[Virtual preoperative planning and 3D-printed templates for pre-contoured plates in treatment of acetabular posterior wall fractures].

OBJECTIVE: To evaluate the feasibility and accuracy of virtual preoperative planning and 3D-printed templates for pre-contoured plates for the treatment of posterior wall fractures of the acetabulum. METHODS: A retrospective analysis of 29 patients with posterior acetabular wall fractures treated between August 2017 and March 2021 were divided into 2 groups based on whether to use preoperative virtual planning and 3D printed template. In 3D-printing group, there were 14 patients, including 10 males and 4 females； aged from 21 to 53 years old；CT-based virtual surgical planning was done using Mimics and 3-Matic software and 3D-printed templates for pre-contoured plates were adopted. In conventional group, there were 15 patients, including 10 males and 5 females；aged from 19 to 55 years old；conventional method of intra-operative contouring to adapt the plate to the fracture region was adopted. Blood loss, surgical time, radiographic quality of reduction, and hip function were compared between groups. RESULTS: The difference in operation time and intraoperative blood loss was significant（P<0.05）. Twenty-three patients were followed up from 12 to 30 months, and the fractures in both groups healed with a healing time of 3 to 6 months. At the last follow-up, the Merle d'Aubign-Postel score of the 3D printed group was lower than that of the conventional group（P<0.05）, with no significant differences in walking ability, hip mobility and total score（P>0.05）. In 3D printing group, 6 cases were excellent, 5 cases were good, 3 cases were fair；in conventional group, 5 cases were excellent, 5 cases were good, 4 cases were fair, 1 case was worse；no significant difference between two groups（P>0.05）. CONCLUSION: Virtual preoperative planning and 3D-printed templates for pre-contoured plates can reduce operative time and the blood loss of surgery, improve the quality of reduction. This method is efficient, accurate and reliable to treat acetabular posterior wall fractures.

Il-1ß Promotes Superficial Zone Cells Senescence in Articular Cartilage by Inhibiting Autophagy.

OBJECTIVE: The superficial zone cells in articular cartilage (SFZCs) have been identified as stem/progenitor chondrocytes and promoted cell self-renewal in the osteoarthritis (OA). Several studies emphasized the involvement of senescence and autophagy in OA. Interleukin-1ß (IL-1ß) is one of the main inflammatory mediators of OA, and whether it induces senescence and autophagy in SFZCs remains unclear. The present study aimed to investigate autophagy flux, mitochondrial function, and intracellular reactive oxygen species (ROS) that resulted in senescence in SFZCs induced by IL-1ß. METHODS: Using western blotting, reverse transcription-quantitative PCR, immunofluorescence, intracellular ROS detection, mitochondrial staining, and determination of mitochondrial membrane potential, we tested senescence and autophagy markers in SFZCs induced by IL-1ß in vitro. The consequences of mitochondrial function and ROS were also studied with IL-1ß-induced senescence. RESULTS: IL-1ß treatment decreased SFZC proliferation, induced SFZC senescence, and reduced SFZCs' chondrogenic differentiation capacity. Moreover, IL-1ß impaired autophagy flux, and the autophagy activator, rapamycin, attenuated the senescence of SFZCs. IL-1ß-induced autophagy defect resulted in mitochondrial dysfunction and overproduction of ROS, and autophagy activation notably protected against mitochondrial dysfunction and reduced the levels of ROS. Moreover, antioxidant N-acetylcysteine reversed the senescence of IL-1ß in SFZCs. CONCLUSION: IL-1ß promotes autophagy impairment and subsequently results in dysfunctional mitochondria and overproduction of ROS, which finally causes SFZC senescence.

[Effectiveness of multidirectionally three-dimensional steel wire ring sleeve fixation in treatment of inferior patellar pole avulsion fractures].

OBJECTIVE: To explore the method and effectiveness of multidirectionally three-dimensional steel wire ring sleeve fixation in the treatment of inferior patellar pole avulsion fractures. METHODS: Betweern January 2015 and January 2019, 22 patients with inferior patellar pole avulsion fractures were admitted and treated. There were 12 males and 10 females. The age ranged from 20 to 69 years, with an average age of 39.4 years. The causes of injury included 9 cases of traffic accident and 13 cases of falling. All of them were unilateral closed injury of knee joint, including 7 cases of skin contusion around patella. Preoperative range of motion of the affected knee was (20.82±7.16)° (range, 10°-35°). The time from injury to operation ranged from 3 to 12 days, with an average of 5.9 days. During the operation, the inferior patellar avulsion fracture was reduced with forceps; the patella was circumferentially ligated through the distal bone surface of the fracture with 0.8 mm diameter steel wire; then 3 longitudinal bone tunnels were made in the upper patella, respectively. The 0.8 mm diameter steel wire passed through the bone tunnel, and the longitudinal ring was attached to the ring to fix the upper and inferior patellar fracture. Tighten the transverse and longitudinal rings with No.2 tendon suture line, then longitudinally ringed and sutured to strengthen the patella. The knee range of motion, fracture healing time, and complications were recorded. The functional recovery of the knee joint was evaluated by Böstman score. RESULTS: All incisions healed by first intention, and no incision related complications occurred. All the 22 patients were followed up 13 months to 5 years with an average of 26.7 months. The fracture healing time was 9-12 weeks (mean, 10.9 weeks). At last follow-up, the knee range of motion was (129.77±2.35)° (range, 126°-135°), showing significant difference when compared with preoperative one ( t=-67.022, P=0.000). The Böstman score ranged from 31 to 36, with an average of 34.3. No reduction loss, fracture of steel wire, failure of internal fixation, and other complications occurred during follow-up. CONCLUSION: Multidirectionally three-dimensional steel wire ring sleeve fixation in the treatment of inferior patellar pole avulsion fractures has the advantages of reliable fixation, early functional recovery, and fewer complications, so the effectiveness is satisfactory.

A 3D Printed Porous Titanium Alloy Rod with Diamond Crystal Lattice for Treatment of the Early-Stage Femoral Head Osteonecrosis in Sheep.

Instruments made of porous titanium alloy and fabricated with a 3D printed technique are increasingly used in experimental and clinical research. To date, however, few studies have assessed their use in early-stage osteonecrosis of the femoral head (ONFH). In this study, porous titanium alloy rods (Ti-Rod) with diamond crystal lattice, fabricated using an electron beam melting (EBM) technique, were implanted into sheep models (n=9) of early-stage ONFH for 6 months. Bone ingrowth and integration were investigated and compared with those of sheep (n=9) undergoing core decompression (CD) alone. Following Ti-Rod implantation, femoral heads showed fine osteointegration, with X-ray evaluation showing compact integration between peripheral bone and rods without radiolucent lines encircling the rods, as well as new bone growth along the metal trabeculae without the intervention of fibrous tissue. The regions of interest (ROIs) of femoral heads showed fine bone ingrowth after Ti-Rod implantation than CD alone. By micro-CT evaluation, the ratios of bone volume to total volume (BV/TV) of ROIs in Rod group was 930 % and 452 % higher than CD group after 3 (0.206 ± 0.0095 vs. 0.020 ± 0.0058, p < 0.05, n=3) and 6 (0.232 ± 0.0161 vs. 0.042 ± 0.0061, p < 0.05, n=3) months respectively. By histological evaluation, the BV/TV of ROIs in Rod group was 647 % and 422 % higher than CD group after 3 (0.157 ± 0.0061 vs. 0.021 ± 0.0061, p < 0.05, n=3) and 6 (0.235 ± 0.0145 vs. 0.045 ± 0.0059, p < 0.05, n=3) months respectively. The new bone grew along metal trabeculae into the center of the rod with a rapid bone ingrowth in Rod gorup. Whereas in CD group, new bone grew mainly at the periphery of the decompressive channel with a slow bone ingrowth. Mechanical analysis showed that maximum load on the femoral head-necks was 31 % greater 6 months after Ti-Rod implantation than after CD alone when the vertical press reached the apex (3751.75 ± 391.96 vs. 2858.25 ± 512.91 N, p < 0.05, n=3). The association of rod implantation with fine bone ingrowth, osteointegration, and favorable mechanical properties suggests that implantation of the porous titanium alloy rod with the diamond crystal lattice may be a beneficial intervention for patients with early-stage ONFH.

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.

[Effectiveness of tibio-talo-calcaneal arthrodesis with full thread headless compression screws via combined minimal incisions].

Objective: To investigate the effectiveness of tibio-talo-calcaneal arthrodesis with full thread headless compression screws via combined minimal incisions. Methods: Between January 2012 and December 2016, 36 patients (36 feet) with ankle diseases underwent tibio-talo-calcaneal arthrodesis with parallel double thread headless compression screws via minimal anterior and lateral oblique incisions. There were 14 males and 22 females with an average age of 53.8 years (range, 18-76 years). There were 19 cases of left feet and 17 cases of right feet. There were 21 cases of talar necrosis, 7 cases of post-traumatic arthritis, 3 cases of rheumatoid arthritis, 2 cases of tuberculosis infection (inactive), 1 case of talar absence, 1 case of Charcot's disease, and 1 case of pigmented villonodular synovitis of ankle and subtalar joints. Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score were 53.7±2.5 and 5.9±0.2, respectively. The operation time was recorded and the wound healing and complications were observed. The bone healing was assessed by X-ray film and CT scanning. The function and pain of joint were evaluated by AOFAS and VAS scores. Results: The mean operation time was 49.8 minutes (range, 33-82 minutes). Incision infection occurred in 1 patient (2.8%) at 3 weeks after operation, and recovered after debridement. The other incisions healed by first intention without complications. Thirty-five patients were followed up with an average of 18.5 months (range, 12-29 months). Imaging examination showed fusion of the ankle and subtalar joints with an average fusion time of 10.9 weeks (range, 8-15 weeks). After 1 year, the AOFAS score (84.7±0.6) and VAS score (0.3±0.1) were significantly higher than preoperative scores ( t=12.596, P=0.000; t=30.393, P=0.000). Conclusion: It is an effective surgical method of tibio-talo-calcaneal arthrodesis with full thread headless compression screws via combined minimal incisions for end-stage ankle disease because of the less complications incidence and the higher postoperative fusion rate.

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.

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.

Individualized coracoid osteotomy and 3D congruent arc reconstruction of glenoid for the treatment of recurrent anterior shoulder dislocation.

BACKGROUND: The present study investigated individualized coracoid osteotomy for 3D congruent arc glenoid reconstruction and evaluated the clinical outcomes in recurrent anterior shoulder dislocation. METHODS: From January 2005 to July 2015, 78 patients with glenoid defect underwent coracoid and conjoint tendon transposition. The patients were divided into the individualized group (n = 34) and the non-individualized group (n = 44). All patients had CT data to reconstruct the shoulder model using Mimics software. In the individualized group, the individual coracoid osteotomy and bone fixation position parameters were measured from preoperative planification through simulating a 3D congruent arc glenoid reconstruction model. The non-individualized group underwent classic Bristow-Latarjet (B-L) procedure. The postoperative evaluation parameters included 3D congruent arc index, coracoid bone position, shoulder osteoarthritis index (Samilson-Prieto) and shoulder function score (Rowe, Constant-Murley score). RESULTS: The mean follow-up time was 51.0 months (ranging from 24 to 146). The individualized group got 3D congruent arc reconstruction of the glenoid by postoperative CT scanning. Bone position was more precise in the individual group than that in the B-L group. There was a lower incidence of shoulder osteoarthritis (Samilson-Prieto) in the individual group compared with that in the B-L group: 0 vs 13.6% (mild 6/44, P = 0.027), respectively. No significant difference was observed between the individual and B-L groups in rate of re-dislocation: 0 vs 4.5% (2/44, P = 0.315), respectively. The postoperative Rowe and Constant score was significantly improved but was not significantly different between the two groups. CONCLUSION: The individual procedure achieved 3D congruent arc glenoid reconstruction. The clinical effects in patients with medium glenoid defect were good, especially the low incidence of shoulder osteoarthritis in middle-term follow-up.

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.

[Measurement of radiological parameters and Logistic regression analysis for adult acquired flatfoot].

OBJECTIVE: To evaluate and compare the radiographic parameters between patients of adult acquired flatfoot and normal participants to provide rationales for diagnosis and operative reconstruction. METHODS: The adult acquired deformity group consisted of 85 patients (85 feet) and normal group 90 normal participants (90 feet) from January 2008 to May 2014. The weight-bearing anteroposterior and lateral foot radiographs were taken. And the following parameters were measured and compared: medial column length (MCL), lateral column length (LCL), medial column height (MCH), lateral column height (LCH), talonavicular uncoverage angle (TNUA), talus-first metatarsal angle (TMTA) and calcaneal pitch angle (CPA). Age and all parameters were included for Logistic regression analysis. RESULTS: On anteroposterior radiographs, the values of MCL for adult acquired deformity and normal groups were (103.5 ± 9.0),(105.8 ± 7.8)mm and LCL (94.6 ± 6.9),(96.2 ± 6.1)mm respectively.No significant difference existed in MCL or LCL (P > 0.05).However, significant inter-group differences existed in TMTA and TNUA (P < 0.01). The values of TMTA were (18.9 ± 2.5)°,(7.8 ± 2.2)° and TNUA (23.6 ± 3.2)°,(8.0 ± 2.2)°.On lateral radiographs, significant inter-group differences existed in MCH, LCH, CPA and TMTA (P < 0.01). And the values of MCH were (16.3 ± 1.7),(23.6 ± 2.8)mm, LCH (14.9 ± 1.1),(13.96 ± 1.39)mm, CPA (14.86 ± 2.76)°,(22.9 ± 1.9)° and TMTA (10.0 ± 2.0)°,(-3.6 ± 1.0)° respectively. According to Logistic regression analysis, the significance of parameters ranged from lateral TMTA (B = 0.032), anteroposterior TNUA (B = 0.014), anteroposterior TMTA (B = 0.015) to lateral MCH (B = -0.012), lateral CPA B (B = -0.009). CONCLUSION: No differences exist in anteroposterior MCL or LCL. There are positive differences in lateral TMTA, anteroposterior TNUA and anteroposterior TMTA. And negative differences exist in lateral MCH and lateral CPA between adult flatfoot and normal foot. Lateral TMTA may be an excellent radiographic identifier of patients with adult acquired flatfoot during diagnosis and treatment.

[Effectiveness comparison of modified percutaneous mini-incision and open Achilles tendon lengthening for treatment of Achilles contracture syndrome].

OBJECTIVE: To explore the effectiveness of modified percutaneous mini-incision Achilles tendon lengthening for the treatment of Achilles contracture syndrome by comparing with traditional open Achilles tendon lengthening. METHODS: Between May 2008 and May 2012, 42 patients with Achilles contracture syndrome were treated and the clinical data were retrospectively analyzed according to the inclusion criteria. The modified percutaneous mini-incision Achilles tendon lengthening was used in 19 cases (19 feet, trial group); 0.5 cm incisions were designed at medial and lateral Achilles tendon according to the degree of Achilles contracture syndrome; and percutaneous double hemi-section was done according to the deformity range ofvarus and valgus foot. The traditional open Achilles tendon lengthening was used in 23 cases (24 feet, control group). There was no significant difference in age, gender, disease duration, motion of ankle dorsiflexion, and Hannover Achilles tendon score (P > 0.05). RESULTS: The operation time, postoperative hospitalization days, and intraoperative blood loss in the trial group were less than those in the control group, showing significant differences (P < 0.05). After operation, incision healing by first intention was obtained in the other cases except 1 case which had infection in the control group. The patients were followed up 6-35 months in the trial group and 8-34 months in the control group. Correction of varus deformity foot was not obvious in 1 case of the trial group, correction of varus and valgus deformity feet were satisfactory in the other cases. There was no significant difference in motion of ankle dorsiflexion and Hannover Achilles tendon score between 2 groups at last follow-up (P > 0.05), but significant differences were found between preoperation and last follow-up in 2 groups (P < 0.05). There were significant differences in motion of ankle dorsiflexion and Hannover Achilles tendon score between normal and affected sides in 2 groups at last follow-up (P < 0.05). CONCLUSION: Modified percutaneous mini-incision Achilles tendon lengthening has similar effectiveness to the traditional open Achilles tendon lengthening for Achilles tendon contracture syndrome. And it can effectively correct varus and valgus deformities of the foot with less trauma and fast recovery.

[Short-term effectiveness of suture anchor after debridement of extensor tendon insertion for recalcitrant lateral epicondylitis].

OBJECTIVE: To analyze the short-term effectiveness of repairing musculus extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC) tendon using suture anchor after debridement of extensor tendon insertion for recalcitrant lateral epicondylitis. METHODS: Between March 2009 and May 2011, 10 patients (10 elbows) with recalcitrant lateral epicondylitis received repair of the ECRB and EDC tendon to the lateral epicondyle using a single suture anchor after debridement of extensor tendon insertion. There were 6 males and 4 females with an average age of 45.4 years (range, 36-57 years). The dominant elbow was involved in 8 patients and nondominant elbow in 2 patients; there were 4 manual workers and 6 ordinary workers. The disease duration ranged from 8 to 24 months (mean, 12.3 months). All patients had epicondylus lateralis humeri pain, local swelling and tenderness, and positive Mill sign. The average elbow range of motion (ROM) was 11.3 degrees (range, 0-30 degrees) in extension and was 132.5 degrees (range, 120-145 degrees) in flexion. Preoperative MRI showed external humeral epicondylitis in all patients. RESULTS: Primary wound healing was obtained in all patients without complications of infection, leakage of joint fluid, and stiffness of elbow. Ten patients were followed up 4 to 23 months with an average of 12 months (more than 12 months in 7 cases). The time to return to work was (3.75 +/- 0.95) months for manual workers and was (2.91 +/- 0.20) months for ordinary workers, showing no significant difference (t = 1.715, P = 0.180). Compared with preoperation, the mean visual analogue scale (VAS) score significantly decreased (P < 0.05), and Mayo score and the grip strength of dominant and nondominant significantly increased (P < 0.05), but no significant difference was found when compared with non-surgical side at last follow-up (P > 0.05). At last follow-up, the average ROM was -1.5 degrees (range, 0-10 degrees) in extension and was 150.5 degrees (range, 140-160 degrees) in flexion. CONCLUSION: To suture anchor for repairing the ECRB and EDC after debridement is a satisfactory procedure to treat recalcitrant lateral epicondylitis. It can effectively prevent loss of the forearm extensor strength, relieve the pain, recover the grip strength, and obtain good results.

[Percutaneous achilles tendon lengthening through double hemisection in the treatment of achilles contracture syndrome].

OBJECTIVE: To explore the surgical approach of percutaneous double hemisection and evaluate its clinical efficacies. METHODS: From May 2006 to November 2011, a total of 59 patients were recruited. There were 36 males and 21 females with a mean age of 38.2 years (range: 8 - 62). Forty-two varus and 6 valgus feet underwent percutaneous double hemisection. The 0.5 cm coracoid incision was adopted at the medial and lateral aspects of Achilles tendon. Percutaneous double hemisection was employed according to the deformity angles of varus and valgus feet. Manipulative correction was applied slowly until 30° dorsiflexion of ankle. Short leg cast was immobilized for 5 weeks at 30° dorsiflexion of ankle. The force of Achilles tendon, motion of ankle and Hannover Achilles tendon scores were followed up. RESULTS: Fifty-two patients were followed up for a mean period of 16.5 months (range: 6 - 60). Seven patients were lost. At the end of follow-up, 48 patients with varus and valgus deformities were corrected effectively. When compared with the normal side, the force of Achilles of the operated side of 50 patients had no change while that of 2 patients decreased slightly; the motion of ankle joint increased from (2.8 ± 0.3)° preoperatively to (28.5 ± 1.4)° postoperatively (P < 0.05); the Hannover Achilles Tendon Scores rose from (68.5 ± 3.5) preoperatively to (82.6 ± 4.2) points postoperatively (P < 0.05). The outcomes were excellent (n = 44), very good (n = 5), good (n = 2) and poor (n = 1). The excellent and good rate was 94.2%. CONCLUSION: As an effective therapy for Achilles tendon contracture syndrome, percutaneous double hemisection has fewer complications and a faster recovery.

[Effects of exogenous prostaglandin E2 on collagen content of Achilles tendon of rabbits in vivo].

OBJECTIVE: Prostaglandin E2 (PGE2) production increases in human tendon fibroblasts after the tendon injuries and repetitive mechanical loading in vitro. To analyze the relations between PGE2 and tendinopathy by observing the changes of collagen content and proportion after the Achilles tendon of rabbits is repeatedly exposed to PGE2. METHODS: Twenty-four Japanese rabbits (aged 3-4 months, weighing 2.0-2.5 kg, and male or female) were equally randomized into 2 groups according to injection dose of PGE2: low dose group (50 ng) and high dose group (500 ng). Corresponding PGE2 (0.2 mL) was injected into the middle segment of the Achilles tendon of hindlimb, the same dose saline into the same site of the other side as controls once a week for 4 weeks or 8 weeks. The Achilles tendons were harvested at 4 and 8 weeks after injection. HE staining was used to observe the cell structure and matrix, and picric acid-sirius red staining to observe the distribution and types of collagen fibers, and transmission electron microscopy was used to measure the density of the unit area and diameter of collagen fibers. RESULTS: HE staining showed that collagen structural damage was observed in low dose and high dose groups. Picric acid-sirius red staining showed that the content of type I collagen significantly decreased while the content of type III collagen significantly increased in experimental side of 2 groups at 4 and 8 weeks after injection when compared with control sides (P < 0.05). The content of type I collagen was significantly lower and the content of type III collagen and ratio of type III to type I were significantly higher in high dose group than in low dose group (P < 0.05). Transmission electron microscopy showed that the collagen fibers density of unit area was significantly lower and the diameter was significantly smaller in high dose and low dose groups than in the controls (P < 0.05), and in high dose group than in low dose group (P < 0.05). CONCLUSION: Repeat exposure of the Achilles tendon of rabbit to PGE2 can cause the decrease of type I collagen, the increase of type III collagen, the reverse ratio of type I to type III, reduced unit density of collagen fibers, and thinner collagen fibers diameter, which is related with tendinopathy.

[Effects of different cyclic mechanical stretching loads on human tenocytic cytoskeleton in vitro].

OBJECTIVE: To investigate the human tenocyte cytoskeleton under different in vitro stretching conditions and analyze the relations between the changes of tenocytic cytoskeleton and different stretching loads. METHODS: Human tenocytes, cultivated for 5 -7 passages, were stretched under 4%, 8% and 12% cyclic mechanical stretching with a duration of 2, 4, 8, 12, 24 hours and a frequency of 0.5 and 1.0 Hz. Laser scanning confocal microscope was used to examine the changes of F-actin and nucleus after immunofluorescent staining at different cyclic mechanical stretching loads on human tenocyte. The uni-cell average fluorescence intensity was measured with an image analysis system by the photos of human tenocyte cytoskeleton and analyzed by the single factor analysis of variance. RESULTS: After cyclic stretching under 4% stretching with a duration of 2 hours at 0.5 Hz, the microfilament of human tenocyte had an irregular and dim alignment. F-actin was thicker and ruptured under 4% stretching with a duration of 4 hours. Under 8% stretching with a duration of 4 hours at 0.5 Hz, all actin microfilaments ruptured, but part of membrane microfilament remained intact. There was a rising trend of actin filament fracturing under 12% stretching with a duration of 2, 4, 8, 12, 24 hours at 1.0 Hz. And all actin filaments fractured at 24 hours. In the control group, the fluorescent intensity of F-actin was at the highest and the filament remained intact. Under the same stretching frequency, the fluorescent intensity of F-actin had a declining trend and significant differences existed under different stretching loads with different durations (P < 0.05). The fluorescent intensity of F-actin increased in all experimental groups, but it was lower than that of the control group with a duration of 8 hours. The expression of F-actin decreased with a longer duration and reached its lowest at 24 hours. The most obvious phenomenon of nuclear condensation and apoptotic body formation was observed under 4% stretching with a duration of 4 hours at 0.5 Hz. CONCLUSION: Different cyclic mechanical stretching may cause the in vitro breakage and depolymerization of human tenocytic F-actin. Such an effect correlates with stretching force and its duration.

[Triple arthrodesis with osteotomy for the treatment of stage IIB and stage III adult-acquired flatfoot deformity].

OBJECTIVE: To analyze the clinical outcomes of triple arthrodesis with osteotomy in the treatment of Stage IIB and Stage III adult-acquired flatfoot. METHODS: The authors reviewed 10 cases of adult-acquired flatfoot, including 3 cases of stage IIB adult-acquired flatfoot and 7 cases of stage III adult-acquired flatfoot. They were treated by triple arthrodesis with osteotomy of subtalar joint (STJ), talonavicular joint (TNJ) and calcaneocuboid joint (CCJ). The combined medial and lateral incisions were used to obtain adequate exposure for CCJ, STJ and TNJ. Then the cartilages of CCJ, STJ and TNJ were completely denuded and osteotomies to restore their proper alignments. The optimal positioning of hindfoot could be achieved and fixed by Kirschner wires. Two cannulated screws of 7.3 mm were delivered through the plantar aspect of heel to fix STJ. And then two 4.5 mm cannulated screws individually fixed TNJ and CCJ distal to proximal. Clinical evaluations were based on the AOFAS ankle-hindfoot scale and subjective assessments of pains, function, cosmesis and overall satisfaction. Radiographic evaluations included measurements of anterior-posterior talo-first metatarsal angle, lateral talocalcaneal angle, lateral talo-first metatarsal angle and an assessment of time to union for all arthrodeses. RESULTS: All patients were followed-up with a mean time of 13.2 (6 - 21) months. The average AOFAS ankle-hindfoot scale improved from 39.4 ± 4.4 preoperatively to 83.7 ± 2.6 postoperatively (P < 0.01). And the patients experienced subjective improvements in pain, function and cosmesis. Overall, all patients were satisfied. Radiographically, the rate of bone healing was 100%. The anterior-posterior talo-first metatarsal angle, lateral talocalcaneal angle and lateral talo-first metatarsal angle statistically improved. No complication, such as infection and un-union, was reported. CONCLUSION: Triple arthrodesis with osteotomy is an effective procedure for the treatment of stage IIB and III adult-acquired flatfoot deformity. It may relieve pains, correct structural deformities and obtain excellent clinical outcomes.

[Medial displacement calcaneal osteotomy with mini-incision for the treatment of acquired flexible flatfoot caused by posterior tibial tendon dysfunction].

OBJECTIVE: To investigate the clinical outcomes of medial displacement calcaneal osteotomy with mini-incision for the treatment of acquired flexible flatfoot caused by posterior tibial tendon dysfunction. METHODS: From 2005 to 2009, 10 patients (13 feet) of acquired flexible flatfoot with obvious heel valgus underwent medial displacement calcaneal osteotomy with mini-incision. The lateral skin incision of 3.0 - 4.5cm was made to explore the lateral calcaneal wall. Calcaneal osteotomy was performed from inferior and lateral to superior and medial, perpendicular to the longitudinal axis of calcaneal body. The distal segment was displaced medially for 1/3-1/2 width of calcaneal body and fixed by two parallel cannulated screws. All patients were evaluated at 6 weeks, 3 months, 6 months, 12 months and every 6 months pre- and post-operatively by clinical examinations and radiological studies. All patients were physically examined with an extended protocol of questionnaires and the AOFAS Ankle & Hindfoot Scales. The lateral view of full foot allowed an assessment of bone healing, calcaneus inclination angle (CI), talocalcaneal angle (TC) and talar first metatarsal angle (TMT). The AP view of full foot allows assessment of TC and TMT. The heel varus/valgus alignment could be evaluated on the axial radiographs of hindfoot. RESULTS: With a mean postoperative follow-up period of 20.3 months (range 7 - 55 Ms), all patients had bone union as confirmed by clinical examination and radiology. The AOFAS rating scale improved from a pre-operative mean of 50.3 to a mean of 80.2 at 6 months and a mean of 84.2 at last follow-up, without any complication of infection, nerve injure and so on. All radiographic parameters were statistically significant (P < 0.001), including CI, TC and TMT on the lateral view and TC and TMT on the AP view. The heel varus/valgus was corrected on the axial view. CONCLUSION: The medial displacement calcaneal osteotomy with mini-incision is a recommended procedure for the treatment of acquired flexible flatfoot with excellent clinical outcomes, correction of deformity and fewer complications.

[Relationship between glenoid inclination or version and supraspinatus tendon full-thickness tears].

OBJECTIVE: To investigate the relationship between glenoid inclination or version and supraspinatus tendon full-thickness tears. METHODS: Forty-two cases of unilateral supraspinatus tendon full-thickness tears were confirmed by clinical examinations and MRI scans. The bilateral glenoid inclination and version angles, measured by the volume rendering technique (VRT) and multi-planar reformation (MPR) of multi-slice computed tomography (MSCT) under 16-slice spiral CT scans, were compared by paired t test in all cases. RESULTS: The average inclination angle was (97.6 ± 4.0)° and (96.1 ± 2.9) at affected and healthy sides respectively. And the difference had statistical significance (P = 0.001); the average version angle was (-3.2 ± 5.0)° and (-3.1 ± 4.7)° at affected and healthy sides respectively. And the difference had no statistical significance (P = 0.79). CONCLUSION: The glenoid inclination angles are correlated with supraspinatus tendon full thickness tears while but the glenoid version angles are not. A larger glenoid inclination angle may be a positive predictive factor of supraspinatus tendon full-thickness tears.