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Objective: To investigate the procedure and efficacy of anatomical medial patellofemoral ligament (MPFL) reconstruction for the treatment of recurrent patellar dislocation assisted with arthroscopy.
, Methods: Between January, 2010 and December 2012, 13 patients with recurrent patellar dislocation, who underwent anatomical MPFL reconstruction and the grafts of operation, were all adopted with autograft semitendinosus. The patellar side used the modified double bone tunnels and the minimally invasive percutaneous grafts through double patellar bone tunnels, and then fixed in the femoral tunnel with absorbable interference screw. Follow-up included the records of the subjective feeling, patellar apprehension test, recurrent dislocation, CT evaluation of bone tunnel position and patellar tilt angle. Knee function was evaluated by the Lysholm score and Kujala score. 
, Results: Twelve patients were followed up for 36 months (range 24-60 months). All patients were satisfied with the treatment. No recurrent dislocation occurred. All the patients showed negative apprehension test. Two patients felt uncomfortable after excessive activity in the knee. Another 2 cases lost 10° flexion than the healthy knee. CT showed that the bone tunnel position were all well. The patellar tilt angle was decreased from 20.52°±1.48° preoperative to 13.52°±1.32° postoperative, with significant difference (t=14.88, P<0. 05); the Kujala score was improved from 55.2±4.51 preoperative to 93.8±3.87 postoperative, with significant difference (t=-36.238, P<0.05); and the Lysholm score was improved from 56.68±5.52 to 93.08±4.68, with significant difference (t=-33.382, P<0.05). 
, Conclusion: MPFL reconstruction assisted with arthroscopy is an effective surgical procedure for the treatment of recurrent patellar dislocation, which can improve the knee function with little trauma and complications.

Osteoarthritis (OA) is the most common joint disease affecting close to 27 million Americans. The pathological change of OA joint is characterized by cartilage degradation and osteophyte formation that have been associated with OA initiation and progression respectively. Upon OA progression, articular chondrocytes undergo hypertrophic differentiation, a process usually occurs only in growth plate chondrocytes during endochondral ossification, suggesting a role of chondrocyte hypertrophy in OA pathogenesis. However, how altered chondrocyte hypertrophy, i.e. accelerated or delayed chondrocyte hypertrophy, influences OA development has not been fully elucidated. We have previously generated transgenic (TG) mice over-expressing Runx2, an essential transcription factor for chondrocyte hypertrophy, using hypertrophic chondrocyte-specific mouse type X collagen gene (Col10a1) control elements. These Col10a1-Runx2 TG mice show delayed chondrocyte hypertrophy and apoptosis in long bone sections of embryonic and new-born mice compared to their wild-type (WT) littermates. Here, we report further analysis of the skeletal phenotypes of these mice at postnatal stages. We have performed histological analysis of 1-month old TG and WT mice. Delayed chondrocyte hypertrophy was also observed in growth plate of TG mice. In addition, μCT analysis showed that the femur length was significantly shorter in TG mice (p = 0.033). Thinner cortical bone and markedly decreased BV/TV were also detected in TG mice compared to their WT littermates (p = 0.027), suggesting that delayed chondrocyte hypertrophy affects postnatal long bone development. Interestingly, histological analysis detected less articular cartilage absorption, while immunohistochemistry assay detected upregulated Sox9 expression in TG mouse joints compared to WT controls, implying that delayed chondrocyte hypertrophy may be OA protective. Indeed, we have performed Tgf-β1 injection and enforced uphill treadmill running (TTR model) to induce OA in TG and WT littermates. The results showed that WT littermates displayed characteristic pathology of fibrotic remodeling at the joint margins and focal cartilage erosion, while the joints in TG mice were essentially protected from remodeling responses, demonstrating that mice with delayed chondrocyte hypertrophy are not susceptible to developing OA. Further translational studies characterizing the role of chondrocyte hypertrophy during OA progression will facilitate identification of therapeutic targets to stop or slow down this degenerative and progressive human joint disease.

Objective: To investigate the role of osteopontin (OPN) on the expressions of matrix metalloproteinase 13 (MMP-13) mRNA and protein in human knee osteoarthritic chondrocytes and to find the optimal time and concentration for OPN treatment., Methods: Chondrocytes were isolated from articular cartilage tissues of patients with primary osteoarthritis (OA) and cultured using one step digestive treatment with collagenase type II. The chondrocytes were then identified using immunohistochemistry of collagen type II. The first generation of chondrocytes were stimulated with OPN at a concentration of 1 μg/mL for 0, 24, 48, and 72 hours, and with OPN at the concentrations of 0, 0.5, 1, 2, and 4 μg/mL for 48 hours. The levels of MMP-13 mRNA and protein expressions were measured with real-time fluorescent quantitative PCR and Western blot., Results: The immunohistochemical staining showed that first generation of chondrocytes expressed collagen type II. Both MMP-13 mRNA and protein expression levels in OA chondrocytes increased significantly in the presence of OPN (1 μg/mL) and peaked at 48 hours after incubation, showing significant difference between different time points (P < 0.05). The MMP-13 mRNA expression level in OA chondrocytes at the OPN concentration of 1 μg/mL was significantly higher than those at the other concentrations (P < 0.05), and the MMP-13 protein expression level at the OPN concentration of 1 μg/mL was significantly higher than that at 0 μg/mL (P < 0.05). MMP-13 protein expression level at the OPN concentrations of 0.5, 2, and 4 μg/mL were significantly higher than that at 0 μg/mL (P < 0.05)., Conclusion: OPN induces up-regulation of MMP-13 mRNA and protein expressions in human knee osteoarthritic chondrocytes in time- and dose-dependent manners. The optimal time and concentration for OPN treatment are 48 hours and 1 μg/mL, respectively.

Osteosarcoma (OS) is the most common bone cancer in children and young adults. The etiology of osteosarcoma is currently unknown. Besides the predominant osteoblasts, the presence of cartilage forming chondrocytes within its tumor tissues suggests a role of chondrogenesis in osteosarcoma development. Runx2 is a master transcription factor both for osteoblast differentiation and for chondrocyte maturation. Interestingly, RUNX2 has been shown to directly interact with p53 and Rb1, two genes essential for osteosarcoma development in mice. However the in vivo relevance of Runx2 during osteosarcoma progression has not been elucidated. We have recently shown that targeting Runx2 expression in hypertrophic chondrocytes delays chondrocyte maturation. It has also been shown that osteoblast-specific deletion of p53 and Rb1 genes developed osteosarcoma in mice. Here, we report our recent research findings using these osteosarcoma mouse models as well as human osteosarcoma tissues. We have detected high-level RUNX2 expression in human osteoblastic osteosarcoma, while chondroblastic osteosarcoma is predominant with chondroid matrix. To minimize the effect of strain difference, we have backcrossed osterix-Cre mice onto congenic FVB/N genetic background. We also detected low-GC content (36%) in sequence around the floxed Rb1 gene and demonstrated that addition of BSA into the reaction system increases the efficiency of PCR genotyping of floxed Rb1 gene. Finally, we successfully generated multiple osteosarcoma mouse models with or without Runx2 transgenic background. These mice showed heterogeneous osteosarcoma phenotypes and marker gene expression. Characterization of these mice will facilitate understanding the role of Runx2 in osteosarcoma pathogenesis and possibly, for osteosarcoma treatment.

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.

Objective: To summarize the anatomic features of the posterior septum of the knee joint and its application in posterior trans-septal portal for arthroscopic surgery., Methods: The literature related to posterior septum of the knee joint and arthroscopic surgery was extensively reviewed and analyzed., Results: The posterior septum of the knee joint has more mechanoreceptors and blood vessels in the upper part, which are close to arteria popliteal at the tibial plateau level; the posterior compartment is divided into wider posteromedial and narrower posterolateral compartments. A safe arthroscopic trans-septal portal is established, in the knee flexion of 90 degrees, in a lateral-to-medial direction, and with an inserting location below the middle of posterior septum., Conclusion: The establishment method of posterior trans-septal portal is not uniform and all the features of posterior septum should be considered to decrease the complications.

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., (Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Objective: To compare the efficacy of proximal femoral nail anti-rotation (PFNA) versus dynamic hip screw (DHS) in the treatment of trochanteric fractures in adults., Methods: Reports of studies using randomized controlled trials (RCT) to compare PFNA with DHS in the management of intertrochanteric fractures were retrieved (up to December 5, 2011) from the Cochrane Library, MEDLINE, Elsevier, the Chinese Biomedical Database, Wanfang Data,and manually. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software Revman? 5.0 was used for data-analysis., Results: Thirteen RCTs involving 958 cases were included in the Meta-analysis. The results showed that, compared with DHS, PFNA significantly decreased the duration of surgery [WMD = -21.38, 95%CI (-33.05,-9.26), P<0.05], intra-operative blood loss [WMD = -176.36, 95%CI (-232.20, -120.52), P<0.05], the rate of post-operative complication [RR=0.46, 95%CI (0.31, 0.70), P<0.05], the rate of post-operative fixation failure[RR=0.27, 95%CI(0.11,0.62), P<0.05]., Conclusion: PFNA for intertrochanteric fractures is superior to DHS in regards to the mean duration of surgery, mean intra-operative blood loss, the rate of post-operative complication, and the rate of post-operative fixation failure. But there is not enough evidence to show any difference between PFNA and DHS in regards to the mean duration of hospital, the mean duration of fracture healing, the rate of post-operative fracture, the rate of post-operative coxa vara, the rate of postoperative superficial wound infection, the rate of other post-operative complications or the Harris score after surgery.

Unstable closed reduction often leads to unsatisfied function. Abnormal force transmission after unstable closed reduction can cause pain, episodes of instability and restriction of range of movement. There is a limited number of literature data which suggests overgrown greater trochanteric located in the acetabulum as a false femoral head without any functional deterioration. In this article, we reported a five-year-old girl with developmental dysplasia of the left hip redislocated following closed reduction. After five-years of follow-up, overgrown greater trochanter was located in the left acetabulum and it unexpectedly resulted in a satisfied function. The unforeseen overgrown greater trochanteric as a false femoral head may lead to a satisfactory function at five-years after reduction. However, long-term follow is required, as its role in early-onset degenerative osteoarthritis remains inconclusive.

Objective: To determine the effectiveness of external fixator combined with limited internal fixation for Tile B pelvic fractures., Methods: Fourteen patients with Tile B pelvic fracture were treated by external fixator combined with limited internal fixation between September 2004 and June 2009., Results: All the patients were followed for 6-49 (20.2 +/- 10.2) months. According to the Matta standard, the outcome of 9 patients was excellent, 4 patients were good, while the other one patient was fair., Conclusion: External fixator combined with limited internal fixation is effective for Tile B pelvic fracture. It can not only reduce the anatomic position of the pelvis, but also strengthen the stability of the pelvis as a whole. This method is less invasive and traumatic, which promotes the recovery of patients.

Objective: To investigate the surgical techniques and clinical outcomes of total hip replacement for patients with end-stage osteoarthritis secondary to developmental dysplasia of the hip., Methods: From May 2004 to March 2008, a total of 36 total hip replacements were performed in 32 patients with end-stage osteoarthritis secondary to developmental dysplasia of the hip. The acetabulum cup was reconstructed in the corresponding anatomical position in all cases. Cemented components were used in 16 hips, and cementless components in the other 20 hips. The mean follow-up was 31.3 months. Clinical outcomes were determined with Harris hip score. Radiographs were taken after the surgery and in every follow-up examination for further reference., Results: All patients postoperatively gained a limb lengthening with an average of (3.4+/-1.3) cm. Three patients had complications, 2 had nondisplaced fractures of the proximal part of the femur,and 1 sciatic nerve palsy which disappeared after 3 months. There was no infection, dislocation and symptomatic deep vein thrombosis. Compared with preoperation, the mean Harris hip scores on the 3rd day, the 14th day after the operation and at the last follow-up were all improved significantly (all P<0.05). There was no loosening, migration, heterotopic ossification radiographically, and no revision during the follow-up., Conclusion: Total hip replacement is an effective treatment for patients with end-stage osteoarthritis secondary to developmental dysplasia of the hip. The key is to place the acetabulum cup in the corresponding anatomical position, and choose proper prosthesises during the surgery.

Objective: To measure the anatomic data of the proximal femur and to design an internal fixation instrument aiming at subtrochanteric fracture., Methods: We measured the anatomic data of 56 pairs of the matching proximal femur specimens: the diameter of femoral head (HD), the axis length of femoral head (HAL), 135 degree femoral head-neck axis length (HNAL), 135 degree femoral head-neck axis upper length (HNAUL), 135 degree femoral head-neck axis underside length (HNADL), the anterior-posterior axis diameter of femoral neck (NAPD), the upper-underside diameter of femoral neck (NUUD), femoral neck-shaft angle (NFA), femoral shaft lateral cortex-greater trochanter angle (SLGA), the medial-lateral diameter of lesser trochanter level's femoral shaft (LSMLD), the anterior-posterior diameter of lesser trochanter level's femoral shaft (LSAPD), the medial-lateral diameter of 5 cm below lesser trochanter femoral shaft (5 cm MLD), and the anterior-posterior diameter of 5 cm below lesser trochanter femoral shaft (5 cm APD). Part of the data was analyzed and compared., Results: HD was (46.69+/-3.73) mm, HAL was (39.22+/-4.17) mm, HNAL was (95.45+/-8.16) mm, HNAUL was (84.02+/-7.11) mm, HNADL was (99.95+/-9.34) mm, NAPD was (26.27+/-3.15) mm, NUUD was (32.24+/-3.31) mm, NFA was 126.21 degree+/-7.13 degree, SLGA was 16.38 degree+/-4.04 degree, LSMLD was (31.05+/-3.57) mm, LSAPD was (27.63+/-2.96) mm, 5 cm MLD was (26.36+/-3.22) mm, and 5 cm APD was (25.59+/-2.75) mm. NFA was positively correlated with SLGA (r=0.396, P=0.003)., Conclusion: It is necessary to design internal fixator to fit the anatomical feature of Chinese femur for the treatment of subtrochanteric fracture, and we should thoroughly consider the angle of the SLGA.

Objective: To examine the biomechanical effect of lumbar discectomy and disc replacement on compressive load in proximal adjacent segment, to understand the characteristics of the prosthesis and effects in spine after artificial disc replacement (ADR), and to evaluate long-term clinical effect in adjacent segments., Methods: Complete human cadaveric ligamentous lumbar spine specimens were used to make 3 models: an intact sample, a discectomy sample, and a sample of ADR after the discectomy. The compressive load in proximal segment above the injury segment was measured separately in various loading cases on the 3 models., Results: The changes of intervertebral loads in the adjacent segments made the compressive load increase in the proximal segment after the discectomy. The compressive load in the proximal segment was lower in the ADR group than that in the injury group. There was no significant difference between the ADR group and intact group., Conclusion: Discectomy increases the compressive load in the proximal segment, while ADR reduces it, showing the same compressive load level with the intact model in the proximal segment. Changes of compressive loading in adjacent level segments after discectomy and ADR, may be the cause of abnormal stress distribution and movements of adjacent segments, and be of benefit for the disc replacement.

Objective: To explore the effect of arthroscopy in diagnosis and treatment of osteochondritis dissecans of elbow joint in adolescent., Methods: From May 2003 to February 2006, 11 patients with osteochondritis dissecans of elbow joint were diagnosed and treated with arthroscopy. There were 6 males and 5 females, aging from 13 to 19 years. The left joints were involved in 4 cases and right joints in 7 cases. Seven patients had obvious history of injury. The interval of injury and operation was from 7 months to 12 years. The score of VAS was 80 +/- 10, the range of flexion and extend of joint 80 +/- 10 degrees, the range of rotation of joint 100 +/- 5 degrees preoperatively. The brachial plexus anesthesia, the elbow hung to traction, soft spot, interna and extra-pathway were given to explore and debride elbow joint and remove corpus liberum., Results: All patients recovered daily life and work 7 to 12 days postoperatively. There were no complications of blood vessel and nerve injuries. Eleven cases were followed up for 6 to 18 months (mean 12.5 months). The results were excellent in 7 and good in 4 according to HSS scoring system. At the final follow-up, the score of VAS was 32 +/- 15, showing statistically significant difference when compared with pre-operation (P < 0.05). The range of flexion and extend of joint was 110 +/- 10 degrees, the range of rotation of joint was 120 +/- 5 degrees post-operatively, showing statistically significant differences when compared with pre-operation (P < 0.05)., Conclusion: The elbow arthroscopy might be a reliable method to diagnose and treat osteochondritis dissecans of elbow joint in adolescent with minor trauma, quick recovery, significant improving function and less complications.

Objective: To discuss short-term effect of rotating hinge knee prosthesis., Methods: From July 2002 to April 2005, 17 cases of severe knee joint deformity and instability received rotating hinge knee prosthesis for total knee arthroplasty. There were 8 males and 9 females, aging from 4l to 79 years. The left joints were involved in 10 cases and right joint in 7 cases. All patients were admitted because of pain. The course of disease was from 1 to 7 years. There were 10 cases of osteoarthritis, 5 cases of rheumatoid arthritis, 1 case of traumatic arthritis after operation of left femur fracture,and 1 case of traumatic arthritis with injury of anterior cruciate ligament, meniscus medialis and medial collateral ligament after operation of left fracture of tibial plateau. According to HSS (hospital for special surgery) scoring system, the preoperative score was 36 to 58 with an average of 48.6. The preoperative flexed motion range of articulation was 21 degrees to 80 degrees with an average of 57.4 degrees., Results: All patients were followed up from 7 months to 3 years with an average of 23. 6 months. There were no complications of thrombogenesis of veins of lower extremity, pulmonary embolism, palsy of peroneal nerve, fracture, and breakage of extended knee structure. Infection occurred in 1 case at 3 months postoperatively, the prosthesis was dislodged, antibiotic-impregnated cement was filled with knee joint, two-stage arthroplasty was expected. At the last follow-up, the HSS score was 78 to 98 with an average of 91.1 in 16 patients. The flexed motion range of articulation was 75 degrees to 100 degrees with an average of 85.2 degrees at 2 weeks postoperatively. The flexed motion range of articular was 85 degrees to 123 degrees with an average of 108.3 degrees at the last follow-up. There were significant differences in HSS score and motion range of articular between preoperation and the last follow-up (P < 0.05)., Conclusion: The short-term outcome of rotating hinge knee prosthesis is good and a long term follow-up is necessary.

Objective: To summarize the clinical outcome of the Ribbed anatomic cementless total hip arthroplasty (THA) in the treatment of hip-joint disease., Methods: From January 2001 to June 2005, 34 patients (38 hips) with hip-joint disease were treated with Ribbed anatomic cementless THA. Their ages ranged from 29 to 55 years with an average age of 42.7 years. The disease course was from 3 to 18 years. Among these cases, there were 7 cases (7 hips) of femoral neck fracture, 5 cases (5 hips) of traumatic arthritis after fracture of acetabulum, 15 cases (16 hips) of necrosis of the femoral head and 7 cases (10 hips) of ankylosing spondylitis. Four patients were operated on both hip joints. The average Harris hip score was 38.6 (25-57) before operation., Results: Twenty-one patients(23 hips) were followed up 8-61 months with an average of 35 months. The Harris hip score was 76-98 after operation with an average of 92.3, showing significant difference when compared with that before operation (P < 0.05). The excellent and good result was achieved in 93.5% of patients. Radiographs showed no prosthetic osteolysis and no evidence of loosening. Pain in the thigh occurred in 4 patients,and it can be relieved by using non-steroid anti-inflammatory drug., Conclusion: Ribbed anatomic cementless THA has good clinical and radiographic results in treating patients with hip-joint disease.

Objective: To study the effect of simultaneous bilateral total hip arthroplasty in a single procedure., Methods: From October 1999 to March 2004, 15 patients (30 hips) underwent simultaneous sequential bilateral total hip arthroplasty (THAs) in a single procedure. Of the 15 patients, 11 were male (22 hips) and 4 were female (8 hips). Their ages ranged from 35 to 70 years. Their courses of disease ranged from 1 year to 50 years (4.8 years on average). The Harris scores of the joint function before the operation ranged from 12 to 45 points (27 points on average). Five were done with Smith-Peterson and 10 were done with Moore., Results: The operative time was 3 hours and 25 minutes to 5 hours (4 hours and 10 minutes on average). The volume of blood transfusion during operation was 400 to 2 400 ml (1160 ml on average). All the 15 patients were followed up for 3 to 35 months (18 months on average). The Harris scores of the joint function after the operation ranged from 70 to 100 points (86 points on average). There was significant difference in the scores between before and after operations (P<0.05). There was only 1 death within 1 months of the operation and no serious between complications such as infection, pulmonary embolism, and deep vein plug. All the patients were still ambulant in the community and gained significant pain relief., Conclusion: Simultaneous bilateral total hip arthroplasty in a single procedure is a safe and effective method. However, the decision of performing single-stage bilateral total hip arthroplasty should be carefully made and preoperative preparation should be sufficiently made.