Modified Single-Working Portal Technique Using Percutaneous Spinal Needle Suture Passing in Arthroscopic Subscapularis Repair.

The main method for arthroscopic repair of the subscapularis is repair with suture anchors. The surgeon generally establishes the anterior and anterolateral operation portals to complete anchor implantation and suture passing, respectively. The single-operation portal technique has been developed recently. However, in the traditional single-operation portal technique, the suture device and grasper are difficult to operate simultaneously. In addition, with the traditional rotator cuff suture device, it is easy to cause further iatrogenic injury to the rotator cuff because of its larger diameter. Therefore, we describe a modified single-operation portal technique for suture passing percutaneously with a spinal needle taking into account the shortcomings of existing techniques. Our modified technique avoids the use of traditional suturing devices and effectively avoids further damage to the rotator cuff. The use of a single operation portal makes the operation more minimally invasive and simple and effectively avoids the problem of interference between the suture device and grasper in the same portal. The entire operational process does not require the use of costly consumables, resulting in increased cost-effectiveness and a significantly reduced operating time. In conclusion, our modified technique achieves the use of a single operation portal to suture the subscapularis through spinal needle suture passing, which has good clinical value.

Arthroscopic In Situ Fixation of Osteochondral Fragments on the Weightbearing Area of the Knee Joint With a Single Anchor.

Osteochondral fracture of knee joint occurring in the femur is a serious clinical trauma. The presence of osteochondral fragments in the knee joint often necessitates surgery. Arthroscopic repair is a minimally invasive treatment, and there are many methods, among which suture anchor is often adopted by clinicians because of its obvious advantages such as simplicity. In the past, there were many methods for fixing osteochondral fragments, but using suture anchors to fix free osteochondral fragments has become a common approach. Moreover, the local mechanical environment will also be affected because of the increase in the number of bone channels. In this report, we describe a method for fixing 1 or 2 osteochondral fragments using a single suture anchor based on the mechanical characteristics of the femoral weightbearing region of the knee joint. We use relevant case reports to introduce our technology. Through the application of our improved technique, the arthroscopic repair of osteochondral fractures in the weightbearing area of femur can be more convenient and more economical, and the rehabilitation of patients will not be affected.

Construction and analysis of a lncRNA-miRNA-mRNA competing endogenous RNA network from inflamed and normal synovial tissues after anterior cruciate ligament and/or meniscus injuries.

Background: Despite ample evidence demonstrating that anterior cruciate ligament (ACL) and meniscus tears are associated with posttraumatic osteoarthritis (PTOA) development, the contributing factors remain unknown. Synovial inflammation has recently been recognized as a pivotal factor in the pathogenesis of OA. However, there is a lack of data on synovial profiles after ACL or meniscus injuries, which may contribute to PTOA. Methods: Twelve patients with ACL tears and/or meniscus injuries were recruited. During surgery, synovial tissues were obtained from the injured knees. The inflammation status of the synovium was characterized according to macroscopic criteria and histological synovitis grades. Then the synovial tissues were classified as control group or inflamed group. High-throughput RNA sequencing of the synovial samples (3 vs. 3) was conducted to identify differentially expressed (DE) RNAs. Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway, and protein-protein interaction (PPI) analyses were performed to investigate DE mRNAs. Next, competing endogenous RNA (ceRNA) networks were constructed based on bioinformatics analyses. Associations of the identified DE genes (DEGs) with infiltrating immune cells were explored using Pearson correlation analysis. Results: The results showed that 2793 mRNAs, 3392 lncRNAs and 211 miRNAs were significantly DE between two groups. The top 3 significantly upregulated GO terms and KEGG pathways were immune response, adaptive immune response and immune system process, systemic lupus erythematosus, haematopoietic cell lineage and cytokine-cytokine receptor interaction, respectively. In PPI networks, the top 10 hub genes were IL6, CCR7, C3, CCR5, CXCR3, CXCL8, IL2, CCR3, CCR2 and CXCL1. Seven mRNAs (EPHA5, GSN, ORC1, TLN2, SOX6, NKD2 and ADAMTS19), 4 lncRNAs (MIR4435-2HG, TNXA, CEROX1 and TMEM92-AS1) and 3 miRNAs (miR-486-5p, miR-199a-3p and miR-21-3p) were validated by quantitative real-time polymerase chain reaction and sub-networks were constructed. In correlation analysis, MMP9 correlated positively with M0 macrophages and plasma cells, NKD2 positively with CD8 T cells, and CCR7 and IL2RB positively with naive B cells. Conclusion: Our study provides foundational synovial inflammation profiles following knee trauma. The ceRNA and PPI networks provide new insight into the biological processes and underlying mechanisms of PTOA. The differential infiltration profiles of immune cells in synovium may contribute to PTOA development. This study also highlights immune-related DEGs as potential PTOA treatment biomarkers.

Conversion from Spanning External Fixation to Open Reduction Internal Fixation Contributes to Healing of Soft Tissues and Fractures in Open Distal Humeral Fractures.

BACKGROUND Open distal humeral fractures (DHFs) often lead to loss of elbow function, thereby seriously affecting patient quality of life. The aim of this study was to evaluate the treatment outcomes of 2 surgical techniques to determine the better method for repairing open DHFs. Both groups were treated with immediate debridement first, and then group I had only internal fixation (IF), while group II underwent initial external fixation (EF) followed by IF surgery. MATERIAL AND METHODS This retrospective study included 32 patients who had open DHFs between 2013 and 2018. Twelve patients underwent thorough debridement and temporary EF treatment and converted to IF as the ultimate treatment. Twenty patients were treated with immediate open reduction and internal fixation (ORIF). Data of final treatment outcomes were analyzed at the latest follow-up. A comparative analysis of radiological results, function observations, and complications was performed for the 2 surgical groups. RESULTS All DHFs and osteotomized olecranon united after a mean of 5.2±1.21 months. No significant differences were observed in other preoperative demographic data between the 2 groups. Moreover, there was no significant difference in postoperative complications, elbow range of motion, or fracture healing time between the 2 groups. CONCLUSIONS The evidence provided by our study highlights the efficacy of definitive IF in treating open DHFs, which is recommended whenever possible. Furthermore, the combination of EF and ORIF, according to the type of soft tissue damage, may be a promising treatment option with a low revision rate for patients with open DHFs.

Arthroscopic Treatment of Calcific Tendinitis of Gemellus Superior and Gemellus Inferior: A Case Report and Literature Review.

BACKGROUND: Tendon calcification is a common disease, and it could happen in the tendons of the shoulder, wrist, etc. However, tendon calcification in the superior and inferior gemellus is rare, and in this region is likely to be misdiagnosed. CASE PRESENTATION: Here, our case report first reported a 53-year-old female patient with an unusual case of calcific tendinitis of the gemellus superior and gemellus inferior muscles. The patient presented with severe pain in the right hip and lower extremities, not relieved using nonsteroidal anti-inflammatory drugs (NSAIDs). The preoperative physical examination indicated an abnormality in the hip joint. Preoperative imaging confirmed the results of the physical examination and showed a right hip lesion. We did not make a definite diagnosis preoperatively but considered that the patient might have an osteochondroma. However, surgical findings indicated that the lesion was not in the hip capsule on subsequent arthroscopic surgery, which suggested that the preoperative diagnosis might be wrong. We opened the posterior capsule and found a "toothpaste-like" lesion in the superior and inferior gemellus muscles' tendon. We thought this might be the calcified tendon. Then the arthroscopic surgery was finished to remove the lesion, and the removed tissue was sent to the pathology department for pathological examination. The pathological report confirmed the diagnosis of the calcified tendon. Postoperative follow-up was conducted. The effect of the operation was noticeable. Postoperative symptoms were relieved. CONCLUSIONS: Calcification of the tendons of the superior and inferior gemellus muscles can be easily misdiagnosed, and the disease can be treated minimally with arthroscopy.

Argon inhibits reactive oxygen species oxidative stress via the miR-21-mediated PDCD4/PTEN pathway to prevent myocardial ischemia/reperfusion injury.

The objective of this study was to explore the effect of argon preconditioning on myocardial ischemia reperfusion (MI/R) injury and its mechanism. Cardiomyocytes H2C9 were pre-treated with 50% argon, and a cell model of oxygen-glucose deprivation (OGD) was established. CCK-8 and cytotoxicity detection kits were used to detect cell viability and lactate dehydrogenase (LDH) release. The miR-21 expression was detected using quantitative real-time polymerase chain reaction. Western blot analysis was performed to detect the expression of programmed cell death protein 4 (PDCD4) and homologous phosphatase and tensin homolog (PTEN) proteins. The levels of inflammatory factors (IL-1ß, IL-6, and IL-8) and oxidative stress factors (reactive oxygen species ROS], malondialdehyde [MDA], and superoxide dismutase [SOD]) were measured using an enzyme-linked immunosorbent assay. The effect of argon on cell apoptosis was detected using flow cytometry. Argon increased the proliferation of cardiomyocytes induced by OGD, decreased the release of LDH in cell culture medium, increased miR-21 expression in cells, decreased the expression of miR-21 target proteins PDCD4 and PTEN, decreased the levels of inflammatory factors (interleukin-1ß [IL-1ß], interleukin-6 [IL-6], and interleukin-8 [IL-8]) and oxidative stress factors (ROS and MDA), increased the SOD content, and decreased the cell apoptosis rate. Our results suggest that argon preconditioning inhibited the PDCD4/PTEN pathway via miR-21, thereby inhibiting ROS oxidative stress and preventing MI/R injury.

Controlled delivery of bone morphogenic protein-2-related peptide from mineralised extracellular matrix-based scaffold induces bone regeneration.

Ideal bone tissue engineering scaffolds composed of extracellular matrix (ECM) require excellent osteoconductive ability to imitate the bone environment. We developed a mineralised tissue-derived ECM-modified true bone ceramic (TBC) scaffold for the delivery of aspartic acid-modified bone morphogenic protein-2 (BMP-2) peptide (P28) and assessed its osteogenic capacity. Decellularized ECM from porcine small intestinal submucosa (SIS) was coated onto the surface of TBC, followed by mineralisation modification (mSIS/TBC). P28 was subsequently immobilised onto the scaffolds in the absence of a crosslinker. The alkaline phosphatase activity and other osteogenic differentiation marker results showed that osteogenesis of the P28/mSIS/TBC scaffolds was significantly greater than that of the TBC and mSIS/TBC groups. In addition, to examine the osteoconductive capability of this system in vivo, we established a rat calvarial bone defect model and evaluated the new bone area and new blood vessel density. Histological observation showed that P28/mSIS/TBC exhibited favourable bone regeneration efficacy. This study proposes the use of mSIS/TBC loaded with P28 as a promising osteogenic scaffold for bone tissue engineering applications.

In situ bone regeneration with sequential delivery of aptamer and BMP2 from an ECM-based scaffold fabricated by cryogenic free-form extrusion.

In situ tissue engineering is a powerful strategy for the treatment of bone defects. It could overcome the limitations of traditional bone tissue engineering, which typically involves extensive cell expansion steps, low cell survival rates upon transplantation, and a risk of immuno-rejection. Here, a porous scaffold polycaprolactone (PCL)/decellularized small intestine submucosa (SIS) was fabricated via cryogenic free-form extrusion, followed by surface modification with aptamer and PlGF-2123-144*-fused BMP2 (pBMP2). The two bioactive molecules were delivered sequentially. The aptamer Apt19s, which exhibited binding affinity to bone marrow-derived mesenchymal stem cells (BMSCs), was quickly released, facilitating the mobilization and recruitment of host BMSCs. BMP2 fused with a PlGF-2123-144 peptide, which showed "super-affinity" to the ECM matrix, was released in a slow and sustained manner, inducing BMSC osteogenic differentiation. In vitro results showed that the sequential release of PCL/SIS-pBMP2-Apt19s promoted cell migration, proliferation, alkaline phosphatase activity, and mRNA expression of osteogenesis-related genes. The in vivo results demonstrated that the sequential release system of PCL/SIS-pBMP2-Apt19s evidently increased bone formation in rat calvarial critical-sized defects compared to the sequential release system of PCL/SIS-BMP2-Apt19s. Thus, the novel delivery system shows potential as an ideal alternative for achieving cell-free scaffold-based bone regeneration in situ.

Sequential Epiphyseal Cartilage Changes of Femoral Heads in C57BL/6 Female Mice Treated with Excessive Glucocorticoids.

OBJECTIVE: Excessive use of glucocorticoids (GCs) may cause adverse effects on the skeletal system in children. However, only a few studies have reported the effects of GCs on the epiphyseal cartilage. This study aimed to uncover the subsequent epiphyseal cartilage changes of immature femoral heads after excessive GC treatment in a mouse model and explain the pathological changes preliminarily. DESIGN: Female C57BL/6 mice were divided into control and model (excessive GC treatment) groups. The structure of the femoral heads was evaluated by using micro-computed tomography, hematoxylin-eosin staining, and safranin staining analyses. Immunohistochemistry was used to detect angiogenesis and cartilage metabolism. Western blotting and TUNEL staining were used to examine epiphyseal cartilage chondrocyte apoptosis. Primary chondrocytes were isolated from the femoral heads of healthy mice for in vitro studies. The effects of GCs on chondrocyte apoptosis and metabolism were determined by flow cytometry and Western blotting. RESULTS: The epiphyseal cartilage ossification had started at 4 weeks posttreatment in a portion of mice; the ossification presented as a sequential process in the model group, while the epiphyseal cartilage maintained an unossified state in the control group. Vascular invasion into the epiphyseal cartilage of the model mice was observed at 4 weeks posttreatment. GCs induced chondrocyte apoptosis and altered chondrocyte metabolism in the epiphyseal cartilage. CONCLUSIONS: The epiphyseal cartilage ossification accelerated in the femoral heads of female C57BL/6 mice after excessive GC treatment. Increased chondrocyte apoptosis, altered chondrocyte metabolism, as well as increased vascular invasion, are the potential factors influencing epiphyseal cartilage ossification.

The Resumption of Sports Medicine During the COVID-19 Post-Epidemic Period: Experiences from Wuhan, People's Republic of China.

ABSTRACT: Coronavirus disease 2019 (COVID-19) is spreading worldwide, with its outlook not looking optimistic. Simultaneously, the epidemic is currently under control in many areas. The resumption of work and production in areas that have achieved control of outbreaks is a problem. Considering the extremely transmissible nature of COVID-19, and the presence of asymptomatic infected people, avoiding nosocomial infection and protecting medical staff and patients during the post-epidemic period remain difficult problems that need to be solved. At present, few articles have examined relevant experiences in the field of sports medicine. Wuhan, the People's Republic of China, was the original epicenter of COVID-19, with physicians as the initial frontline workers. Wuhan is now gradually returning to a more normal state after a series of urgent, strict, and effective measures were utilized to combat the epidemic. During this time, we collected first-hand experiences of sports medicine work resumption in the initial 2-month period, including preparations before resuming work, outpatient management methods, online outpatient services, inpatient ward management, principles for determination of the examination results, and preparations for operations. The strict and feasible management strategies that we conducted were useful in avoiding hospital-based infections. We intend to share our own experiences and thoughts in this area. We hope that this will be helpful and inspiring to our sports medicine colleagues around the world.

Curcumin prevents osteocyte apoptosis by inhibiting M1-type macrophage polarization in mice model of glucocorticoid-associated osteonecrosis of the femoral head.

Inflammation is a contributing factor in osteocyte apoptosis, which is strongly associated with the development of glucocorticoid-associated osteonecrosis of the femoral head (GA-ONFH). Curcumin is a naturally derived drug that regulates immunity and inhibits inflammation. This study aimed to examine the capacity of curcumin to prevent osteocyte apoptosis and GA-ONFH, while elucidating possible mechanisms of action. C57/BL6 female mice were divided into control, GA-ONFH, and curcumin-treated GA-ONFH groups. We determined the effect of curcumin on the polarization of RAW264.7 and the apoptosis of MLO-Y4 cells. We found that curcumin reduced the infiltration of M1-type macrophages in the femoral heads and alleviated systemic inflammation in GA-ONFH models. Additionally, curcumin decreased the apoptosis of osteocytes in the femoral heads and the ratio of GA-ONFH in mice. Further, in vitro curcumin intervention inhibited M1-type polarization via the Janus kinase1/2-signal transducer and activator of transcription protein1 (JAK1/2-STAT1) pathway. Taken together, this study demonstrates that curcumin is effective in preventing osteocyte apoptosis and the development of GA-ONFH in a mouse model. Curcumin prevents inflammatory-mediated apoptosis of osteocytes in part through inhibition of M1 polarization through the JAK1/2-STAT1 pathway. These findings provide novel insights as well as a potential preventive agent for GA-ONFH. This article is protected by copyright. All rights reserved.

Protective effect of Agrimonia pilosa polysaccharides on dexamethasone-treated MC3T3-E1 cells via Wnt/ß-Catenin pathway.

A water-soluble polysaccharide (APP-AW) was isolated from Agrimonia pilosa and prepared to three sulphated derivatives (S1, S2 and S3). The results showed that pre-treatment with APP-AW, S1, S2 and S3 each at the concentration of 50 µg/mL for 48 hours was able to prevent cytotoxicity induced by 1 µmol/L dexamethasone (Dex) in MC3T3-E1 cells via inhibition of apoptosis, which is in line with the findings in flow cytometry analysis. Meanwhile, the decreased ALP activity, collagen content, mineralization, BMP2, Runx2, OSX and OCN protein expression in DEX-treated MC3T3-E1 cells were reversed by the addition of APP-AW, S1, S2 and S3. Moreover, APP-AW, S1, S2 and S3 rescued DEX-induced increase of Bax, cytochrome c and caspase-3 and decrease of Bcl-2, Wnt3, ß-catenin and c-Myc protein expression in MC3T3-E1 cells. Our findings suggest that pre-treatment with APP-AW, S1, S2 and S3 could significantly protect MC3T3-E1 cells against Dex-induced cell injury via inhibiting apoptosis and activating Wnt/ß-Catenin signalling pathway, thus application of these polysaccharides may be a promising alternative strategy for steroid-induced avascular necrosis of the femoral head (SANFH) therapy.

Expression and methylation levels of suppressor of cytokine signaling 3 in rheumatic arthritis synovial fibroblasts.

BACKGROUND: In the present study, we aimed to understand the expression and methylation levels of the suppressor of cytokine signaling 3 (SOCS3) in rheumatoid arthritis (RA) synovial fibroblasts. METHOD: The RA model was established using Freund's complete adjuvant, and then the synovial fibroblasts were isolated and cultured. Next, RNA extraction and reverse transcription were performed. The SOCS3 transcription level was detected using qPCR, and SOCS3 protein expression was detected using western blotting (WB). Lastly, methylation-specific PCR (MSP) was performed. RESULTS: The RA model was successfully demonstrated. SOCS3 gene (p < .01) and protein expression levels were significantly increased in the RA rat group compared to in the wild type (WT) group. However, no significant difference was observed in the MSP products between the RA and WT groups. CONCLUSION: The increased expression of the SOCS3 can be correlated with the development of RA.

Agrimonia pilosa polysaccharide and its sulfate derives facilitate cell proliferation and osteogenic differentiation of MC3T3-E1 cells by targeting miR-107.

The present study showed that low level of miR-107 in femoral head tissues from rats suffering steroid-induced osteonecrosis of the femoral head (SANFH) was associated with high degree of osteonecrosis and apoptosis. In vitro assay, pretreatment with an Agrimonia pilos polysaccharide (APP-AW) and its sulphated derivatives (S2) at 50 µg/ml for 48 h or overexpressing miR-107 were able to prevent cytotoxicity induced by 1 µM dexamethasone (DEX) in MC3T3-E1 cells via inhibition of apoptosis. Meanwhile, the decreased ALP activity, collagen content, BMP2, Runx2, OSX and OCN protein expression in DEX-treated MC3T3-E1 cells were rescued by the addition of APP-AW and S2, or miR-107 transfection. Moreover, DEX-induced increase of Bax, cytochrome c and caspase-3, as well as decrease of Bcl-2, Wnt3, ß-catenin and c-Myc protein expression in MC3T3-E1 cells were also reversed. These findings suggest that APP-AW and S2 promote cell proliferation and osteogenic differentiation by enhancing miR-107 during the development of SANFH.

Arthroscopic arthrolysis of posttraumatic and non-traumatic elbow stiffness offers comparable clinical outcomes.

BACKGROUND: Primary purpose of this study is to compare the clinical outcomes of patients undergoing arthroscopic arthrolysis in posttraumatic and non-traumatic elbow stiffness. Secondary aims are to compare the level of satisfaction and complications. METHODS: We retrospectively evaluated the patients undergoing arthroscopic elbow arthrolysis between January 2008 and September 2015 and have completed a minimum 2-year follow-up. Total of 141 patients (male = 90; female = 51) with 143 elbows (posttraumatic, n = 75; non-traumatic, n = 68) with an average age of 33 years were available for final evaluation. The average follow-up period was 44 months. We used the Mayo Elbow Performance Index (MEPI) score, range of motion (ROM), Visual Analogue Scale (VAS) to measure clinical outcomes. The level of satisfaction was measured by a self-constructed questionnaire. RESULTS: All parameters were significantly improved postoperatively (P < 0.01). However, statistically significant differences were not present in the rate of postoperative improvement of elbow ROM (P = 0.08) and MEPI (P = 0.21) in both groups. According to MEPI, 72(96%) elbows in posttraumatic and 60(88%) elbows in non-traumatic group were rated as good to excellent. No statistically significant differences were observed in the level of satisfaction (P = 0.76) and rate of complications (P = 0.91). CONCLUSIONS: Arthroscopic arthrolysis is an effective tool and a good option for the treatment of patients with posttraumatic and non-traumatic elbow stiffness. The rate of elbow ROM and MEPI score improvements were significant and comparable postoperatively with a high level of patient's satisfaction. However, postoperative rehabilitation is equally essential to maintain intraoperative elbow ROM, to attain optimal outcome and to prevent complications.

A polysaccharide from dried aerial parts of Agrimonia pilosa: Structural characterization and its potential therapeutic activity for steroid­induced necrosis of the femoral head (SANFH).

In this study, one homogeneous polysaccharide (APP-AW), with an average molecular weight of 9550 Da, was purified from Agrimonia pilosa. Analysis by gas chromatography (GC), methylation, UV, Infrared spectra (IR), 1D and 2D nuclear magnetic resonance (NMR) spectroscopy indicated that APP-AW was a ß-(1 → 3)-d-glucan. The effect of APP-AW on dexamethasone (Dex)-induced apoptosis in osteoblasts was also examined. Pretreatment of APP-AW (100 µg/ml) significantly attenuated cell loss and apoptosis induced by Dex (1 µM) in osteoblasts as determined by MTT, Annexin V-FITC/ propidium iodide (PI) and Transferase (TdT)-mediated dUTP nick end labeling (TUNEL) staining assay. Collectively, the present study demonstrated that APP-AW might be an alternative therapeutics for the treatment of SANFH via reducing Dex­induced bone cellular apoptosis.

A Single Bundle Anterior Cruciate Ligament Reconstruction (ACL-R) Using Hamstring Tendon Autograft and Tibialis Anterior Tendon Allograft: A Comparative Study.

The main purpose of this study was to compare the clinical outcomes of patients undergoing a single bundle anterior cruciate ligament reconstruction (ACL-R) of using quadrupled hamstring (4HT) autografts and two-strand tibialis anterior (2TA) allografts, and to find out the rate of graft failure and possible causes. We hypothesized that there would be no difference in the clinical outcome, and graft failure would be associated with the use of small sized allograft in young active males with high demand of sports activities. We retrospectively evaluated 222 patients (male, n=167, female, n=55) undergoing ACL-R between January 2010 and July 2014. Of 222 patients, 115 were included in the 4HT autograft group and 107 patients in the 2TA allograft group. Inclusion criteria were primary unilateral ACL-R with a minor MCL (

Correction to: Arthroscopic release using F and C method versus conventional open release method in the treatment of gluteal muscle contracture: a comparative study.

Upon publication of this article [1], it was requested that: the corresponding author, Hong Wang's affiliation address be changed from.

Arthroscopic release using F and C method versus conventional open release method in the treatment of gluteal muscle contracture: a comparative study.

BACKGROUND: Gluteal muscle contracture (GMC), a debilitating disease, usually starts in early childhood after variable dose of injections around the buttock, if left untreated it worsens gradually and persists throughout the life. Because the disease mostly affects adolescents and adults, there is always an aesthetic concerns. Purposeof the study was to introduce the arthroscopic F and C method of GMC release, and to compare its clinical efficiency with conventional open surgery in terms of clinical outcome, rate of complications, patient's satisfactions, and recurrence. METHODS: Between Jan 2013 and July 2015, 75 patients received an arthroscopic release with F and C release method and 71 patients received conventional open release of GMC. Primary surgeries in 16 years or older patients were included in the study. Two groups were compared clinically using Hip Outcome Scores - Activities of Daily Living Subscale (HOS-ADL), Hip Outcome Scores - Sports Subscale (HOS-Sports), Visual Analogue Scale (VAS), and Ye et al. evaluation criteria. RESULTS: No statistically significant differences were observed in Hip Outcome Scores - Activities of Daily Living Subscale (HOS-ADL) (P = 0.078), Hip Outcome Scores - Sports Subscale (HOS-Sports) (P = 0.340), and Visual Analogue Scale (VAS) (P = 0.524) between the two groups. 74 (98.7%) patients in the arthroscopic surgery group had good to excellent results, whereas 69 (97.1%) patients in the conventional open surgery group had good to excellent results (P = 0.727). No statistically significant difference was observed in recurrence rate (P = 0.612). Statistically significant differences were observed in incision length, use of post-operative analgesia, post-operative off-bed activity, and hospital stay. Complications were significantly higher in the conventional open surgery group (n = 21) than in the arthroscopic surgery group (n = 10) (P = 0.016). More importantly, cosmetic satisfaction was 100% in arthroscopic release group, whereas only 71% had cosmetic satisfaction in conventional open surgery group (P < 0.001). CONCLUSION: Both, arthroscopic surgery and conventional open surgery, are highly effective tools for the GMC release in adolescent and adult patients. Arthroscopic GMC release with F and C method allows precise and selective release of contracture bands with small surgical trauma resulting fewer complications, high cosmetic satisfaction and minimal recurrence.

Gluteal muscle contracture: diagnosis and management options.

Gluteal muscle contracture (GMC), a debilitating disease, exists all over the globe but it is much more prevalent in China. Patients typically present with abduction and external rotation of the hip and are unable to bring both the knees together while squatting. Multiple etiologies have been postulated, the commonest being repeated intramuscular injection into the buttocks. The disease is diagnosed primarily by clinical features but radiological features are necessary for the exclusion of other pathological conditions. Non-operative treatment with physiotherapy can be tried before surgery is considered but it usually fails. Different surgical techniques have been described and claimed to have a better outcome of one over another but controversy still exists. Based on published literatures, the clinical outcome is exceptionally good in all established methods of surgery. However, endoscopic surgery is superior to conventional open surgery in terms of cosmetic outcome with fewer complications. Nevertheless, its use has been limited by lack of adequate knowledge, instrumentations, and some inherent limitations. Above all, post-operative rehabilitation plays a key role in better outcome, which however should be started gradually.