proliferation assay, western blots, qRT-PCR, immunohistochemistry, flow cytometric analysis were performed to investigate the effect of IL-15 on proliferation and adipogensis of FAPs. Acute muscle injury was induced by injection of glycerol or cardiotoxin to analyze how IL-15 effected on FAPs in vivo and its function on fatty infiltration or muscle regeneration. RESULTS: We identified that the expression of IL-15 in injured muscle was negatively associated with fatty infiltration. IL-15 can stimulate the proliferation of FAPs and prevent the adipogenesis of FAPs in vitro and in vivo. The growth of FAPs caused by IL-15 was mediated through JAK-STAT pathway. In addition, desert hedgehog pathway may participate in IL-15 inhibiting adipogenesis of FAPs. Our study showed IL-15 can cause the fibrosis after muscle damage and promote the myofiber regeneration. Finally, the expression of IL-15 was positively associated with severity of fibrosis and number of FAPs in patients with chronic rotator cuff tear. CONCLUSIONS: These findings supported the potential role of IL-15 as a modulator on fate of FAPs in injured muscle and as a novel therapy for chronic muscle injury.

Bioinspired Synergy Sensor Chip of Photonic Crystals-Graphene Oxide for Multiamines Recognition.

Benefiting from the integrated functions of cilia and glomeruli in the olfactory system, animals can discriminate various odors even in hostile environments. Inspired by this synergetic system of response and signal processing units, a sensor chip of graphene oxide (GO) and photonic crystals (PCs) is fabricated. The GO aerogel functions like the olfactory cilia, which effectively captures the analytes and generates abundant sensing signals for recognition; and the PCs act as the olfactory glomeruli, whose periodic structure enables selective enhancement of the fluorescent signals to realize further signal processing. Ten biogenic amines and seven drug amines are effectively discriminated. The integrated sensor strategy of response and signal manipulation units will promote enormous pursuits of rapid clinical diagnosis or intractable pathology analysis.

3D printing lunate prosthesis for stage IIIc Kienböck's disease: a case report.

Stage IIIc Kienböck's disease is a clinical challenge to treat collapse of the lunate bone. A new reconstructive surgery was described in one patient using 3D printing lunate prosthesis. The prosthesis shape was designed by tomographic image processing and segmentation using technology compared with the intact side matched by mirror symmetry and 3D post-processing technologies. The patient recovered nearly full range of motion of the wrist after 12 months. The visual analog scale scores and Cooney scores were 2 points and 91 points. We demonstrated that an anatomical reconstruction to Kienböck's Disease is possible using 3D printing lunate prosthesis.

Isolated talonavicular arthrodesis and talonavicular-cuneiform arthrodesis for the Müller-Weiss disease.

BACKGROUND: The study aimed to introduce the isolated talonavicular and talonavicular-cuneiform arthrodesis for the stage III and IV Müller-Weiss disease and analyze their clinical outcomes. METHODS: Thirty patients of stage III and IV Müller-Weiss disease were divided into the talonavicular (TN) arthrodesis group and the talonavicular-cuneiform (TNC) arthrodesis group according to the perinavicular osteoarthritis by MRI scans. For the isolated talonavicular arthrodesis group, 16 patients underwent talonavicular arthrodesis with two 4.0 mm hollow headless compression screws. For the TNC arthrodesis group, 14 patients were received the TNC arthrodesis with reverse "V" shape osteotomy and autoallergic iliac bone graft. All patients were followed up at 3, 6, 9, and 12 months, and per 6 months after 1 year, by the AOFAS ankle-midfoot scores, and evaluated by radiographic measurements. RESULTS: All of them were followed up in two groups and all patients were satisfied with their clinical results. At the TN arthrodesis group, the patients' mean was 39.8 months (range, 11-66 months) follow-up. The mean AOFAS ankle and hindfoot scores had improved from 38.3 ± 5.1 preoperatively to 88.9 ± 1.9 at the last postoperative assessment. At the TNC arthrodesis group, the mean follow-up was 51.7 months (range, 12-90 months). The mean AOFAS ankle and hindfoot scores were 40.1 ± 7.9 preoperatively to 90.1 ± 2.0 at the last postoperative. All of the cases were solid fusion on the radiograph. CONCLUSIONS: According to MRI evaluation, either TN or TNC arthrodesis for stage III or IV Müller-Weiss disease have the good clinical outcomes with solid fusion rate and obvious improvement of the quality of life of patients.

Individual headless compression screws fixed with three-dimensional image processing technology improves fusion rates of isolated talonavicular arthrodesis.

BACKGROUND: Screw fixation is a typical technique for isolated talonavicular arthrodesis (TNA), however, no consensus has been reached on how to select most suitable inserted position and direction. The study aimed to present a new fixation technique and to evaluate the clinical outcome of individual headless compression screws (HCSs) applied with three-dimensional (3D) image processing technology to isolated TNA. METHODS: From 2007 to 2014, 69 patients underwent isolated TNA by using double Acutrak HCSs. The preoperative three-dimensional (3D) insertion model of double HCSs was applied by Mimics, Catia, and SolidWorks reconstruction software. One HCS oriented antegradely from the edge of dorsal navicular tail where intersected interspace between the first and the second cuneiform into the talus body along the talus axis, and the other one paralleled the first screw oriented from the dorsal-medial navicular where intersected at the medial plane of the first cuneiform. The anteroposterior and lateral X-ray examinations certified that the double HCSs were placed along the longitudinal axis of the talus. Postoperative assessment included the American Orthopaedic Foot & Ankle Society hindfoot (AOFAS), the visual analogue scale (VAS) score, satisfaction score, imaging assessments, and complications. RESULTS: At the mean 44-months follow-up, all patients exhibited good articular congruity and solid bone fusion at an average of 11.26 ± 0.85 weeks (range, 10 ~ 13 weeks) without screw loosening, shifting, or breakage. The overall fusion rates were 100%. The average AOFAS score increased from 46.62 ± 4.6 (range, 37 ~ 56) preoperatively to 74.77 ± 5.4 (range, 64-88) at the final follow-up (95% CI: -30.86 ~ -27.34; p < 0.001). The mean VAS score decreased from 7.01 ± 1.2 (range, 4 ~ 9) to 1.93 ± 1.3 (range, 0 ~ 4) (95% CI: 4.69 ~ 5.48; p < 0.001). One cases (1.45%) and three cases (4.35%) experienced wound infection and adjacent arthritis respectively. The postoperative satisfaction score including pain relief, activities of daily living, and return to recreational activities were good to excellent in 62 (89.9%) cases. CONCLUSIONS: Individual 3D reconstruction of HCSs insertion model can be designed with three-dimensional image processing technology in TNA. The technology is safe, effective, and reliable to isolated TNA method with high bone fusion rates, low incidences of complications.