Search

Subscapular tendon plays an important role in shoulder joint function. With the advance of magnetic resonance imaging technology and the popularization of arthroscopic shoulder surgery, subscapularis tears have been increasingly detected. However, reduction and fixation of subscapular tendon tears appears to be technically challenging. This study aims to describe an arthroscopic intra-articular X-shaped fixation technique: a procedure of subscapularis tendon repair performed with the aid of a suture passer using only a single anterior portal and a single suture anchor. By incorporating the advantages of a single anterior working portal for anchor placement and tear repair, this technique provides an easier way to use suture lasso and make knots in a limited working space, and the whole procedure is minimally invasive with a short learning curve. This technique has been applied in patients with subscapularis tears involving no intraoperative or postoperative complications. Our technology offers a valuable new treatment option for subscapularis tears.

Neurodegenerative disorders (NDs) are characterized by a gradual loss of neurons and functions that eventually leads to progressive neurological impairment. In view of the heavy burden on the healthcare system, efficient and reliable biomarkers for early diagnosis and therapeutic treatments to reverse the progression of NDs are in urgent need. There has been an increasing interest in using exosomal miRNAs as biomarkers or targeted therapies for neurological diseases recently. In this review, we overviewed the updated studies on exosomal miRNAs as biomarkers and potential therapeutic approaches in NDs, as well as their association with the pathophysiology of this group of disorders, especially Alzheimer’s disease (AD), Parkinson’s disease (PD), amyotrophic lateral sclerosis (ALS), and Huntington’s disease (HD). The exosomal miRNAs that are commonly dysregulated across different NDs or are commonly used as therapeutic candidates were also identified and summarized. In summary, the feasibility of exosomal miRNAs as biomarkers and potential targeted therapy for NDs has been verified. However, due to the limitations of existing studies and the discrepancies across different studies, high quality laboratory and clinical investigations are still required.

Our study aimed at validating the effect of WISP1 on osteoarthritis (OA) and the pathway involved in the WISP1-induced protection against OA. The expression of WISP1 was measured by immunohistochemical analyses. We found that WISP1 expression was shown to be upregulated within human OA cartilage compared with controls. WISP1 expression was related to knee OA severity. rhWISP1 inhibited OA chondrocyte senescence and apoptosis in vitro, which was reversed by the αvβ3 antibody and PI3K/Akt inhibitor LY294002. WISP1 overexpression induced by knee injection of LiCI could also prevent the senescence and apoptosis of rat chondrocytes. Safranin-O staining and Mankin score revealed that WISP1 overexpression can protect rat chondrocytes from degeneration. Nearly opposite results were obtained in the treatment of ICG-001 and siRNA-WISP1 in vivo. These data strongly suggest that WISP1 can protect against the senescence and apoptosis of chondrocytes via modulating the αvβ3 receptor and PI3K/Akt signaling pathway within OA. Therefore, the development of specific activators of WISP1 may present the value of an underlying OA treatment.

Anatomic tunnel formation and remnant preservation are the recent trends in posterior cruciate ligament (PCL) reconstruction. However, it is difficult to observe the anatomical PCL footprint and perform the operation in the process of remnant‐preserving PCL reconstruction. This study describes a single‐bundle, transtibial PCL reconstruction technique with anatomic graft passage over the remnant PCL fibers. A femoral tunnel of PCL is created at 2 mm medial to the roof of the intercondylar notch and 3 mm proximal to the margin of the articular cartilage. The tibial insertion of PCL is observed using a figure‐of‐four position through a posterior trans‐septal portal. A tibial bone tunnel is made below the distal center portion of the tibial insertion of residual PCL fibers. The graft is passed over the PCL through the tibial bone tunnel, the space between the anterior cruciate ligament (ACL) and the residual PCL fibers, to the femoral socket and is fixed by the EndoButton and screw. This technique is able to ensure a reasonable intra‐articular length and optimal isometry. It has been applied in patients with PCL rupture and posterior instability of the knee joint, and no intraoperative or postoperative complications occurred. Our technology provides a valuable new treatment option for PCL rupture. Future comparative studies are needed to further clarify its beneficial effect.

Background Cartilage destruction is the main characteristic of osteoarthritis (OA), and osteopontin (OPN) is elevated in OA articular cartilage; however, the reason for the increased OPN level is not determined. In addition, Wnt/β-catenin signaling participates in the progression of OA. The aim of the present study was to evaluate whether canonical Wnt signaling could regulate the expression of OPN in human chondrocytes in vitro. Methods Human chondrocytes were cultured in vitro, and we first assayed the mRNA levels of OPN and β-catenin in chondrocytes. Next, we performed transient transfection of TCF 4 shRNA into chondrocytes to inhibit TCF 4 expression and explore changes in the OPN level. Then, the Wnt/β-catenin signaling inhibitor Dickkopf-1 (Dkk-1) was incubated with chondrocytes, and we assayed the changes in β-catenin and OPN. Results Our results showed that the expression of both β-catenin and OPN was increased in OA chondrocytes, but there were no correlations between β-catenin and OPN expression. TCF4 shRNA downregulated the expression of TCF 4 and OPN in chondrocytes, while after treatment with rDKK-1 at a concentration of 400 ng/ml for 24 h, the mRNA and protein expression of both β-catenin and OPN was significantly decreased in chondrocytes. Conclusions Elevated OPN expression might be regulated by the β-catenin/TCF-4 pathway, and the Wnt/β-catenin inhibitor DKK1 could inhibit the expression of β-catenin and OPN in OA chondrocytes.

OBJECTIVE To assess the clinical results of the "figure-of-eight" suture-button technique in the arthroscopic treatment of anterior cruciate ligament (ACL) tibial avulsion fractures. METHODS This was a retrospective study reviewing data from September 2013 to June 2019. A total of 27 patients (13 males and 14 females) who underwent arthroscopic "figure-of-eight" suture-button fixation for displaced ACL avulsion fractures were analyzed. The mean age of the patients in the sample was 15.8 years (10-29 years), with a mean follow-up of 24 months (6-48 months). According to Meyers-McKeever classification, 11 patients were classified as type III and 16 as type IV. All patients were evaluated following the guidelines of the radiological union, the Lysholm knee scoring scale, and the International Knee Documentation Committee (IKDC). RESULTS Fractures were united within 3 months after surgery in all 27 cases. During the last follow-up, all the anterior drawer and Lachman tests were negative, except in 1 patient whose anterior drawer test was 1° positive. The range of motion was improved from 72.22° ± 27.92° before surgery to 137.78° ± 7.38° at the last follow-up (P

BackgroundTo evaluate the clinical outcomes of arthroscopic tight fibrous band release in the treatment of adult moderate-to-severe gluteal fibrosis using anterior and posterior portals during mid-term follow-up.MethodsThe data of 138 patients (58 males, 80 females) aged between 18 and 42 years (mean, 28.6 years), presenting with bilateral moderate-to-severe gluteal fibrosis (GF) from October 2013 to August 2019, was retrospectively analyzed. All patients underwent arthroscopic tight fibrous band release using anterior and posterior portals with radiofrequency energy. Under arthroscopic guidance through the posterior portal, we debrided the fatty tissue overlying the contracted band of the gluteal muscle and excised the contracted bands using a radiofrequency device introduced through the anterior portal. The pre- and post-operative gluteal muscle contracture disability (GD) scale and the patient satisfaction rate were compared to evaluate the curative effect of the operation.ResultsThe average operation time was 18 min (range, 10–30 min) and the average blood loss was 4 ml (range, 2–10 ml) for unilateral arthroscopic release. Two cases of post-operative minimal hematomas, 2 cases of bruising and 2 cases of local subcutaneous edema were observed as early complications and were cured by conservative treatment. After surgery, all incisions healed in stage I, and no other complications such as wound infection, nerve and blood vessel injury were detected. One hundred eighteen patients were followed up for 6 to 72 months (mean, 36 months). No lateral instability of the hip was observed and all patients returned to normal gait. The degree of adduction of the hip joint in all these 118 patients was significantly improved relative to their pre-operative conditions. One hundred fifteen patients (97.5%) were able to crouch with knees close to each other after surgery. One hundred fourteen patients (96.6%) were able to cross the affected leg completely without any support. The GD scale was improved from 55.5 ± 10.6 before operation to 90.1 ± 5.2 at the last follow-up (p ConclusionArthroscopic tight fibrous band release using anterior and posterior portals is minimally invasive for adult moderate-to-severe gluteal fibrosis, with a high success rate, quick recovery after surgery and reliable medium-term effect.

Background: During the current COVID-19 pandemic, offline clinical education was mandated to suspend at the neurology department of many teaching hospitals globally, yet there is insufficient evidence regarding the preferred practice and methods for online neurology intern training course. Objective: The investigation aimed to examine whether the online neurology training course based on Small Private Online Course (SPOC) and blending learning mode can achieve a good effect and cater for interns from different medical programs and whether the learning group size affects the teaching effect. Design: The subjects were 92 students enrolled in the neurology internship at the Second Xiangya Hospital of China from 9 March to 9 August 2020. After completing the online course, the final scores and evaluation results were compared among different groups of interns, and their preference to distinct contents of the course was analyzed. Statistical analysis was performed using the SPSS program (version 22.0). Results: Our online course received consistent positive recognition from the interns. Ninety-nine percent of the interns recommended incorporating the online course into the conventional offline training program after the pandemic. There was no significant difference between interns from different programs concerning the final scores and course evaluation. A smaller learning group size (

Background This study aimed to compare the arthroscopic internal drainage of popliteal cysts alone or in combination with cyst wall resection in terms of clinical outcomes. Methods Forty-two consecutive patients with symptomatic popliteal cysts received arthroscopic treatment. Specifically, 20 of them received arthroscopic internal drainage (AI group) alone and 22 received arthroscopic internal drainage combined with cyst wall resection (AICR group) through double posteromedial portals. Magnetic resonance imaging (MRI) was performed to identify recurrence of popliteal cysts. The Lysholm score and Rauschning-Lindgren grade were used to assess the clinical outcomes. The median of the follow-up period was 24 months (12–48 months). Results The two groups (AI group and AICR group) were similar in age, gender, cyst diameter, associated joint disorder, preoperative Lysholm score, preoperative Rauschning-Lindgren grade and follow-up period (P > 0.05). Relative to the AI group, the AICR group had a significantly prolonged operation time (P P P P P > 0.05). According to the MRI results, the cyst disappeared in 11 (55%), shrank in size in 6 (30%) and existed in 3 (15%) patients in the AI group, and was absent in 18 (81.8%) and shrank in size in 4 (18.2%) patients in the AICR group, suggesting a significant difference between the two (P Conclusion Additional resection of cyst wall can result in a lower recurrence rate of cysts but extend the operation time and increase the incidence of perioperative complications compared with arthroscopic internal drainage of popliteal cysts alone.

Objective To assess the clinical results of the remnant‐preserving and I.D.E.A.L. femoral tunnel technique in the arthroscopic treatment of anterior cruciate ligament (ACL) injuries. Methods This was a retrospective single‐center, single‐surgeon study reviewing data from November 2016 to March 2019. Based on our inclusion/exclusion criteria, a total of 31 patients (18 males, 13 females; mean age, 23.6 years) who underwent arthroscopic ACL reconstruction with the remnant preservation and I.D.E.A.L. femoral tunnel technique were recruited and had a minimum follow‐up of 12 months. Clinical data and status of knee stability were recorded. The International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity scale were collected both preoperatively and at a minimum of 1‐year follow‐up. Results Statistically significant differences were detected between the preoperative and postoperative values for Lachman test and pivot‐shift test (P, (A) MRI of the right knee showed rupture of the femoral end of ACL. (B) A routine arthroscopic examination was performed using a probe with a 30° oblique arthroscope in the anterolateral (AL) portal and another probe in the anteromedial (AM) portal. ACL avulsion from femoral insertion was observed. (C) Position of the I.D.E.A.L. femoral tunnel (arthroscopic view). A guide PDS was placed through the femoral bone tunnel. (D) The tibial tunnel (the position of the Kirschner wire) was located at the center of ACL remnant. (E) The position of ACL graft in the joint after fixation through the tibial and femoral tunnels. (F) The ACL graft and ACL remnant were sutured together with PDS suture. (G,H) Postoperative anteroposterior and lateral plain radiographs showed the correct position of the titanium plate. (I) Volumetrically rendered image from sagittal CT taken after primary ACLR showed that the tunnels were located at the anatomic position. (J) 3D CT scan reconstruction with a femoral tunnel position. (K) 3D CT scan reconstruction with a tibial tunnel position.

Objectives. A recent work has reported that the elevated osteopontin (OPN) levels in the articular cartilage and synovial fluid are correlated with the progressive osteoarthritis (OA) joint damage, and OPN has a protective effect against OA by suppressing the expressions of OA-associated genes. The present study examined whether the OPN deficiency was susceptible to OA through the regulation of chondrocyte senescence and apoptosis and the expressions of OA-associated genes. Methods. The mRNA levels of COL2A1 and OPN were compared between human OA chondrocytes and normal chondrocytes. The effects of OPN siRNA on the SA-β-Gal expressions and the percentage of apoptotic chondrocytes were examined by using SA-β-Gal staining and apoptosis assay, and the effects on the expressions of COL2A1 and OA-associated genes (COL10A1, IL-1β, TNF-ɑ, MMP-13, and ADAMTS5) were examined by western blot analysis and quantitative real-time RT-PCR. Furthermore, an in vivo OA model was established to examine the effects of OPN siRNA on the senescence and apoptosis of OA chondrocytes and the expressions of OA-associated genes. Results. The mRNA levels of COL2A1 and OPN were decreased in knee OA chondrocytes in comparison with those in normal chondrocytes. The OPN deficiency enhanced the senescence and apoptosis of OA chondrocytes and increased the expressions of COL10A1, IL-1β, TNF-ɑ, MMP-13, and ADAMTS5 but decreased the expression of COL2A1. Meanwhile, OPN deficiency could result in severe, accelerated OA in vivo, which was also associated with enhanced senescence and apoptosis of chondrocytes and elevated expressions of OA-associated genes. Conclusions. The findings of this study suggest that the OPN deficiency can result in accelerated OA, which is associated with enhanced senescence and apoptosis of OA chondrocytes and the upregulated expressions of OA-associated genes.

This study aimed to examine the associations of dietary magnesium (Mg) intake and serum Mg concentration with the high-sensitivity C-reactive protein (hsCRP) level in early radiographic knee osteoarthritis (OA) patients.Multivariable logistic regression was used to test the associations of dietary and serum Mg with the serum hsCRP in early radiographic knee OA patients after adjustment of a number of potential confounding factors.A total of 936 early radiographic knee OA patients were included. A significant association between dietary Mg intake and hsCRP was observed. The multivariable-adjusted odds ratio (OR) (95% CI) for elevated hsCRP (≥3.0 mg/l) in the second, third, fourth, and fifth dietary Mg intake quintile were 0.44 (95% CI: 0.24-0.82), 0.58 (95% CI: 0.31-1.10), 0.34 (95% CI: 0.15-0.77), and 0.19 (95% CI: 0.06-0.57), respectively, compared with the lowest (first) quintile, and p for trend was 0.01. A significant association between serum Mg concentration and hsCRP was observed. The multivariable-adjusted OR (95% CI) for elevated hsCRP in the second, third, fourth, and fifth serum Mg concentration quintile were 0.63 (95% CI: 0.35-1.12), 0.83 (95% CI: 0.50-1.39), 0.53 (95% CI: 0.31-0.91), and 0.46 (95% CI: 0.25-0.85), respectively, compared with the lowest quintile, and p for trend was 0.01.The present study indicated that both dietary and serum Mg were inversely associated with serum hsCRP in early radiographic knee OA patients.

The purpose of this study was to examine the cross-sectional association between dietary soy milk intake and the prevalence of radiographic knee joint space narrowing (JSN) and osteophytes (OST). Soy milk intake was assessed using a validated semiquantitative food frequency questionnaire and classified into three categories: never

The aim of the study is to examine the cross-sectional associations between dietary antioxidants (carotenoid, vitamin C, E, and selenium) intake and radiographic knee osteoarthritis (OA). A total of 4685 participants were included in this study. Dietary intake was assessed using a validated semi-quantitative food frequency questionnaire. Radiographic knee OA was defined as Kellgren-Lawrence (K-L) grade 2 in at least one leg. A multivariable logistic analysis model was established to test the relationship between dietary antioxidants (carotenoid, vitamin C, E, and selenium) intake and radiographic knee OA with adjustment of a number of potential confounding factors. A significant positive association between dietary vitamin C intake (P value for trend was 0.04 in multivariable adjusted analysis) and radiographic knee OA was observed. The relative odds of radiographic knee OA were increased by 0.39 times in the third quintile (OR 1.39, 95 % CI 1.11-1.73), 0.42 times in the fourth quintile (OR 1.42, 95 % CI 1.13-1.79), and 0.33 times in the fifth quintile (OR 1.33, 95 % CI 1.03-1.71). However, radiographic knee OA was not significantly associated with dietary carotenoid, vitamin E, and selenium. Among dietary antioxidants, dietary vitamin C intake was positively correlated with the prevalence of radiographic knee OA, while no significant association was found between dietary intake of carotenoid, vitamin E, and selenium and the prevalence of radiographic knee OA.

This study aimed to: (1) examine whether the association between posterior tibial slope and noncontact ACL injury exists in Chinese population; (2) compare the reliability and consistency of the three methods (longitudinal axis, posterior and anterior tibial cortex axis) in lateral radiograph. Case–control study contained 146 patients in total (73 noncontact ACL injuries and 73 meniscus injuries, matched for age and gender), which were verified by arthroscopy, MRI and physical examination. For the total population and the male subgroup, the mean posterior tibial slope of the ACL-injured group was significantly higher than that of the control group (P

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by joint swelling, joint tenderness, and destruction of synovial joints, leading to severe disability and premature mortality. RA is a multifactorial disease with genetic, environmental, and stochastic components related to its susceptibility. It has been demonstrated that the expression of osteopontin (OPN) is upregulated in the RA patients. Numerous studies have indicated that the full-length OPN or even OPN fragments, such as thrombin-cleaved OPN and its receptors, play the key roles in RA pathogenesis. Therapeutic application of siRNA to target OPN or neutralizing antibodies related to OPN epitopes in RA animal models are in progress, and some results are encouraging. However, there is a long way to go along with the clinical trials. This review focuses on the recent development in research associated with the OPN role in the pathogenesis of RA and provides insights concerning the OPN targeting as therapeutic approaches for patients with RA.

Purpose The purpose of this study was to test the hypothesis that double-bundle anterior cruciate ligament reconstruction yields better improvement in stability and functional recovery than the single-bundle technique. Methods An Internet search was performed of the Pubmed, Embase, AMED, Cochrane Library, CNKI, Wanfang and VIP databases to find all published randomized controlled trials of anterior cruciate ligament reconstruction treated with the double-bundle versus single-bundle technique. Outcomes of stability improvement and functional recovery were meta-analyzed. Results One thousand six hundred sixty-seven patients in 19 randomized controlled trials were involved in the meta-analysis. The overall relative risk (with 95% confidence interval) calculated with the random effects model in the pivot shift test and the International Knee Documentation Committee (IKDC) objective score for single-bundle versus double-bundle ACL reconstruction were 0.77 (0.67, 0.89) and 0.80 (0.68, 0.93), respectively. The overall relative risk calculated with the fixed effects model in the Lachman test was 0.84 (0.78 to 0.92). The overall standard mean differences (with 95% confidence interval) calculated with the random effects model were 0.26 (0.05, 0.46) for anterior side-to-side difference; −0.08 (−0.28,0.12) for Lysholm score; Tegner activity scale, −0.41 (−0.85, 0.03) for Tegner activity score; and −0.08 (−0.32, 0.15) for IKDC subjective score. Conclusions Meta-analysis of random controlled trials revealed that double-bundle anterior cruciate ligament reconstruction resulted in significantly better anterior and rotational stability and higher IKDC objective scores compared with single-bundle reconstruction. However, the meta-analysis did not detect any significant differences in subjective outcome measures between double-bundle and single-bundle reconstruction, as evidenced by the Lysholm score, Tegner activity scale, and IKDC subjective score. Level of Evidence Level II, meta-analysis of Level I and II studies.

Vasoactive intestinal peptide (VIP) is a molecule shared by the neuroendocrine immune network and is considered to be a potential candidate for treatment of inflammatory and autoimmune diseases. Although some recent studies demonstrate that VIP has a protective role in animal RA models, its variant in different disease grade of OA remains uncertain.Fifty patients with primary knee OA and ten controls with severe trauma were enrolled. Synovial fluid and articular cartilage samples were collected from specimens of total knee arthroplasty (TKA) or knee above amputation. VIP levels in these samples were assessed by ELISA and immunohistochemistry. Kellgren-Lawrence criteria and Mankin score were taken to determine the disease severity.Compared to the controls, OA patients have lower VIP concentration in synovial fluid (659.70±112.79, 95%CI 579.01-740.38 vs 470.83±156.40, 95%CI 426.38-515.28 pg/mL, P0.001) and articular cartilage (0.26±0.02, 95%CI 0.24-0.28 vs 0.20±0.04, 95%CI 0.18-0.21, P0.001). Subsequent analysis show that the VIP expression in synovial fluid is markedly correlated with its OD in articular cartilage (Pearson's r=0.580, P0.001). Furthermore, the synovial fluid and articular cartilage levels of VIP both demonstrated to be negatively correlated with severity of disease (Spearman's ρ=0.838, P0.001; Spearman's ρ=0.814, P0.001).VIP in synovial fluid and articular cartilage is negatively associated with progressive joint damage in OA and is a potential indictor of disease severity.

To examine the analgesic effect and safety of single-dose intra-articular (IA) magnesium (Mg) after arthroscopic surgery. Pubmed, Embase and Cochrane library were searched through in January 2016. Eight RCTs and eight experimental studies were included. The IA Mg exhibited a significantly lower pain score when compared with placebo (MD, −0.41, 95% CI, −0.78 to −0.05, p = 0.03). There was no significant difference between Mg and bupivacaine in terms of pain relief and the time to first analgesic request. Furthermore, statistically significant differences both in pain score (MD, −0.62, 95% CI, −0.81 to −0.42, p in vitro studies reported the chondrocyte protective effect of Mg supplementation. There were also two in vivo studies showing the cartilage protective effect of IA Mg. The single-dose IA Mg following arthroscopic surgery was effective in pain relief without increasing adverse reactions, and it could also enhance the analgesic effect of bupivacaine. In addition, Mg seemed to possess the cartilage or chondrocyte protective effect based on experimental studies.

The aim of this study was to determine the specific microRNA (miRNA) that regulates expression of osteopontin (OPN) in osteoarthritis (OA). The potential regulatory miRNAs for OPN messenger RNA (mRNA) were predicted by miRNA prediction programs. Among eight potential regulatory miRNAs, miR-220b, miR-513a-3p and miR-548n increased, while miR-181a, miR-181b, miR-181c, miR-181d and miR-127-5p decreased in OA patients. miRNA-127-5p mimics suppressed OPN production as well as the activity of a reporter construct containing the 3′-UTR of human OPN mRNA. In addition, mutation of miR-127-5p binding site in the 3′-UTR of OPN mRNA abolished miR-127-5p-mediated repression of reporter activity. Conversely, treatment with miR-127-5p inhibitor increased reporter activity and OPN production. Interestingly, miR-127-5p inhibited proliferation of chondrocytes through OPN. In conclusion, miRNA-127-5p is an important regulator of OPN in human chondrocytes and may contribute to the development of OA.

To examine the relationship between serum calcium (Ca) concentration and radiographic knee osteoarthritis (OA). This study covered a total of 2855 subjects. The serum Ca concentration was detected by the Arsenazo III method. The radiographic OA of the knee was defined as changes equivalent to Kellgren–Lawrence grade 2 on 1 side at least. The serum Ca concentration was categorized into 4 quartiles, which are ≤2.27, 2.28–2.34, 2.35–2.41, and ≥2.42 mmol/L, respectively. The relationship between serum Ca and radiographic knee OA was examined using the multivariable logistic analysis after adjusting a series of potential confounding factors. For each quartile of the relationship between serum Ca concentration and radiographic knee OA, the OR with 95% CI was calculated, and the one with the lowest value was considered to be the reference. An inverse association existed between serum Ca concentration and radiographic OA of the knee in the multivariable model and the model where the factors of age, sex, and BMI were adjusted. The multivariable-adjusted OR (95% CI) for radiographic knee OA in the second, third, and fourth quartiles of serum Ca concentration were 1.05 (95% CI: 0.83–1.31), 1.01 (95% CI: 0.80–1.27), and 0.79 (95% CI: 0.62–1.00), respectively, in comparison with the reference (first) quartile. A trend approaching to statistical significant (P = 0.06) was observed. Meanwhile, the relative odds of radiographic OA of the knee were decreased by 0.79 times in the fourth quartile in comparison with the reference. There is likely to be an inverse association between serum Ca concentration and radiographic OA of the knee.

The aim of this meta-analysis was to examine the effect of the intercondylar notch dimensions, intercondylar notch width index (NWI) and intercondylar notch width (NW), separately in anterior cruciate ligament (ACL) injury. The PubMed and Wanfang database were searched through until 1 November 2011 to identify studies that met pre-stated inclusion criteria. Reference lists of retrieved articles were also reviewed. Two authors independently extracted information on the designs of the studies, the characteristics of the study participants, exposure and outcome assessments and control for potential confounding factors. Either a fixed- or a random-effects model was used to calculate the overall weighted mean difference (WMD). Sixteen studies (n = 4,291) were included (1,222 subjects in ACL-injured group and 3,069 subjects in the control group). Statistically significant differences were observed in the NWI (WMD, −0.02; 95 % confidence interval, −0.04 to −0.01), and in the NW (WMD, −2.15; 95 % confidence interval, −3.09 to −1.21) among the ACL-injured group when compared to the control group. The meta-analysis findings concluded that narrow intercondylar notch dimensions were associated with the risk of ACL injury. A lower NWI or NW stenosis predisposes an individual to ACL injury. Further original studies should include more anatomical risk factors that could be associated with the risk of ACL injury. III.

OBJECTIVE: A meta-analysis to compare the intraoperative and postoperative outcome data for the proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS) implant systems for the treatment of patients with trochanteric fractures. METHODS: A detailed search of several electronic databases was undertaken to identify randomized controlled trials published before 5 December 2011 that compared PFNA with DHS in patients with trochanteric fractures. RESULTS: A quantitative meta-analysis of 11 studies including 798 patients was performed. PFNA was associated with significant reductions in duration of surgery (weighted mean difference [WMD] −21.38 min; 95% confidence interval [CI] −33.50, −9.26 min), intraoperative blood loss (WMD −176.36 ml; 95% CI −232.20, −120.52 ml), rate of fixation failure (relative risk [RR] 0.27, 95% CI 0.11, 0.62) and rate of postoperative complications (RR 0.46; 95% CI 0.31, 0.70) compared with DHS. CONCLUSION: The use of PFNA for treatment of trochanteric fractures was found to be superior to DHS in terms of the duration of surgery, intraoperative blood loss, and rates of fixation failure and overall complications.

The aim of this study was to investigate the effect of hyaluronic acid (HA) on the expression of osteopontin (OPN) and CD44 mRNA of fibroblast-like synoviocytes (FLS) in the patients with osteoarthritis (OA) of the knee. FLS were obtained from the knees of 10 patients with OA. Real-time quantitative polymerase chain reaction (Q-PCR) was used to assess the expression of the OPN mRNA and CD44 mRNA. The relative OPN mRNA expression in HA group (6.47 ± 2.30-fold) was significantly higher than in the control group (P = 0.045, P0.05), while in HYL group (0.65 ± 0.21-fold) it was lower than in the control group (P = 0.037, P0.05), and the difference in OPN mRNA expression between HA group and HYL group also showed statistically significant (P = 0.001, P0.05); however, there was no significant difference between each group of the relative CD44 mRNA expression (P0.05). Our study showed that HA can upregulate OPN mRNA expression in OA fibroblast-like synoviocytes, and the high expression of OPN mRNA in OA may be a result of increased HA level of OA synovitis; however, HA cannot affect the CD44 mRNA expression in OA fibroblast-like synoviocytes, and the high expression of CD44 mRNA in OA may be not a result of increased HA level of OA synovitis.

Isolated deltoid ligament injuries are relatively uncommon but can be a significant source of pain and disability. Several approaches to deltoid reconstruction have been reported. However, there is no previous comparative study of Wiltberger, Deland, Kitaoka and Hintermann procedures with respect to biomechanical characteristics such as kinematics, ligaments and grafts stresses using finite element analysis. The purpose of this study was to evaluate the biomechanical results of those deltoid ligament reconstructions using finite element analysis. A three-dimensional finite element model of the ankle including six bony structures, cartilage and nine principal ligaments surrounding the ankle joint complex was developed and validated. In addition to the intact model, superficial deltoid-deficient, deltoid-deficient, Wiltberger reconstruction, Deland reconstruction, Kitaoka reconstruction and Hintermann reconstruction models were simulated. Then, the forces in the ligaments and grafts and the kinematics of talus and calcaneus were predicted for an eversional or external torque through the range of ankle flexion. No reconstructions could completely restore the values for ankle flexibility and the stresses of the lateral ligaments to normality. The Kitaoka procedure was the most effective technique in eliminating external rotation displacement. The Deland procedure restored better the talar tilt than the other three reconstructions. This study showed that Kitaoka and Deland procedures have advantages with regard to rotational stabilities as well as ligaments stress in comparison with other methods.

This study aimed to investigate the effectiveness and safety of glucosamine, chondroitin, the two in combination, or celecoxib in the treatment of knee osteoarthritis (OA). PubMed, Embase and Cochrane Library were searched through from inception to February 2015. A total of 54 studies covering 16427 patients were included. Glucosamine plus chondroitin, glucosamine alone and celecoxib were all more effective than placebo in pain relief and function improvement. Specifically, celecoxib is most likely to be the best treatment option, followed by the combination group. All treatment options showed clinically significant improvement from baseline pain, but only glucosamine plus chondroitin showed clinically significant improvement from baseline function. In terms of the structure-modifying effect, both glucosamine alone and chondroitin alone achieved a statistically significant reduction in joint space narrowing. Although no significant difference was observed among the five options with respect to the three major adverse effects (withdrawal due to adverse events, serious adverse events and the number of patients with adverse events), the additional classical meta-analysis showed that celecoxib exhibited a higher rate of gastrointestinal adverse effect comparing with the placebo group. The present study provided evidence for the symptomatic efficacy of glucosamine plus chondroitin in the treatment of knee OA.

To examine the cross-sectional associations of the serum uric acid level and hyperuricemia (HU) with the radiographic features of osteoarthritis (OA), including osteophytes (OST) and joint space narrowing (JSN), a total of 4685 subjects were included in this study. Blood samples were drawn from all subjects. Serum uric acid and some other indexes were detected. OST and JSN were assessed for each subject according to the Osteoarthritis Research Society International (OARSI) atlas. A multivariable logistic analysis model was applied to test the target associations after adjusting a number of potential confounding factors. The prevalence of OST was increased in the highest tertile of uric acid compared to the lowest in female subjects (OR 1.46, 95 % CI 1.07-1.99, P for trend = 0.02). Meanwhile, a positive association between OST and HU was observed in female subjects (OR 1.43, 95 % CI 1.01-2.03, P = 0.05). However, serum uric acid and HU were not significantly associated with JSN in male subjects. The findings of this study indicated that the serum uric acid concentration and prevalence of HU are positively associated with OST of the knee in the female population. Level of evidence Cross-sectional study, Level III.

Objective To examine the associations between dietary zinc intake and hyperuricaemia. Design Cross-sectional study. Setting This study was conducted in a health examination centre of China. Participants A total of 5168 middle-aged and older participants (aged 40 years or above) (2697 men and 2471 women) were included. Outcome measures Dietary zinc intake was assessed using a validated semiquantitative food frequency questionnaire. Hyperuricaemia was defined as uric acid ≥416 µmol/L for males and ≥360 µmol/L for females. Results For males, the prevalence of hyperuricaemia was 22.9%. After adjusting for age, body mass index (BMI) and energy intake, the ORs were 0.68 (95% CI 0.45 to 0.92) in the second quintile, 0.63 (95% CI 0.45 to 0.89) in the third quintile, 0.68 (95% CI 0.46 to 1.00) in the fourth quintile and 0.55 (95% CI 0.35 to 0.87) in the fifth quintile comparing the lowest quintile of Zn intake, respectively (p for trend=0.03). In the multivariable adjusted model, the relative odds of hyperuricaemia were significantly decreased by 0.71 times in the second quintile of zinc intake (OR 0.71, 95% CI 0.52 to 0.98), 0.64 times in the third quintile (OR 0.65, 95% CI 0.44 to 0.94) and 0.55 times in the fifth quintile (OR 0.56, 95% CI 0.32 to 0.97) compared with those in the lowest quintile, and p for trend was 0.064. For females, the prevalence of hyperuricaemia was 10.0%, and unadjusted, minimally adjusted as well as multivariable adjusted ORs all suggested no significant association between dietary zinc intake and hyperuricaemia. Conclusions The findings of this cross-sectional study indicated that dietary zinc intake was inversely associated with hyperuricaemia in middle-aged and older males, but not in females. The association was significant after considering the influence of age, BMI and energy intake, and after that, minimum adjustment remained independent of further confounding factors such as vitamin C intake, alcohol drinking status and nutrient supplementation.

The aim of the study was to examine the cross-sectional association between high-sensitivity C-reactive protein (hsCRP) and hyperuricemia (HU). The hsCRP was measured by latex turbidity method. Uric acid was detected on Beckman Coulter AU 5800. HU was defined as uric acid ≥416 μmol/L for the male population and ≥360 μmol/L for the female population. A multivariable logistic analysis model was applied to test the association after adjusting for a number of potential confounding factors. A total of 1935 subjects were included in this study. According to the multivariable regression model, the relative odds of the prevalence of HU were increased by 0.56 times in the third quintile (OR 1.56, 95 % CI 1.03-2.38, P = 0.04), 0.55 times in the fourth quintile (OR 1.55, 95 % CI 1.01-2.36, P = 0.04) and 0.96 times in the fifth quintile (OR 1.96, 95 % CI 1.29-2.98, P

Aim The purposes of this study were to investigate senescence-associated beta-galactosidase (SA-beta-Gal) levels in articular cartilage of knee osteoarthritis (OA) and the relationship with severity of the disease. Methods All the 50 cartilage tissues, including normal (controls) and OA cartilage were ascribed to four groups of normal, mild lesions, moderate lesions and severe lesions on the basis of the modified Mankin score. Immunohistochemistry was used to assess the SA-beta-Gal expression in articular cartilage. Results No SA-beta-Gal staining was observed in the normal articular cartilage samples. SA-beta-Gal staining was found in a subset of the chondrocytes close to the lesion site of mild, moderate and severe damaged knee OA cartilage. The percentage of SA-beta-Gal-positive chondrocytes in articular cartilage was 0% in controls, 13.00 ± 5.77% in mild lesions, 31.65 ± 6.91% in moderate lesions and 51.95 ± 6.21% in severe lesions. SA-beta-Gal expression in mild lesions, moderate lesions and severe lesions was higher compared with that of controls (P

This network meta-analysis aimed to investigate the effectiveness and safety of 100 mg BID and 200 mg QD oral celecoxib in the treatment of OA of the knee or hip. PubMed, Embase and Cochrane Library were searched through from inception to August 2014. Bayesian network meta-analysis was used to combine direct and indirect evidences on treatment effectiveness and safety. A total of 24 RCTs covering 11696 patients were included. For the comparison in between the two dosage regimens, 100 mg BID oral celecoxib exhibited a greater probability to be the preferred one either in terms of pain intensity or function at the last follow-up time point. For total gastrointestinal (GI) adverse effects (AEs), both of the two dosage regimens demonstrated a higher incidence compared to the placebo group. Further analyses of GI AEs revealed that only 200 mg QD was associated with a significantly higher risk of abdominal pain when compared with placebo. Furthermore, 100 mg BID showed a significantly lower incidence of skin AEs when compared with 200 mg QD and placebo. Maybe 100 mg BID should be considered as the preferred dosage regimen in the treatment of knee or hip OA.

This prospective study aimed to investigate the relationship between higher hematocrit (Hct) level and hyperuricemia (HU) incidence. A total of 27540 subjects were included. Baseline Hct was classified into four categories based on the quartile distribution of the study population. A cox proportional hazards regression was used to evaluate the risk of HU incidence across the Hct quartiles after adjusting a number of potential confounding factors. Out of the 62897 person-years of follow-up, 2745 new cases of HU were developed. In models adjusted for known risk factors of HU, higher Hct was used to predict HU incidence independently in a graded manner (p = 0.02): compared with subjects in the lowest quartile, subjects in the highest quartile of Hct (hazard ratio = 1.20; 95% confidence interval: 1.03–1.41) were n20% more likely to develop HU. Sensitivity analysis indicated that the hazard ratios increased with the extension of the minimum follow-up interval. When the minimum follow-up interval was restricted to 4 years, subjects in the highest quartile of Hct were 70% more likely to develop HU, compared with the lowest quartile. Higher Hct, a routinely measured inexpensive biomarker was independently associated with the incidence of HU even within the normal range.

Degradation of the articular cartilage is at the centre of the pathogenesis of osteoarthritis (OA), for which age is the major risk factor. Maintaining the chondrocytes in a healthy condition appears to be an important factor for preservation of the entire cartilage and preventing its degeneration. Autophagy, which is an essential cellular homeostatic mechanism for the removal of dysfunctional cellular organelles and macromolecules, is increased by catabolic and nutritional stresses. Autophagy is increased in OA chondrocytes and cartilage, particularly during the initial degenerative phase, to regulate changes in OA-like gene expression through modulation of apoptosis and reactive oxygen species (ROS). In this way, autophagy acts as an adaptive response to protect chondrocytes from various environmental changes, while with gradual cartilage degradation, decreased autophagy is linked with cell death. Rapamycin, which is a specific inhibitor of the mTOR signaling pathway, enhances expression of autophagy regulators and prevents chondrocyte death. In the future, pharmacological activation of autophagy may be an effective therapeutic approach for OA.

The joint disease osteoarthritis (OA) is the most common form of arthritis, which mainly affects the older people. OA is becoming one of the major non-fatal health burdens of the world. The etiology of OA is mostly unclear, and it cannot be cured totally. Osteopontin (OPN) is a multifunctional phosphoprotein, of which overexpression and high level of presence in synovial fluid and articular cartilage were found to be associated with OA progression. Usually, in OA progression, OPN plays important role as an intrinsic regulator. Recent studies have taken attempt to use this protein as a diagnostic marker of OA and use OPN as a target for the drug development against OA. This review summarizes the role of OPN in OA, with focusing on the mechanism of action, and also discussing the diagnostic and therapeutic aspects of OA related to OPN.

Objectives This meta-analysis compared the earliest clinical effects of intra-articular bupivacaine and morphine for pain management following arthroscopic knee surgery. Materials and methods A comprehensive literature search was conducted using MEDLINE (1966 to 2013), the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Google Scholar databases for identification of randomized-controlled trials that compared IA bupivacaine and morphine for postoperative pain. The relative risk, weighted mean difference (WMD), and their corresponding 95% confidence intervals (CI) were calculated using RevMan statistical software. Results Bupivacaine and morphine group had similar acute postoperative pain scores (WMD: 0.07; 95% CI, -0.18 to 0.32; P=0.60); number of patients requiring supplementary analgesia (relative risk: 0.74; 95% CI, 0.42 to 1.31; P=0.30) for the trials in this meta-analysis (n=13); and side effects (relative risk: 0.63; 95% CI, 0.39 to 1.02, P=0.06). Even though, the time to first analgesic request resulted in a significant difference (WMD: 66.59; 95% CI, 11.75 to 122.14, P=0.02), this result was not supported by the sensitivity analysis. Conclusions On the basis of the currently available literature, this study failed to demonstrate a significant difference between single-dose intra-articular bupivacaine and morphine at the end of the arthroscopic knee surgery in terms of pain relief, need for supplementary analgesics, times interval before the first request for additional analgesic, and short-term side effects. Level of evidence Level II-meta-analysis of Level I and II studies.

Objectives A meta-analysis was conducted to examine the effect of mud therapy on pain relief in patients with knee osteoarthritis (OA). Methods A detailed search of PubMed®/MEDLINE® was undertaken to identify randomized controlled trials and prospective comparative studies published before 9 March 2013 that compared mud therapy with control group treatments in patients with knee OA. Results A quantitative meta-analysis of seven studies (410 patients) was performed. There was a significant difference between the groups in the visual analogue scale pain score (standardized mean difference [SMD] −0.73) and Western Ontario and McMaster Universities Osteoarthritis Index pain score (SMD −0.30), with differences in favour of mud therapy. Conclusions Mud therapy is a favourable option for pain relief in patients with knee OA. Additional high-quality randomized controlled trials need to be conducted to explore this issue further and to confirm this conclusion.

The severity of avascular necrosis (AVN) after closed reduction of developmental dysplasia of the hip determines the final clinical outcomes. Our study aimed to correlate the possible predictors with the severity of AVN. After follow-up of the patients on skeletal maturity, 37 patients (39 hips) were included. Age at reduction is important to predict the severity of AVN. Older patients are at a greater risk of suffering from more severe AVN. Other values such as the degree of initial dislocation or the impact of the femoral head ossific nucleus show no precognition to the severity of AVN.

Chronic low back pain is one of the most common reasons that people seek medical treatment, and the consequent disability creates a great financial burden on individuals and society. The etiology of chronic low back pain is not clear, which means it is often refractory to treatment. Acupuncture has been reported to be effective in providing symptomatic relief of chronic low back pain. However, it is not known whether the effects of acupuncture are due to the needling itself or nonspecific effects arising from the manipulation. To determine the effectiveness of acupuncture therapy, a meta-analysis was performed to compare acupuncture with sham acupuncture and other treatments. Overall, 2678 patients were identified from thirteen randomized controlled trials. The meta-analysis was performed by a random model (Cohen's test), using the I-square test for heterogeneity and Begg's test to assess for publication bias. Clinical outcomes were evaluated by pain intensity, disability, spinal flexion, and quality of life. Compared with no treatment, acupuncture achieved better outcomes in terms of pain relief, disability recovery and better quality of life, but these effects were not observed when compared to sham acupuncture. Acupuncture achieved better outcomes when compared with other treatments. No publication bias was detected. Acupuncture is an effective treatment for chronic low back pain, but this effect is likely to be produced by the nonspecific effects of manipulation.

Purpose To compare autograft with allograft in anterior cruciate ligament reconstruction by conducting a meta-analysis of randomized controlled trials (RCTs) and a systematic review of overlapping systematic reviews. Methods PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched through June 28, 2014, to identify Level I and II evidence RCTs with a minimum follow-up of 2 years and systematic reviews that compared autograft with allograft in anterior cruciate ligament reconstruction. Both objective and subjective outcomes with respect to knee stability and function were meta-analyzed and summarized. The overall risk ratio (RR) or the weighted mean difference (WMD) was calculated using either a fixed- or random-effects model. The quality of evidence of the systematic review of overlapping systematic reviews was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Results Nine RCTs and 10 systematic reviews were included. In general, statistically significant differences in favor of autograft were observed for clinical failure (RR, 0.47; P = .0007), the Lachman test (RR, 1.18; P = .03), the instrumented laxity test (WMD, −0.88; P = .004), and the Tegner score (WMD, 0.36; P = .004). When subgroup analyses were conducted based on whether irradiation was used, autograft achieved better clinical outcomes than irradiated allograft in terms of the Lysholm score, clinical failure, the pivot-shift test, the Lachman test, the instrumented laxity test, and the Tegner score. In addition, there were no significant differences between the autograft and nonirradiated allograft groups for all 8 indices. The final results of this systematic review of overlapping systematic reviews were in accordance with our meta-analysis. Conclusions Autograft had greater advantages than irradiated allograft with respect to function and stability, whereas there were no significant differences between autograft and nonirradiated allograft. Level of Evidence Level IV, meta-analysis of Level II, III, and IV studies.

Summary The white-white tears (meniscus lesion completely in the avascular zone) are without blood supply and theoretically cannot heal. Basal research has demonstrated that menisci are unquestionably important in load bearing, load redistribution, shock absorption, joint lubrication and the stabilization of the knee joint. It has been proven that partial or all-meniscusectomy results in an accelerated degeneration of cartilage and an increased rate of early osteoarthritis. Knee surgeons must face the difficult decision of removing or, if possible, retaining the meniscus; if it is possible to retain the meniscus, surgeons must address the difficulties of meniscal healing. Some preliminary approaches have progressed to improve meniscal healing. However, the problem of promoting meniscal healing in the avascular area has not yet been resolved. The demanding nature of the approach as well as its low utility and efficacy has impeded the progress of these enhancement techniques. Platelet-rich plasma (PRP) is a platelet concentration derived from autologous blood. In recent years, PRP has been used widely in preclinical and clinical applications for bone regeneration and wound healing. Therefore, we hypothesize that the application of platelet-rich plasma for white-white meniscal tears will be a simple and novel technique of high utility in knee surgery.

To investigate CD44 levels in articular cartilage of knee osteoarthritis (OA) and the relationship between CD44 and severity of the disease. All 50 cartilage tissues included normal and OA cartilage, and were ascribed to the following four groups on the basis of modified Mankin score: normal, mild lesions, moderate lesions and severe lesions. CD44 levels in articular cartilage were assessed by immunohistochemical methods. CD44 levels were detected in all four groups. The difference in average gray value of CD44 expression showed statistical significance when compared between each group (P

The purpose of this meta-analysis was (1) to examine the effect of the tibial plateau slopes (medial and lateral) on anterior cruciate ligament (ACL) injury and (2) to investigate gender differences between ACL-injured subjects and gender-matched controls. The PubMed database was searched through to 1 November 2011 to identify studies that met pre-stated inclusion criteria. Reference lists of retrieved articles were also reviewed. Two authors independently extracted information on the designs of the studies, the characteristics of the study participants, exposure and outcome assessments, and control for potential confounding factors. A meta-analysis was conducted, and either a fixed- or a random-effects model was used to calculate the overall weighted mean difference (WMD). Twelve studies (n = 1,871: 923 patients in the ACL-injured group and 938 patients in the control group) were included. The medial tibial plateau slope in the ACL group ranged from 1.8° ± 3.7° to 12.1° ± 3.3° while it ranged from 2.9° ± 2.8° to 9.5° ± 3° among the controls. The lateral tibial plateau slope in the ACL ranged from 1.8° ± 3.2° to 11.5° ± 3.5° and 0.3° ± 3.6° to 9° ± 4° in the control group. Statistically significant increased angles were observed in ACL-injured group compared to control group for medial tibial plateau slope (WMD, 1.1°; 95 % confidence interval, 0.5°–1.7°) and lateral tibial plateau slope (WMD, 1.8°; 95 % confidence interval, 1.3°–2.3°). Sensitivity analysis and subgroup analysis proved this to be a reliable result. The current meta-analysis suggests that both, increased medial and lateral tibial plateau slopes, are associated with increased susceptibility to ACL injury regardless of gender. In addition, this study indicates a stronger evidence for lateral tibial plateau slope to be associated with ACL injury compared with medial tibial plateau slope due to the larger increased angle value and on the basis of consistency among the included studies. III.

The purpose of this study is to observe the differences of osteopontin (OPN) phosphorylation in osteoarthritis (OA) cartilage and normal cartilage, and evaluate the possible correlations between the OPN phosphorylation and MMP-13 expression. Degenerative cartilage (n = 29) and normal cartilage (n = 10) were identified by hematoxylin-eosin, safranin-O staining and modified Mankin score. The phosphorylation level of OPN in OA cartilage and normal cartilage was detected by immunoprecipitation. Chondrocytes were treated with phospho-OPN, OPN or buffer. Quantitative reverse transcription polymerase chain reaction (qPCR) and ELISA were used to assess the expression of MMP-13 in different treatments. The OD values of phosphorylation of OPN in normal cartilage and OA cartilage were 137.89 ± 10.59 and 153.52 ± 8.80, respectively, (P = 0.000). Chondrocytes treated with OPN showed a higher MMP-13 expression at gene and protein level compared with control group. Chondrocytes treated with phospho-OPN showed the highest MMP-13 expression in gene and protein. In conclusion, our results revealed a higher phosphorylation level of OPN in OA cartilage than in normal cartilage. We found OPN leads to elevated expression of MMP-13 (both at gene level and protein level), and phospho-OPN had a more obvious upregulation effect on MMP-13 expression than nonphospho-OPN. Further studies are needed to reveal the mechanism of OPN phosphorylation on cartilage degeneration.

To investigate whether platelet-rich plasma (PRP) when used with allograft bone improves the management outcome of displaced intra-articular calcaneal fractures. Over a 7-year period, all displaced type III calcaneal fractures admitted in our department (276 fractures in 254 patients) were randomly divided into three groups according to the plan of management: autograft alone (n = 101), allograft combined with PRP (n = 85), or allograft alone (n = 90). Radiographic imaging and three-dimensional computed tomography were used to assess the thalamic portion, Bohler's angle, the crucial angle of Gissane, and the height, width and length of the calcaneum. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind-foot scoring system was used to evaluate the hind foot function at 12, 24, and 72 months postsurgery. At 12 months no significant difference existed in outcome amongst the treatment groups (p > 0.05). However, at 24 and 72 months the results of the autograft, and the allograft combined with PRP, were similar and both were significantly better than that of the allograft alone (p < 0.05). PRP augmented the favorable outcome of allografts in the management of displaced calcaneal fractures, and matched that of autograft used alone. The findings of this study thus support the clinical use of PRP in conjunction with allograft in the treatment of displaced intra-articular calcaneal fractures.

With the increasing advocacy for total disc replacement (TDR) as a potential alternative to fusion in the management of lumbar degenerative disc disease, intradiscal pressures (IDPs) and facet joint stresses at the adjacent levels of spine have generated considerable interest. The purpose of this study was to compare adjacent-level IDPs and facet joint stresses among TDR, discectomy, and fusion.Ten fresh human cadaveric lumbar specimens (L2-S1) were subjected to an unconstrained load in axial torsion, lateral bending, flexion, and extension by using multidirectional flexibility test. Four surgical treatment modes-control (disc intact), discectomy, TDR, and fusion-were tested in sequential order at L4-5. During testing, the IDPs and facet forces following each treatment were calculated at the adjacent vertebral levels (L3-4 and L5-S1).Intradiscal pressures and facet force pressures were similar between the intact condition and the TDR reconstruction at the L3-4 and L5-S1 levels under all loading conditions (p0.05). Compared with the intact and TDR groups, the discectomy and fusion groups had higher IDPs at the L3-4 and L5-S1 levels under all loading conditions (p0.05). No significant difference in the facet force pressure was noted among the intact, discectomy, and TDR groups at the L3-4 and L5-S1 levels under any loading conditions (p0.05). However, the facet force pressure produced for fusion was significantly higher than the mean values obtained for the intact, discectomy, and TDR groups at the L3-4 and L5-S1 levels under all loading conditions (p0.05).Lumbar TDR maintained adjacent-level IDPs and facet force pressures near the values for intact spines, whereas adjacent-level IDPs tended to increase after discectomy or fusion and facet forces tended to increase after fusion.

The goal of this study was to evaluate the array of causative organisms for septic arthritis in children and their antibiotic resistance patterns over a 20-year period at a single medical center. The medical records of children younger than 16 years with septic arthritis admitted to a hospital in China from 1989 to 2008 were retrospectively reviewed. A total of 158 cases of septic arthritis were studied, 70 from 1989 to 1998 and 88 from 1999 to 2008. Between the first and second decades, occurrence of serious illnesses decreased significantly from 44.3% to 28.4% ( P Staphylococcus aureus (MRSA) increasing significantly. Staphylococci remained the major causative organisms for joint infection. The percentage of Staphylococcus aureus resistance to various antibiotics increased: 85% to 100% for penicillin, 58.8% to 75% for erythromycin, 0% to 31.3% for cefazolin, and 15% to 29.4% for multi-resistance. In the second decade, 4 MRSA stains were multi-resistant. However, gentamincin resistance remained at the same level. Antibiotic resistance of coagulase-negative staphylococci and gram-negative bacilli changed little. The incidences of osteomyelitis and joint dislocation decreased significantly, from 15.7% to 6% and 28.6% to 14.8%, respectively ( P

To investigate clinical features of the traumatic cervical disc herniation and through retrospective analysis 62 cases of traumatic cervical disc herniation.Among 62 patients with traumatic cervical disc herniation, 46 patients were male and 16 patients were female, with an average ages of 36.4 years. According to the clinical manifestation, there were 30 cases of symmetrical limb palsy, 19 cases of upper motor palsy serious than lower, 13 cases of unilateral palsy and contralateral disorder of algesthesia and thermesthesia. There were 58 patients treated with operation and 4 patients treated with conservative method.All of the incisions were with primary healing. Twenty-four patients recovered to normal, and other 34 cases improved obviously and the duration of follow-up ranged from 6 to 28 months. The average time was 11 months. JOA scores increased from preoperative 5.6 to postoperative 12.7.Operative treatment is effective for different types of the traumatic cervical disc herniation.

SummaryObjectiveTo investigate osteopontin (OPN) levels in both synovial fluid and articular cartilage of patients with primary knee osteoarthritis (OA) and their relationship with severity of the disease.MethodFifty patients aged 48–81 years with knee OA and 10 healthy controls were enrolled in this study. Anteroposterior knee radiographs or/and Mankin score were taken to determine the disease severity of the affected knee. The radiographic grading of OA in the knee was performed by using the Kellgren-Lawrence criteria. OPN levels in synovial fluid were measured using enzyme-linked immunosorbent assay. OPN levels in articular cartilage were assessed by immunohistochemical methods.ResultsCompared to healthy controls, OA patients had higher OPN concentration in synovial fluid (4519.60±1830.37, 95%CI 3999.42–5039.79 vs 1179.70±303.39, 95%CI 1035.53–1438.74pg/ml, P