Case-control study on remnant-preserving strategy for preservation and reconstruction of anterior cruciate ligament / 中国骨伤

OBJECTIVE@#To investigate and compare the clinical efficacies of remnant-preserving and remnant-non-preserving, remnant-non-preserving remnant segment preserving and remnant root preserving with anterior cruciate ligament reconstruction.@*METHODS@#From March 2014 to December 2017, 204 patients with anterior cruciate ligament (ACL) injuries were treated by single-bundle ACL reconstruction with hamstring tendon autograft. According to the different methods of remnant preservation, the procedures were divided into remnant segment preserving group (A), remnant root preserving group (B), and remnant-non-preserving group (C). There were 37 males and 39 femalesin group A aged from 16 to 43 years old with an average of (28.80±5.41) years old. The time from injury to operation ranged from 2 to 11 weeks with an average of (3.68±1.04) weeks. In group B, there were 39 males and 25 females aged from 18 to 41 years old with an average of (28.42±5.60) years old. The time from injury to operation ranged from 2 to 10 weeks with an average of (3.36±1.68) weeks. In group C, there were 37 males and 27 females aged from 18 to 43 years old with an average of (29.10±6.11) years old. The time from injury to operation ranged from 3 to 11 weeks with an average of (3.54±1.46) weeks. The range of motion (ROM) of the knee was used to assess the range of extension and flextion of the knee at pre-operation and 24 months after operation. Lysholm score and the international knee documentation committee (IKDC) score were used to assess the knee function. The differences among three procedures were judged by comparing among the three groups at 6, 12 and 24 months postoperatively.@*RESULTS@#All incisions got a one stage healing, and no complications, such as vascular injury, nerve damage and articular infect or the like, occurred. All the patients were followed up, and the follow-up duration of group A ranged from 24.00 to 45.96 months with a mean of (35.52±14.40) months;the follow up duration of group B ranged from 27.96 to 48.00 months with a mean of (37.56±10.68) month;and the follow up duration of group C ranged from 24.00 to 66.00 months with a mean of (37.08±13.44) month. There were no significant differences in follow up time among three groups (@*CONCLUSION@#Compared with remnant-non-preserving group, the residual tissue of anterior cruciate ligament is preserved, which is conducive to promote the healing and remodeling of tendon graft and accelerate the recovery of joint function. Proper fixation of residual tissue and restoration of its tension are the key factors affecting the postoperative efficacy.

Biomechanical study on different high-strength sutures and suture site for repairing posterior root tear of the medial meniscus / 中国骨伤

OBJECTIVE@#To compare biomechanical characteristic of different high-strength sutures and suture sites for repairing posterior root tear of the medial meniscus with modified Mason-Allen technique.@*METHODS@#Forty-eight specimen of medial meniscus of knee joint from fresh porcine (female, aged from 5 to 9 months with an average of 7 months) were chosen and established experimental model. The samples were divided into red zone fixation group and red-white zone fixation group according to suture sites, 24 in each group; and then were randomly divided into 3 subgroups which 8 in each group, and fixed with Ethibond suture, Ultrabraid suture and FiberWire suture, respectively. Biomechanical tests were performedon universal electromagnetic and mechanical testing machine. Each specimen was underwent 1 000 cyclic tests on the first time, then pull out test until failure. The maximum failure load, yield load, stiffness and displacement were analyzed.@*RESULTS@#All specimen were successfully completed biomechanical tests. The failure mode of Ethibond group was caused by suture fracture; 6 cases of Ultrabraid suture group was caused by suture fracture which belong to red zone fixation group, 10 cases were caused by suture pull out, which 2 cases belong to red zone fixation group, 8 cases belong to red-white zone fixation group;8 cases of FiberWire group was caused by suture pull-out. Biomechanical test showed that:(1)In terms of suture strength, comparison of the maximum failure load, yield load and stiffness showed that Ethibond suture group

Arthroscopic repair of Bankart lesion with bioabsorbable suture anchors / 中国骨伤

OBJECTIVE@#To evaluate early clinical effects of bioabsorbable suture anchors for the treatment of Bankart lesion.@*METHODS@#Total 23 patients with the Bankart lesion were treated with arthroscopic repair using bioabsorbable suture anchors from January 2010 to June 2017. There were 20 males and 3 females, with an average age of (23.4±3.9) years old (ranged, 19 to 34 years old). Fourteen patients had injuries on the right shoulder joint and 9 patients had the injuries on the left side. The mechanism of primary dislocation included 17 cases of training, 5 cases of sports injury and 1 case of falling down. The mean interval time from injury to surgery was(10.9±5.8) months (ranged, 3 to 36 months). The Bankart lesion was repaired by bio-cortical suture anchors. The Rowes rating system for Bankart repair was used to evaluate therapeutic effects.@*RESULTS@#All 23 patients were followed up, with a mean duration of(24.5±3.7) months(ranged, 18 to 39 months). At the latest follow up, there was no recurrent dislocation occurred, and all patients had returned to sports and work. The Rowes rating system for Bankart repair was 53.91±11.67 pre-operationally and 91.74±12.30 post operationally, respectively (@*CONCLUSION@#Applying bio-cortical bone suture anchors for the Bankart lesion is a reliable, efficient and cost effective treatment, which is also suitable for the revision of the Bankart lesion.

Clinical outcome of arthroscopic anterior cruciate ligament remnant-preserving reconstruction / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical outcome of arthroscopic anterior cruciate ligament(ACL)reconstruction with remnant cuff preservation.</p><p><b>METHODS</b>There were 42 cases of ACL tear were performed reconstruction in our department from January 2012 to December 2014. The patients were 28.4 years old on average, 17 males and 25 females. ACL reconstruction was performed under arthroscopy with remnant cuff preservation. The stability of knee was assessed by Lachman test and anterior drawer test. The function of knee was assessed through Lysholm score and Tegner activity rating. MRI of the knee was checked 12 months postoperatively.</p><p><b>RESULTS</b>The stability tests of all patients were negative postoperatively. Lysholm score of all patients 12 months after operation was 96.8±6.1, which was significantly better than 37.8±7.1 of preoperatively. Tegner activity rating of all patients 12 months after operation was 6.2±0.9, which was significantly better than 2.1±0.4 of preoperatively. It showed the grafts were very well in MRI 12 months after operation.</p><p><b>CONCLUSIONS</b>Arthroscopic anterior cruciate ligament remnant-preserving reconstruction could restore the stability of knee.</p>

Midterm clinical outcome for ankylosing spondylitis patients with early hip-involved diseases treated with arthroscopic technique / 中国骨伤

<p><b>OBJECTIVE</b>To study the clinical outcome of manipulation release combined with arthroscopic debridement and synovia resection under general anesthesia for early hip involvment in patients with ankylosing spondylitis.</p><p><b>METHODS</b>Manipulation release combined with arthroscpic debridement and synovium resection were performed for hip lesion in 22 patients with ankylosing spondylitis from June 2011 to June 2013, incuding 6 males and 16 females with anverage age of 24.7 years ranging from 17 to 23 years. The course of the diseases was from 10 to 41 months(22.1 months on average). After 6 months of conservative treatment, hip pain and other symptoms were no relief. The preoperative and postoperative follow-up evaluation was performed and compared by the hip movement, VAS pain score, mHHS score and NAHS score.</p><p><b>RESULTS</b>All the patients were followed up for 26 to 44 months with an average of 30.2 months. The range of motion in active flexion-extension, abduction-adduction, internal-external rotation in 0° flexion and 90° flexion increased from (78.2±10.2)°, (36.3±6.4)°, (31.1±9.2)° and (37.3±10.5)° before operation to (113.5±8.4)°, (55.7±8.4)°, (58.7±2.1)° and (60.1±9.8)° after operation, respectively. The VAS scores decreased from 8.5±9.4 before operation to 5.5±7.1 after operation. The modified Harris and NAHS scores increased from 60.8±6.9 and 56.9±6.25 before operation to 88.1±10.4 and 84.6±5.4 after operation, respectively.</p><p><b>CONCLUSIONS</b>Manipulation release combined with arthroscopic debridement and synovium resection under general anesthesia could effectively control the progression of hip lesion in patients with ankylosing spondylitis restoring the ROM, relieve pain symptoms, delay joint deformity and ankylosis with less bleeding, faster recovery, and significantly improve patients' quality of life.</p>

Experimental study on staphylococcal enterotoxin promoting tendon-bone healing after reconstruction of anterior cruciate ligament in rabbits / 中国骨伤

<p><b>OBJECTIVE</b>To explore highly agglutinative staphylococcin (HAS) pomoting on tendon-bone healing after reconstruction of anterior cruciate ligament(ACL) in rabbits.</p><p><b>METHODS</b>Animal model of ACL reconstruction in 24 mature New Zealand white rabbits(3 months, 2.56 kg on average, either gender) were established using autologous digital long extensor tendon and randomly classified into 2 groups(HAS and control group), 12 rabbits for each group. HAS group was separately injected 0.1ml highly agglutinative staphylococcin immediately into tendon-bone interface during the operation and 2 days after operation. Control group was injected with the same dose of physiological saline for 3 days. All animals were sacrificed at 4, 8, and 12 weeks after operation for histological examinations. The specimens were stained with hematoxylin-eosin, picric acid-sirius red, VEGF immunohistochemistry stain, and toluidine blue to histologically analysis the total pathology changes of the tendon-bone healing tissue, the tendon bone interface morphology classification, hyperplasia and arrangement of collagen fiber, vascularization and new bone formation, respectively.</p><p><b>RESULTS</b>The Yamakado morphological interface results showed that the tissue healing at tendon-bone interface of the HAS group was better than that of the control group. The histological examination revealed that on the 4th week after operation, the tendon-bone interface of HAS group was filled with fibrous connective tissue. The proliferated fibroblasts, chondroblasts and the angiogenesis were rich. On the 8th week after operation, the healing tissue at the bone-tendon interface had developed into dense connective tissue, the neo-vessels were very rich, the collagen fibers were formed abundantly, some Sharpey's fibers spanning parts of the tendon-bone interface. On the 12th week after operation, the transition zones were full of Sharpey's fibers;the neo-vessels were not as much as the 8th weeks, but new bone formation was further increased and immature fibrocartilage appeared. For quantitative histological analysis at 4, 8 and 12 weeks after operation, the proportion of neo-vessel area and the area of now bone formation of the HAS group were all significantly higher than those of the control group(<0.05).</p><p><b>CONCLUSIONS</b>Under the synergy of staphylococcal enterotoxin C and other active ingredients, Highly Agglutinative Staphylococcin can significantly improve the tendon-bone healing after ACL reconstruction in rabbit knees, which is expected to be a new method to improve the clinical results of ACL reconstruction.</p>

Clinical effect of arthroscopy-assisted minimally invasive management of bunion / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the effect of arthroscopy-assisted minimally invasive management of bunion and hallux valgus deformities.</p><p><b>METHODS</b>Total 50 patients (53 feet) with bunion and hallux valgus deformities were treated under arthroscopy from July 2008 to July 2011, with an average age of 42.3 years old (ranging from 30 to 65 years old) involving 19 left feet, 28 right feet and 3 both feet. The American Orthopedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal(MP-IP) Scale Score was used to evaluate the therapeutic effect.</p><p><b>RESULTS</b>There were no complications such as hallux varus, hallux rigid and nerve or blood vessel injury. Clinically, AOFAS MP-IP Scale Score was increased from 62.19 ± 6.01 preoperatively to 88.26 ± 6.81 postoperatively.</p><p><b>CONCLUSION</b>Arthroscopy-assisted minimally invasive management appears to be a good procedure with advantages of less complication, little trauma and early rehabilitation for bunion and hallux valugs deformities.</p>

Hamstring tendon transplantation embedding reconstruction of medial patellofemoral ligament for the treatment of recurrent patellar dislocation / 中国骨伤

<p><b>OBJECTIVE</b>To explore the effectiveness of hamstring tendon graft embedding reconstruction of medial patellofemoral ligament for the treatment of recurrent dislocation of the patella.</p><p><b>METHODS</b>From March 2008 to June 2013,67 patients with recurrent dislocation of patella were treated, including 28 males, 39 females with an average age of 22 years ranging from 10 to 42 years old. The clinical manifestations involved knee joint instability,"giving way", sense of patellar dislocation, anterior knee pain. All 67 patients underwent arthroscopic hamstring tendon graft embedding reconstruction of the medial patellofemoral ligament. The curative effect were evaluated by preoperative and postoperative Lysholm score and Q angle changes.</p><p><b>RESULTS</b>All cases were followed up after operation and the mean follow-up time was(27.5±13.4) months(4 to 69 months). Postoperative incision were healed well and no patellar dislocation or subluxation occurred. Lysholm score improved from preoperative 76.35±2.86 to 82.71±2.29 postoperatively; Q angle decreased from preoperative (18.75±2.33)° to postoperative(13.28±1.75)°.</p><p><b>CONCLUSION</b>The method for the reconstruction of medial patellofemoral ligament can provide enough tension, patellar stability.imoroving the function of knee ioint.</p>

Clinical effect of arthroscopic debridement and infusion-drainage on septic arthritis after arthroscopic anterior cruciate ligament reconstruction / 中国骨伤

<p><b>OBJECTIVE</b>To investigate therapeutic strategy on septic arthritis after arthroscopic anterior cruciate ligament reconstruction.</p><p><b>METHODS</b>The clinical data of 6 cases of septic arthritis after arthroscopic anterior cruciate ligament reconstruction in our department from March 2005 to February 2014 were analyzed. All the patients were male,ranging in age from 18 to 36 years old. After operation, the knee joint became painful and swollen, and ESR and CRP were both increased. Culture of joint fluid allowed the recovery of staphylococcus epidermidis. The patients were dealt with arthroscopic debridement and infusion-drainage. The clinical results were evaluated by Lysholm rating system and range of motion.</p><p><b>RESULTS</b>The infection of all the patients was controlled. The ESR and CRP both recovered to normal level. The score of Lysholm rating system ranged from 85 to 95,and the range of motion was 120 to 135 degree.</p><p><b>CONCLUSION</b>Arthroscopic debridement combined with infusion-drainage is effective in septic arthritis after arthroscopic anterior cruciate ligament reconstruction.</p>

Arthroscopic patelloplasty and circumpatellar denervation for the treatment of patellofemoral osteoarthritis / 中国骨伤

<p><b>OBJECTIVE</b>To investigate surgical procedure and clinical effects for the treatment of patellofemoral osteoarthritis (PFOA) with arthroscopic patelloplasty and circumpatellar denervation.</p><p><b>METHODS</b>Totally 156 patients with PFOA (62 males and 94 females; aged from 45 to 61 years old with an average of 52) were treated from September 2011 and March 2013. The clinical manifestations included recurrent swelling and pains on knee-joint,and aggravated pains upon going up/down-stairs, squatting-down, or standing-up. PFOAs were treated with arthroscopic patelloplasty and circumpatellar denervation. The therapeutic effects before and after surgery were evaluated by Lysholm scores and Kujala scores. The therapeutic effects were graded by classification of cartilage injury degrees.</p><p><b>RESULTS</b>Totally 149 cases were successfully followed up for 14.8 months. The incisions were healed well and no complication were occurred. Lysholm score was improved from 73.29 preoperatively to 80.93 postoperatively and average Kajala score from 68.34 preoperatively to 76.48 after surgery. This procedure was highly effective for patients with I - III degree cartilage injury, while not for patients with IV degree cartilage injury.</p><p><b>CONCLUSION</b>For PFOA patients, arthroscopic patelloplasty and circumpatellar denervation is effective for significantly relieving anterior knee pains, improving knee-joint functions and quality of life, and deferring arthritic procession.</p>

Arthroscopic repair of meniscus injury with Fast-fix under local anesthesia / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical outcome of arthroscopic repair method of meniscus injury with Fast-fix under local anesthesia.</p><p><b>METHODS</b>From October 2005 to September 2012,106 patients with meniscus injuries admitted into our - hospital were studied, including 74 males and 32 females, ranging in age from 13 to 71 years old, averaged 27.6 years old. The duration of the disease ranged from 15 days to 5 years. The main clinical manifestations included knee joint pain after exercise, joint locking, pressing pain of knee joint and positive McMurray signs. The MRI showed meniscus tear or degeneration. Arthroscopic repairing surgeries were performed with Fast-fix under local anesthesia. Each patient was assessed with VAS pain evaluation and Lysholm knee-joint score system before and after operation. All the patients were followed up more than 1 year.</p><p><b>RESULTS</b>One hundred and 2 patients were followed up by recording subjective symptoms, clinical examinations and questions naires for an average of 2.6 years (ranged, 1.1 to 8 years), and 4 patients lost follow-up. All the 102 patients had no anesthetic complications. Ninety-six patients had normal subjective symptom and clinical examinations. Four patients had a mild ache with activities,2 patients had moderate pain after activities with joint space pressing pain. VAS pain evaluation and Lysholm knee-joint score after operation both were much better than that before operation.</p><p><b>CONCLUSION</b>onclusion: Local anesthesia can provide nice circumstances for surgeries. Arthroscopic repair using Fast-fix is an idea method for meniscus injury, especially for the posterior horn tear of medial meniscus, which is simple and convenient with less complications, and satisfactory results.</p>

Etiological analysis and significance of anterior knee pain induced by gluteal muscles contracture / 中国骨伤

<p><b>OBJECTIVE</b>To explore causes of gluteal muscle contracture induced anterior knee pain and curative effect of arthroscopic release.</p><p><b>METHODS</b>From March 2002 to August 2013,36 patients with gluteal muscle contracture induced anterior knee pain were treated, including 15 males, 21 females, aged from 9 to 40 years old with an average (18.7±7.2) years old; the courses of diseases ranged from 4 to 30 years. The clinical manifestations involved limited to symmelia, positive Ober sign, buttocks touch contracture belts, knee and patella slide to lateral when doing squat activities. All patients were performed gluteal muscle contracture release under arthroscopic. Postoperative complications were observed, Kujala scoring before and after operation was used for compare curative effect.</p><p><b>RESULTS</b>All patients were followed up with an average of 29 months. The incision were healed well, and no complications were occurred. Postoperative Kujala score were improved more than preoperative.</p><p><b>CONCLUSION</b>Gluteal muscle contracture release could alleviate hypertension of lateral patella, and palys an important role in preventing patellofemoral arthritis.</p>

Clinical classification of gluteal muscle contracture under arthroscopy / 中国骨伤

<p><b>OBJECTIVE</b>To explore clinical effects of gluteal muscle contracture and minimum invasive surgery under the arthroscopy.</p><p><b>METHODS</b>Totally 358 patients with gluteus contracture were treated,which included 175 males and 183 females with an average age of (19.7 +/- 6.8) years old (ranged, 14 to 41). All patients have a history of repetitive intramuscular injection of penicillin with benzyl alcohol solvent. According to clinical characteristics and intraoperative situation, patients were classified into four groups:cable strip (118 cases), fanshaped (107 cases), mixed (87 cases), tensor fasciae latae contracture(46 cases). The curative effects were evaluated according to postoperative function evaluation standard of gluteus contracture.</p><p><b>RESULTS</b>All patients were followed up and 37 cases withdrew. The following up time ranged from 1.5 to 8 years with an average of 3.5 years. According to evaluation standard of gluteus contracture, 303 cases got excellent results, 13 cases good,and 5 cases fair at the final follow-up. No recurrence, infection and neurovascular injury occurred.</p><p><b>CONCLUSION</b>The classification of gluteal muscle contracture is beneficial for choose surgical strategy and improve curative effect. The advantage of plasma knife minimally invasive solution in treating gluteal muscle contracture with radiofrequency under arthroscopy is minimally invasive, safe, and benefit for early functional exercises.</p>

Analysis of the characteristics of articular cartilage lesions under knee arthroscopy in different age groups / 中国骨伤

<p><b>OBJECTIVE</b>To provide reliable data on articular cartilage lesions in different age group of patients with symptomatic knees requiring arthroscopy, and to analyze the characteristics of articular cartilage lesions.</p><p><b>METHODS</b>From November 2004 to September 2005, 568 patients were under arthroscopy in orthopaedics of Chinese PLA General Hospital. There were 242 males and 326 females, with a mean age of (43.0 +/- 11.2) years (ranged, 12 to 80 years). Surgery information including causes of injury, onset of symptoms, meniscus lesions, cruciate ligament pathology, articular cartilage lesions were collected by a special Data Management software. All the patients were divided into two groups : youth group and middle-aged group. The data of articular cartilage lesions of patients in the two groups were collected.</p><p><b>RESULTS</b>There were 923 articular cartilage lesions in 389 patients, and 13 lesions were iatrogenic. In youth group, 212 lesions were found in 121 patients, and the main cause of lesions was menisci menisci injury (57/121 cases). In middle-aged group, 711 lesions were found in 268 patients,and the main cause of lesions was osteoarthritis (218/268 cases). The articular cartilage lesions located majorly in the lateral femoral condyle, medial femoral condyle and patellae in patients of the two groups. The major depth of the lesion was grade IV (330 lesions) in middle-aged group and grade III (71 lesions) in youth group,respectively.</p><p><b>CONCLUSION</b>Articular cartilage lesions are common in patients under arthroscopy, and articular cartilage lesions of different age group of patients are different, so the best treatment method should be chosen regarding to age factors of patients.</p>

Diagnostic value of MRI and MR arthrography in the detection of injuries of anterior labrum in shoulder / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the diagnostic value of MRI and MR arthrography in the detection of injuries of anterior labrum in shoulder and to evaluate the accuracy of MR arthrography in the classification of anterior labrum lesion.</p><p><b>METHODS</b>Seventy-eight patients with arthroscopically proved anterior labrum lesions(study group) and 75 patients with arthroscopically proved intact anterior labrum (control group) from January 2007 to December 2010 were included to the study. All patients underwent MRI and MR arthrography at our institution prior to shoulder arthroscopy. All MRI and MR arthrography were analyzed by one musculoskeletal radiologists and one sports medicine surgeon who had no knowledge of the clinical histories and arthroscopic results. The same classification system of labrum lesions based on arthroscopy was used in image analysis. Imaging findings and arthroscopic findings were compared in all patients. With arthroscopy used as the standard of reference, the sensitivities, specificities and accuracies of MRI and MR arthrography in the detection of anterior labrum lesions were compared, and the sensitivities, specificities and accuracies of MR arthrography in the correct classification of anterior labrum lesions were calculated.</p><p><b>RESULTS</b>In arthroscopy, 78 anterior labrum lesions, 67 rotator cuff lesions and 8 SLAP lesions were diagnosed, for the detection of anterior labrum lesions, the sensitivity of MRI and MR arthrography was 80.8% and 92.3%,the specificity was 89.3% and 97.3%,the accuracy was 85.0% and 94.8% respectively. Seventy-eight patients with arthroscopically proved anterior labrum lesions included 39 Bankart lesions, 32 ALPSA lesions and 7 Perthes lesions, with MR arthrography, Bankart, ALPSA, and Perthes lesions were correctly classified in 84.6%, 84.4%, and 57.1% of cases, respectively.</p><p><b>CONCLUSION</b>MR arthrography has a higher sensitivity, specificity and accuracy than MRI in the detection of anterior labrum injuries. MR arthrography was useful in the classification of different variants of anterior labrum injuries before operations. It may directly influence the surgeon's strategy and is useful in preoperative planning of arthroscopic reconstructions.</p>

Effect of low-energy shock waves in microfracture holes in the repair of articular cartilage defects in a rabbit model / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Microfracture is a type of bone marrow stimulation in arthroscopic cartilage repair. However, the overall concentration of the mesenchymal stem cells is quite low and declines with age, and in the end the lesion is filled by fibrocartilage. The aim of this research was to investigate a novel method of enhancing microfracture by determining whether low-energy shock waves in microfracture holes would facilitate cartilage repair in a rabbit model.</p><p><b>METHODS</b>Full-thickness cartilage defects were created at the medial femoral condyle of 36 mature New Zealand white rabbits without penetrating subchondral bone. The rabbits were randomly divided into three groups. In experimental group A, low-energy shock-wave therapy was performed in microfracture holes (diameter, 1 mm) at an energy flux density (EFD) of 0.095 mJ/mm² and 200 impulses by DolorClast Master (Electro Medical Systems SA, Switzerland) microprobe (diameter, 0.8 mm). In experimental group B, microfracture was performed alone. The untreated rabbits served as a control group. At 4, 8, and 12 weeks after the operations, repair tissues at the defects were analyzed stereologically, histologically, and immunohistochemically.</p><p><b>RESULTS</b>The defects were filled gradually with repair tissues in experimental groups A and B, and no repair tissues had formed in the control group at 12 weeks. Repair tissues in experimental group A contained more chondrocytes, proteoglycans, and collagen type II than those in experimental group B. In experimental group B, fibrous tissues had formed at the defects at 8 and 12 weeks. Histological analysis of experimental group A showed a better Wakitani score (P < 0.05) than in experimental group B at 8 and 12 weeks after the operation.</p><p><b>CONCLUSIONS</b>In the repair of full-thickness articular cartilage defects in rabbits, low-energy shock waves in microfracture holes facilitated the production of hyaline-like cartilage repair tissues more than microfracture alone. This model demonstrates a new method of improving microfracture and applying shock waves in vivo. However, longer-term outcomes require further study.</p>

Arthroscope monitored solution of adult intramuscular injection associated gluteal muscle contracture by radiofrequency / 中华外科杂志

<p><b>OBJECTIVES</b>To evaluate the result of releasing adult intramuscular injection associated gluteal muscle contracture under the monitor of arthroscope by radiofrequency probe.</p><p><b>METHODS</b>From June 2001 to June 2005, 108 cases of bilateral gluteal muscle contracture were treated with radiofrequency colation under the arthroscope and solution with an average age of 24 years (from 18 to 40 years). There were 57 males and 51 females. Preoperatively, the course of the outline of the femur greater trochanter the sciatic nerve in buttocks and the area of gluteal muscle contracture were marked. With the patients firmly anchored in the straight lateral position, normal saline (which contains Adnephrin) was injected between the surface of contracted gluteus and subcutaneous fat to reduce bleeding in operation. The ports for the motorized shaver and radiofrequency probe were located at the edge of gluteal muscle contracture and were 5 mm superior to the greater trochanter. The 6 mm diameter port for the arthroscope was 3 cm inferior to the greater trochanter. Space was made between contracture bands and overlying subcutaneous tissue with a periosteal elevator by blunt dissection. After the anterior and posterior edge of the contracture bands were fully revealed, normal saline were filled in the space. With the monitor of arthroscope, the procedures were: removing fatty tissue from the surface of the contracture bands with motorized shaver, then cutting off the contracture bands curve and carefully probing and cutting off contracture bands which were mixed in gluteus maximus with radiofrequency probe, finally hemostasis by radiofrequency probe. In the operation flexion, adduction, internal rotation and straightening hip joint were repeated, until it got normal range of motion without snap and bleeding. Results One hundred and one patients were followed up with an average of 19 months. According to a comprehensive evaluating system, 91 cases were excellent, 7 were good, and 3 were fair. No infection, recurrence and neurovascular injury occurred.</p><p><b>CONCLUSIONS</b>Gluteal muscle contracture could be effectively released with radiofrequency vaporization and solution. The technique has the advantage of easy to manipulate, minimally invasive, painless, safety and reliable curative effect, and is good for early functional exercises.</p>

Arthroscopically assisted radiofrequency probe to treat achilles tendinitis / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the effectiveness of micro-tenotomy using a radiofrequency (RF) probe to treat chronicity achilles tendinitis.</p><p><b>METHODS</b>Seventeen cases of chronicity achilles tendinitis were treated by RF probe. Eleven cases were male, and 6 female. The average age of the patients was 25 (17-48) years. Nine were athlete, 4 sports activity and 4 students. Seven were in left side, and 10 right side. Before receiving the RF therapy all patients had achilles tendinitis symptoms. The patients were treated with local anesthesia under arthroscopy by Arthrocare 2000 and TOPAZ. The operation were performed through a artificial lacuna under the subcutaneous tissue of achilles tend, insert arthroscope. The pathology test found the achilles tendon surface fibrous tissue hyperplasia and tear. The probe of RF to perforate just as meshwork, the space was 3-5 mm.</p><p><b>RESULTS</b>Patients reported significantly reduced pain from 7 to 14 d postoperatively. The symptoms of pain was completely disappeared in 15, obviously relieve in 2. The functional outcome was assessed using the VAS score evaluation, perioperative 8.7 and postoperative 1.6. There were no perioperative and postoperative complications related to the procedure, as rupture of achilles tendon, blood vessel and nerve injury. No infection and recur was found in the cases.</p><p><b>CONCLUSIONS</b>RF therapy for chronicity achilles tendinitis under the arthroscopy with minimum invasion is less pain and easy for early rehabilitation. The result is satisfactory.</p>

The Preparation of the Recombinant Fusion Protein Human Retinal Pigment Epithelium-derived Factor and the Analysis of Its Angiogenesis Activity / 中国生物工程杂志

Objective:The recombinant human retinal pigment epithelium-derived factor(PEDF)protein to be obtained and the angiogenesis of the rPEDF to be identified.Methods: PEDF gene gene was amplified by PCR and cloned into pET32a,rPEDF protein was expressed in E.coli BL21 and confirmed by SDS-PAGE and Western blot.The rPEDF was purified by Ni-NTA on denature condition.The concentration of the rPEDF was determined by Bradford method.The angiogenesis of the rPEDF was determined by chick chorioallantoic membrane(CAM) method.Results: The expression plasmid pET32a-PEDF was constructed successfully.The rPEDF was expressed with stable efficiency in E.coli BL21.The results of the CAM experiment showed that the rPEDF had notable angiogenesis effect in the concentration 0.4、0.04 ng/ml,but had no effect in 4 ng/ml.Conclusion:The PEDF gene was cloned and expressed efficiently,the angiogenesis of the rPEDF to be identified and the activity was worked in certain range.The results can facilitate studying its function and spreading its application.

Arthroscopic assisted Bankart repair with bio-absorbable fixation tacks / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluated the curative effect of arthroscopic Bankart repair with use of bio-absorbable fixation tacks.</p><p><b>METHODS</b>Sixteen patients were with traumatic recurrent anterior instability of the shoulder. Twelve were males, and 4 were females. Nine were in left shoulder, and 7 in right shoulder. The mean age at the time of the operation was 25 years. The average time from injury to operation was six months. Before operation the shoulder image had been done, in which X-ray film in 16, MRA in 7, CTA in 6 and MRI in 5. The arthroscopic technique included of debridement and Bankart repair using 2 to 3 bio-absorbable fixation tacks underwent arthroscopic.</p><p><b>RESULTS</b>All of the patients were followed up, average time 11 months, no redislocation and instability. According to the UCLA (University of California at Los Angeles) score showed all shoulder scores improved after surgery, preoperative (22.5 +/- 5.6) and postoperative (31.4 +/- 5.8), excellent score in 9, good score in 5 and fair score in 2; no poor score.</p><p><b>CONCLUSION</b>Arthroscopic capsulolabral repair with use of bio-absorbable fixation tacks has provided a satisfactory outcomes in function, stability and range of motion. The procedure has many advantages, such as the operation convenient, fixation safety, mini-invasion, rapid recovery and early rehabilitation.</p>