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Objective:To evaluate the outcomes of endoscopic resection of symptomatic talocalcaneal coalitions in adolescents using a posterior approach.Methods:A retrospective case-series study was performed to analyze the data of 15 adolescent patients (16 feet) with symptomatic talocalcaneal coalitions (TCC) who had been treated by posterior arthroscopy from February 2017 to December 2020 at Department of Orthopaedics, Xuzhou Central Hospital. There were 11 boys and 4 girls with an average of 14.3 years (from 11 to 17 years). The left side was affected in 9 and the right side in 5 patients, and both sides were involved in one. Ten patients had a history of ankle sprain. The clinical outcomes were evaluated by visual analogue scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and 36-item short form health survey (SF-36) postoperatively.Results:The 15 patients were followed up for a mean time of 19.9 months (from 12 to 36 months). At the final follow-up, the VAS significantly decreased from preoperative 6 (6, 7) points to 1 (1, 3) point, the AOFAS ankle-hindfoot score significantly increased from preoperative (54.1±10.4) points to (90.0±16.6) points, and the SF-36 score significantly improved from preoperative (55.5±12.7) points to (88.7±6.5) points ( P<0.05). Follow-ups found such complications as infection, TCC recurrence or osteoarthritis in none of the patients. Conclusion:Endoscopic TCC resection using a posterior approach is an effective surgery for symptomatic TCC in adolescents, showing advantages of limited invasion, fast recovery, a low rate of postoperative complications and precise resection.
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Objective:To investigate the efficacy of total ankle arthroscopy for resection of the talus os trigonum and debridement of the synovium of flexor hallucis longus (FHL) in the treatment of osteogenic posterior ankle impingement syndrome (PAIS) complicated with flexor hallucis longus tenosynovitis (FHLT).Methods:The 14 patients with osteogenic PAIS and FHLT were retrospectively analyzed who had been treated at Department of Hand-Foot-Ankle Microsurgery, Xuzhou Central Hospital from July 2017 to July 2019. They were 8 men and 6 women, aged from 29 to 53 years (mean, 42.4 years). The talus os trigonum and the giant posterolateral process of the talus were resected under total ankle arthroscopy in the prone position of the posterior ankle while the FHL was released and cleared. The efficacy was evaluated by comparing the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Maryland functional score, and pain visual analog scale (VAS) between preoperation and one year postoperation.Results:All patients were followed up for 12 to 24 months (average, 15 months). For all patients, their plantar flexion and dorsal extension were improved significantly from preoperative 19.2°±4.0° and 14.2°±2.7° to postoperative 42.9°±2.7° and 24.5°±3.2°, their AOFAS score increased significantly from preoperative 42.1±4.2 to 91.6±2.7 at one year postoperation, their Maryland score increased significantly from preoperative 43.9±4.1 to 91.9±3.5 at one year postoperation, and their VAS score decreased significantly from preoperative 6 (6, 7) to 0 (0, 0) at one year postoperation (all P<0.05). Conclusion:In the treatment of osteogenic PAIS complicated with FHLT, total ankle arthroscopy for resection of the talus os trigonum and release of FHL can lead to fine efficacy and limited surgical invasion, resolving the FHL pathological inflammation and PAIS at the same time.
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Objective:To evaluate the clinical outcome of all arthroscopic autogenous tendon suspended fixation for Myerson type III chronic noninsertional achilles tendon rupture in elderly patients.Methods:Data of 18 patients with Myerson type III chronic noninsertional Achilles tendon rupture who had performed all arthroscopic autogenous tendon suspended fixation from February 2016 to February 2019 in Department of Hand and Foot Microsurgery, Xuzhou Central Hospital were retrospectively analyzed. There were 12 males and 6 females (right side, 10 cases and left side, 8 cases) aged from 60 to 79 years with a median of 65.3 years. The mean injury-to-surgery time was 12 weeks (range, 6-32 weeks). All the patients were treated by all arthroscopic autogenous tendon suspended fixation. The function of the ankle and the foot was assessed using visual analogue scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) foot and ankle score and the achilles tendon total rupture score (ATRS), and the excellent and good rate was evaluated according to Arner-Lindholm score.Results:All patients healed at the first stage without any complications such as infection, sural nerve injury or tend re-rupture. The mean follow-up period was 18.6 months (range, 12-50 months). At the latest follow-up, all achilles tendons were healed with the VAS score reduced from 4 (1, 7) preoperatively to 0 (0, 1) postoperatively ( Z=2.334, P< 0.05); the AOFAS ankle and hindfoot score was improved from 60.3±9.7 (range, 40-83) preoperatively to 92.6±4.3 (range, 86-100) postoperatively ( t=34.541, P< 0.05); the ATRS score was improved from 55.7±10.6 (range, 42-80) preoperatively to 93.1±3.2 (range, 88-100) postoperatively ( t=64.773, P< 0.05); one patient was unable to stand on tiptoe of the single injured limb, because he could stand it, no further treatment was given; another patient complained of mild pain after a long time walking,which was alleviated by stretching the achilles tendon consistently. According to the score of Arner-Lindholm, 14 cases were excellent, 4 cases were good, and the excellent and good rate was 100% (18/18). Conclusion:All arthroscopic autogenous tendon suspended fixation for Myerson type III chronic noninsertional achilles tendon rupture in elderly patients is an effective method, which has the advantages of less trauma, faster recovery and fewer complications.
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Objective@#To examine the clinical effect of all-inside endoscopic treatment of recalcitrant plantar fasciitis through two medial portals.@*Methods@#The recalcitrant plantar fasciitis data of 67 cases (79 feet) that underwent two medial portals all-inside endoscopic treatment at Department of Hand and Foot Microsurgery, Xuzhou Central Hospital from October 2016 to June 2018 were retrospectively analyzed.There were 24 males (30 feet) and 43 females (49 feet) aged 44.3 years old(range:24-76 years).The mean disease duration from the specialist doctor intervention to operation was (23.7±11.0) months (range: 12-60 months). All the patients were treated with the two medial portals all-inside endoscopic procedure when the 6 months conservative treatment had failed.The endoscopic procedure including debridement and partial plantar fasciotomy.The clinical results,including pain,activity,gait and foot health quality,were scored using visual analogue pain scale (VAS),American Orthopaedic Foot & Ankle Society Ankle Hindfoot Scale (AOFAS) and SF-36.@*Results@#All the patients were followed up for (15.2±6.7) months (range: 12-24 months). All cases achieved primarily healing of the wound without postoperative complications of nerve,vessel and tendon.At the last follow-up,the VAS decreased from (5.3±2.0) preoperative to 0 prooperative (t=21.60, P=0.000), AOFAS increased from (72.6±9.4) to (97.3±4.6)(t=19.43,P=0.000),SF-36 increased from (93.6±8.4) to (119.1±7.3) (t=18.78, P=0.000), non-recurrent calcaneal spur, normal foot and ankle activity was recorded.@*Conclusion@#The two medial portals all-inside endoscopic procedure is effective for the treatment of recalcitrant plantar fasciitis.
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Objective To investigate the influence of chondrocytes originating from different source on early chondrogenic differentiation of bone marrow mesenchymal stem cells (MSCs) in isolated co-culture system.Methods We applied hanging cell culture system to culture chondrocytes of different origin (osteoarthritis chondrocyte cells,nomal chondrocyte cells,infant chondrocyte cells) and controls.These chondrocytes and MSCs of the same origin were cultured in the common medium in a separated condition,and observed by microscope at 3,6,9,12 day after co culture.Expression levels of aggrecan,collagen type Ⅱ (Col 2),cartilage-specific transcription factor (Sox-9) in MSCs of different origin were determined by Real-time PCR.Results MSCs showed obviously morphological differentiation induced by chondrocytes of different origin at 12 day after coculture as compared with controls.Real-time PCR analysis showed that SOX9 mRNA level was stimulated by 1.7-fold,1.6-fold and 1.2-fold (all P＜0.05) and aggrecan mRNA level was increased by 2.8-fold,2.2-fold and 1.3-fold (all P＜0.05) in infant chondrocytes group,nomal chondrocytes group,osteoarthritis chondrocytes group respectively as compared with controls while COL2 mRNA level had no significant differences among the four groups.Corresponding protein signal level had obvious differences among the four groups,especially in infant chondrocytes as compared with osteoarthritis chondrocytes and nomal chondrocytes.Conclusions Isolated co-culture system may indirectly promote MSCs differentiation to chondrocytes by local micro-environment regulation.Chondrocytes of different origin have different effects on MSCs differentiation,but they could promote MSCs differentiation to chondrocytes.