Clinical expert consensus on platelet-rich plasma treatment for lateral epicondylitis (2022 version) / 中华创伤杂志

Lateral epicondylitis is a common clinical disease with characteristics of lateral elbow pain, insidious onset and easy recurrence, which can cause forearm pain and decreased wrist strength, seriously affecting patients′ daily life and work. Although there are various treatment methods for lateral epicondylitis with different effects, standard treatments are still lacking nowadays. Platelet-rich plasma (PRP) has good effects on bone and tendon repair, and is now widely used in the treatment of lateral epicondylitis. However, there is a lack of a unified understanding of the technology and specifications of PRP in the treatment of lateral epicondylitis. Therefore, the Sports Medicine Branch of the Chinese Medical Association and Physical Medicine and Rehabilitation Branch of the Chinese Medical Association organized experts in the fields of sports medicine and rehabilitation medicine in China to formulate the "clinical expert consensus on platelet-rich plasma treatment for lateral epicondylitis (2022 version)", and proposed suggestions based on evidence-based medicine mainly from the concept, epidemiology and pathophysiology of lateral epicondylitis, symptoms, signs and imaging manifestations of lateral epicondylitis, PRP concept and application component requirements, quality control of PRP preparation technology, indications and contraindications of PRP in the treatment of lateral epicondylitis, PRP injection in the treatment of lateral epicondylitis, application of PRP in the operation of lateral epicondylitis, related problems after PRP treatment of lateral epicondylitis, evaluation of the results after PRP treatment of lateral epicondylitis, and health and economic evaluation of PRP treatment of lateral epicondylitis, so as to provide guidance for clinical diagnosis and treatment.

Clinical evidence-based guideline for the diagnosis and treatment of anterior cruciate ligament injury (2022 version) / 中华创伤杂志

The anterior cruciate ligament (ACL) injury is a common sports injury that has a significant impact on knee function and patients′ mobility. With the popularity of national fitness campaign in China, the incidence of ACL injury is increasing year by year. Currently, there still lacks clinical standards or guidelines on how to choose appropriate treatment methods, surgical plans and rehabilitation protocols for ACL injury. In order to timely reflect the new treatment concept of ACL injury, standardize its diagnosis and treatment and improve the curative effect, the Sports Medicine Society of Chinese Research Hospital Association and the Editorial Board of Chinese Journal of Trauma organized domestic orthopedic and sports medicine experts to formulate the "clinical evidence-based guideline for the diagnosis and treatment of anterior cruciate ligament injury (2022 version)" based on the level of evidence-based medicine and in compliance with the principle of scientificity, practicability and advancement. The present guideline includes 12 recommendations for the diagnosis, treatment and rehabilitation of ACL injury in order to provide guidance and assistance for the clinical diagnosis and treatment of ACL injury in China.

Three-dimensional parallel collagen scaffold promotes tendon extracellular matrix formation / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the effects of three-dimensional parallel collagen scaffold on the cell shape, arrangement and extracellular matrix formation of tendon stem cells.</p><p><b>METHODS</b>Parallel collagen scaffold was fabricated by unidirectional freezing technique, while random collagen scaffold was fabricated by freeze-drying technique. The effects of two scaffolds on cell shape and extracellular matrix formation were investigated in vitro by seeding tendon stem/progenitor cells and in vivo by ectopic implantation.</p><p><b>RESULTS</b>Parallel and random collagen scaffolds were produced successfully. Parallel collagen scaffold was more akin to tendon than random collagen scaffold. Tendon stem/progenitor cells were spindle-shaped and unified orientated in parallel collagen scaffold, while cells on random collagen scaffold had disorder orientation. Two weeks after ectopic implantation, cells had nearly the same orientation with the collagen substance. In parallel collagen scaffold, cells had parallel arrangement, and more spindly cells were observed. By contrast, cells in random collagen scaffold were disorder.</p><p><b>CONCLUSION</b>Parallel collagen scaffold can induce cells to be in spindly and parallel arrangement, and promote parallel extracellular matrix formation; while random collagen scaffold can induce cells in random arrangement. The results indicate that parallel collagen scaffold is an ideal structure to promote tendon repairing.</p>

Fabrication of bioactive tissue engineering scaffold for reconstructing calcified cartilage layer based on three-dimension printing technique / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To fabricate organic-inorganic composite tissue engineering scaffolds for reconstructing calcified cartilage layer based on three-dimensional (3D) printing technique.</p><p><b>METHODS</b>The scaffolds were developed by 3D-printing technique with highly bioactive calcium-magnesium silicate ultrafine particles of 1%, 3% and 5% of mass fraction, in which the organic phases were composed of type I collagen and sodium hyaluronate. The 3D-printed scaffolds were then crosslinked and solidified by alginate and CaCl₂ aerosol. The pore size and distribution of inorganic phase were observed with scanning electron microscope (SEM); the mechanical properties were tested with universal material testing machine, and the porosity of scaffolds was also measured.</p><p><b>RESULTS</b>Pore size was approximately (212.3 ± 34.2) μm with a porosity of (48.3 ± 5.9)%, the compressive modulus of the scaffolds was (7.2 ± 1.2) MPa, which was irrelevant to the percentage changes of calcium-magnesium silicate, the compressive modulus was between that of cartilage and subchondral bone.</p><p><b>CONCLUSION</b>The porous scaffolds for calcified cartilage layer have been successfully fabricated, which would be used for multi-layered composite scaffolds in osteochondral injury.</p>

Mobile bearing and fixed bearing unicompartmental knee arthroplasty for medial knee osteoarthritis / 中华骨科杂志

Objective To study the short-term clinical outcomes of unicompartmental knee arthroplasty for medial compartmental knee osteoarthritis,and to compare 2 kinds of unicompartmental prosthesis.Methods From March 2010 to June 2013,data of 43 patients underwent unicompartmental knee arthroplasty (UKA) were retrospectively analyzed.17 patients (17knees) used rotating platform prosthesis,and 26 patients (28 knees) used fixed bearing prosthesis.There were 7 males (7 knees)and 9 females (10 knees) in rotating platform group,with an average age of 64.1 years (range,54-82 years);while 10 males (10knees) and 17 females (18 knees) in fixed bearing group,with an average age of 62.2 years (range,43-79 years).All patients presented signs of narrowed medial joint space,medial tenderness and pain on weight-bearing.X-ray and MRI were used for documenting joint narrowing and cartilage defect.The pain and the knee functions were recorded both pre and post-operatively with knee society score (KSS),2 cases of simultaneous anterior cruciate ligament (ACL) reconstruction were assessed with TegnerLysholm knee scoring scale as well.Results All 43 patients were followed up for 6 month to 37 months,and the average duration was 21.1 months.There were no dislocations,joint infection,deep venous thrombosis,prosthetic loosening,etc.The KSS in rotating platform group was 56.11 ±9.51 preoperatively,and 92.23±5.46 postoperatively.While the KSS in fixed bearing group was 57.11 ±9.56,and 93.69±6.37,respectively.There were statistical differences comparing between preoperative and postoperative KSS knee scores.There was no significant difference in KSS scores between rotating platform group and fixed bearing group.Conclusion Unicompartmental knee arthroplasty is a less invasive and effective method for knee osteoarthritis in medial compartment with less complications.There was no significant difference in clinical outcomes between rotating platform and fixed bearing design in terms of patients' satisfactory rate,clinical and functional outcomes in this short-term follow-up study.

Acetabular revision using an anti-protrusion cage in patients with periprosthetic acetabular bone loss / 中华骨科杂志

Objective To investigate the risk factors related to the survival time of anti-protrusion cage in acetabular revision.Methods Data of 40 patients who had received acetabular revision using antiprotrusion cages between January 2002 and June 2010 were retrospectively analyzed.There were 16 males and 24 females,aged from 22 to 77 years (average,60.3 years).All patients were followed up for 12 to 82 months (average,39.2 months).According to the AAOS classification,there were 29 cases of type C and 11 cases of type D； while according to the Paprosky classification,there were 29 cases of type ⅢA and 11 cases of type Ⅲ B.The multiple regression analysis was utilized to investigate the relationships between different factors and anti-protrusion cage failure.The corresponding factors included gender,age,bone loss classification,superior or lateral migration of acetabular center of rotation,abduction angle,fixation manners (simple flange fixation or flange fixation plus transacetabular screw fixation),bone grafting techniques and cup type.Results At final follow-up,the average Harris score was 74.5±15.4.Two patients received rerevision due to prosthetic loosening.Obvious radiological loosening of prosthesis combined with pain was found in 2 cases.The statistical analysis indicated that superior migration of acetabular center of rotation,abduction angle and fixation manners were correlated with cup failure,especially when the superior migration was more than 8.5 mm or the abduction angle was larger than 53.5°.Flange fixation plus transacetabular screw fixation could reduce risk of cup failure.Conclusion There is a higher cup failure risk in acetabular revision using an anti-protrusion cage for patients with serious bone defect.However,implanting cup at the level of the true acetabulum as far as possible,decreasing abduction angle properly and using flange fixation plus transacetabular screw fixation can reduce cup failure risk.

Arthroscopic treatment of calcifying tendinitis of the supraspinatus / 中华骨科杂志

Objective To investigate the pathological features and clinical outcomes of the arthroscopic treatment for calcifying tendinitis of the supraspinatus. Methods From March 2009 to October 2010,34 patients with calcifying tendinitis of the supraspinatus were treated with shoulder arthroscopy. Based on size of calcifying deposits, they were divided into three groups: small (＜10 mm), middle (≥ 10 mm, ≤20mm), and large (＞20 mm). All patients underwent arthroscopic calcium excision and subacromial decompression, and acromioplasty of shoulder was performed in 8 cases, rotator cuff neoplasty in 10. The preoperative and postoperative clinical data such as Constant's score, Visual Analog Scale (VAS) pain score and radiographs were adopted for evaluation. Besides, histological and scanning electronic microscopic examinations of calcium deposits were also carried out. Results All patients were follwed up for average 11.5 months.The patients were regularly examined at a time point of 1 month preoperatively, 2 days preoperatively and of the latest follow-up. The average Constant score was 36.1 ±6.9, 55.6±12.4 and 89.7±2.7 respectively; the average VAS pain score was 8.2±0.8,7.03±0.7,1.7±0.3 respectively. Both scoring systems revealed a significant difference before and after surgery. However, the clinical outcomes of the calcified deposit (small, middle, and large) showed on significant difference among the 3 groups. Collagen fibers were not degenerated around the calcified deposit, and no apoptotic or dead cells could be found, therefore, it is not a pathological calcification. Conclusion Recognition of calcifying tendinitis and good timing of surgery are keys to good clinical results. Shoulder arthroscopy is a safe, effective and minimally invasive method for the treatment of calcifying tendinitis of the supraspinatus. The patients with various size of the calcium deposit treated with shoulder arthroscopy can lead to an excellent clinical outcome postoperatively.

Autologous and artificial vascular transplantation after vascular injuries to the extremities: A retrospective data study in 44 cases / 中国组织工程研究

BACKGROUND: Vascular injuries to the extremities are frequently concomitant with vascular defects. Vascular transplantation repair can induce infection and vascular occlusion, etc.OBJECTIVE: To analyze the outcome of vascular reconstitution in 44 patients with vascular injuries of the extremities undergoing vascular transplantation.DESIGN: A retrospective case analysis.SETTING: Department of Vascular Surgery and Department of Orthopaedics of Hospital Affiliated to Jinhua College of Profession and Technology.PARTICIPANTS: Forty-four patients with vascular injuries to the extremities undergoing autologous and artificial vascular transplantation were selected at the Department of Vascular Surgery and Department of Orthopaedics of Hospital Affiliated to Jinhua College of Profession and Technology from April 1994 to October 2003. There were 29 patients with open injury and 15 patients with closed injury.METHODS: A total of 52 blood vessels were transplanted into 44 patients, including 42 blood vessels in autologous vein transplantation (35 blood vessels in great saphenous vein transplantation by end-to-end anastomosis, 5 blood vessels in small saphenous vein transplantation by end-to-end anastomosis and 2 blood vessels in superficial femoral vein and popliteal vein transplantation) and 10 blood vessels in artificial and trimming vascular transplantation by interrupted suture technique in end-to-end anastomosis.MAIN OUTCOME MEASURES: Outcomes of autologous and artificial vascular transplantation.RESULTS: Three patients received amputated extremity. Six patients developed ischemic contracture. Seven patients developed imperfect recovery of nerve function. In other patients, blood flow in the graft was satisfactory, and there was good condition of blood circulation at the distal extremities.CONCLUSION: Autologous vein is the first choice in vascular transplantation, and prosthetic material is another choice when necessary. It is important to prevent the occurrence of complication after transplantation such as vascular infection.

Hybrid total hip arthroplasty treating femoral neck fracture of elderly patients / 中华急诊医学杂志

Objective To follow up a series of elderly patients who had acute femoral neck fracture, and to examine the performance of the combination of cemented stem and acetabular cup. Methods Forty-one elderly patients were followed up.The average age at operation was 72.1 years and follow-up was 3.2 years. Evaluations on the outcomes of hybrid hip arthroplasty included morphologic feature of bone, quality of cement mantle,and implant stability. Results No cement-related death intra- or postoperatively was documented and systemic diseases did not deteriorate peri-operatively. The total Harris Hip Score was 81.1 points. The bone type was evaluated as Type A, 20%; Type B,56%;Type C,24%. Quality of cement mantle was evaluated as Grade A, 37%; Grade B, 49%;and Grade C, 4%. Conclusion Hybrid total hip replacement is preferred in the elderly with acute femoral neck fracture.The immediate postoperative stability enables quicker rehabilitation of elderly patients and lowers the incidence of complications.Contemporary cementing techniques are mandatory in the operation.