The interpretation of the American Academy of Orthopaedic Surgeons "management of anterior cruciate ligament injuries evidence-based clinical practice guideline (2022)" / 中华骨科杂志

The anterior cruciate ligament (ACL) injury is a common sports injury, which can lead to the knee unstable, make it difficult for the patient to return to sports, and cause post-traumatic osteoarthritis. The difficulty of its clinical diagnosis and treatment has always been the focus of sports medicine research. In August 2022, the American Association of Orthopaedic Surgeons updated and published "evidence-based clinical practice guideline on management of ACL injuries (2022 version)" based on the "evidence-based clinical practice guideline on management of ACL injuries (2014 version)". In the prevention, diagnosis and treatment of ACL injuries, the new guideline offers 8 recommendations and 7 options according to different evidence strength. To assist clinicians in the diagnosis and treatment of ACL injuries, this article provides an interpretation of the new guideline. In comparison to the 2014 version, the new guideline does not recommend allografts any more, shortens the time for reconstruction after ACL injury from 5 months to 3 months, adds advice that ACL reconstruction can be combined with anterolateral ligament reconstruction or lateral extra-articular tenodesis, and does not recommend ACL repair. The new guideline also shares many similarities with the domestic "clinical evidence-based guideline for the diagnosis and treatment of anterior cruciate ligament injury (2022 version)", both of which advocate history and physical examination at diagnosis, early reconstruction, the use of autologous bone-patellar tendon-bone or hamstring tendon, and either single-bundle or double-bundle ACL reconstruction. The new ACL guidelines of the American Association of Orthopaedic Surgeons lack specific recommendations on artificial ligaments, techniques for bone tunnel creation, and rehabilitation programs, all of which are of concern to domestic physicians because they are based on evidence-based research from abroad. Therefore, in order to improve the diagnosis and treatment of ACL injuries in China, clinicians should not only follow the new ACL guidelines of the American Association of Orthopaedic Surgeons, but also combine the characteristics of Chinese patients, clinical practice, and pertinent domestic guidelines when diagnosing and treating ACL injuries.

Research progress of the diagnosis and treatment of anterior shoulder instability / 中国修复重建外科杂志

The shoulder joint is the most prone to dislocation in the whole body, and more than 95% of them are anterior dislocation. Improper treatment after the initial dislocation is easy to lead to recurrent anterior dislocation or anterior shoulder instability, and the outcomes following conservative treatment is poor. Anterior shoulder instability can damage the soft tissue structure and bone structure that maintain the stability of shoulder joint, among which bone structure is the most important factor affecting the stability of shoulder joint. Diagnosis should be combined with medical history, physical examination, and auxiliary examination. Currently, three-dimensional CT is the most commonly used auxiliary examination means. However, various bone defect measurement and preoperative evaluation methods based on three-dimensional CT and the glenoid track theory have their own advantages and disadvantages, and there is still a lack of gold standard. Currently, the mainstream treatment methods mainly include Bankart procedure, coracoid process transposition, glenoid reconstruction with free bone graft, Bankart combined with Remplissage procedure, and subscapular tendon binding tamponade, etc. Each of these procedures has its own advantages and disadvantages. For the diagnosis and treatment of anterior shoulder instability, there are still too many unknown, further research and exploration need to be studied.

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.

Arthroscopic superior capsular reconstruction for massive irreparable rotator cuff tears using the long head of biceps tendon: the biomechanical and clinical study / 中华骨科杂志

Objective:To investigate the biomechanical characteristics and clinical outcomes of arthroscopic superior capsular reconstruction for massive irreparable rotator cuff tears (MIRCT) using the long head of biceps tendon (LHBT) with tenotomizing its distally or not (the "Chinese way" ).Methods:Eight fresh-frozen cadaveric shoulders were used to create a MIRCT model by detaching the footprints of the supraspinatus and infraspinatus tendons on the greater tuberosity. LHBT autograft was transferred and securely fixed onto the footprint of supraspinatus tendon for superior capsular reconstruction. Further, all cadaveric specimens were assigned to the tenotomy group or reservation group (4 cadaveric specimens in each group) according to whether the distal part of LHBT was tentomized or not. Biomechanical tests were conducted to observe the stiffness, ultimate load of fixed LHBT and to measure the length between LHBT tear site and its insertion on the superior labrum. A total of 41 patients with MIRCT who underwent arthroscopic superior capsular reconstruction using LHBT autograft between July 2016 and December 2018 were enrolled in the study. There were 17 males and 24 females, aged from 46 to 76 years (62.6±7.3 years). All patients were assigned to the tenotomy group (23 cases) or reservation group (18 cases) according to whether the distal part of LHBT was tentomized or not. The visual analogue scale (VAS), University of California, Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score and Fudan University Shoulder Score (FUSS) were used to evaluate the clinical outcomes. The range of motion (ROM) of shoulder was recorded before and after operation. Magnetic resonance imaging was used to assess the structural integrity of reconstructed tissue at 12 months after operation (refers to the failure of the transposed LHBT, which may be accompanied by a retear of partial repaired supraspinatus tendon).Results:Biomechanical research showed that the stiffness, ultimate load of fixed LHBT and the length between LHBT tear site and its insertion on the superior labrum in the reservation group (54.0±6.6 N/mm, 141.8±15.9 N, 93.3±12.4 mm, respectively) were significantly higher than those in the tenotomy group (25.7±4.2 N/mm, 80.8±8.0 N, 47.4±2.0 mm, respectively) ( P<0.05). All patients were followed up for 12-18 months (14.5±1.8 months) without significant complications and adverse reactions. No matter the distal part of LHBT was tentomized or not, the ROM and clinical scores (VAS score, UCLA score, Constant-Murley score, ASES score and FUSS) of patients improved significantly at 1 year follow-up than that before operation ( P<0.05). However, there were no significant differences between the reservation group and tenotomy group in terms of postoperative ROM [flexion, abduction, external rotation at side, internal rotation (vertebral level) were 144.3°±15.5° vs. 148.0°±10.3°, 145.1°±14.1° vs. 142.3°±11.2°, 67.3°±14.4° vs. 62.7°±11.7°, 8.3±2.1 vs. 7.8±2.5, respectively], VAS scores (2.3±1.6 vs.1.5±1.2), functional scores (Constant-Murley score, UCLA score, ASES score and FUSS were 88.2±11.4 vs. 85.6±9.6, 29.3±2.8 vs. 31.4±3.5, 86.8±11.8 vs. 82.6±9.2, 92.1±10.1 vs. 88.3±8.2, respectively) and structural failures (35.2% vs. 30.0%, P>0.05). Conclusion:Arthroscopic superior capsular reconstruction using LHBT with reserving its distal part could achieve higher mechanics strength. However, the short-term follow-up showed that tenotomizing the distal part of LHBT exerted no obvious influence on postoperative function and structural integrity.

Systematic review of bone tunnel placement in anterior cruciate ligament near-isometric reconstruction / 中华骨科杂志

Objective@#To identify the optimal placement of bone tunnel during near-isometric anterior cruciate ligament reconstruction (ACLR), and its dimensional relationship with knee anatomic structure after summarizing published researches.@*Methods@#PubMed, Embase, and CNKI were screened for Chinese or English articles on clinical studies, cadaveric studies of knee and reviews on bone tunnel placement in anterior cruciate ligament near-isometric reconstruction and isometry of native anatomic fibers. Related articles were extracted and systematically reviewed.@*Results@#A total of 21 articles were finally included after screening. This systematic review found that most of the literatures were cadaveric studies, among which three dimensional imaging techniques, combined with cadaveric studies, were commonly used as a method of determining the length change between spots on the tibial plateau and lateral condyle of femur in recent years. There were 3 case series and 1 prospective cohort study. On the side of lateral condyle of femur, Blumensaat's line, lateral intercondylar ridge and insertion of intact anterior cruciate ligament were commonly used as reference to describe the near isometric area, while on the side of tibial plateau, the anterior horn of lateral meniscus were used as reference for reconstruction. The bone tunnel on tibial side was ignored compared with the femoral side when considering the isometry of reconstruction. There were overlaps among areas of bone tunnel placement found by different studies in near-isometric reconstruction. Not all native anterior cruciate ligament fibers were near-isometric.@*Conclusion@#The present study found that the area of femoral bone tunnel of anterior cruciate ligament near-isometric reconstruction were near the anterior part of lateral intercondylar ridge, deeply positioned with longitudinal axis close to the extension line of posterior cortical part of femur, coinciding with the distribution of direct fibers. There was contradiction on whether anterior cruciate ligament near-isometric reconstruction areas and anterior cruciate ligament anatomic insertion sites overlapped with each other. The most isometric area within the anatomic insertion site was the area of anterior fibers near lateral intercondylar ridge, which carried a large portion of the total anterior cruciate ligament load. Generally, there was a scarce of clinical researches in the field of isometry of ACLR. For the purpose of attesting the accuracy of the results we found, a combination of intra-operative observation on the displacement of graft relative to bone-tunnel and post-operative imaging such as MRI and three dimensional CT should be considered.

Systematic review of bone tunnel placement in anterior cruciate ligament near-isometric reconstruction / 中华骨科杂志

Objective To identify the optimal placement of bone tunnel during near-isometric anterior cruciate ligament reconstruction (ACLR),and its dimensional relationship with knee anatomic structure after summarizing published researches.Methods PubMed,Embase,and CNKI were screened for Chinese or English articles on clinical studies,cadaveric studies of knee and reviews on bone tunnel placement in anterior cruciate ligament near-isometric reconstruction and isometry of native anatomic fibers.Related articles were extracted and systematically reviewed.Results A total of 21 articles were finally included after screening.This systematic review found that most of the literatures were cadaveric studies,among which three dimensional imaging techniques,combined with cadaveric studies,were commonly used as a method of determining the length change between spots on the tibial plateau and lateral condyle of femur in recent years.There were 3 case series and 1 prospective cohort study.On the side of lateral condyle of femur,Blumensaat's line,lateral intercondylar ridge and insertion of intact anterior cruciate ligament were commonly used as reference to describe the near isometric area,while on the side of tibial plateau,the anterior horn of lateral meniscus were used as reference for reconstruction.The bone tunnel on tibial side was ignored compared with the femoral side when considering the isometry of reconstruction.There were overlaps among areas of bone tunnel placement found by different studies in near-isometric reconstruction.Not all native anterior cruciate ligament fibers were near-isometric.Conclusion The present study found that the area of femoral bone tunnel of anterior cruciate ligament near-isometric reconstruction were near the anterior part of lateral intercondylar ridge,deeply positioned with longitudinal axis close to the extension line of posterior cortical part of femur,coinciding with the distribution of direct fibers.There was contradiction on whether anterior cruciate ligament nearisometric reconstruction areas and anterior cruciate ligament anatomic insertion sites overlapped with each other.The most isometric area within the anatomic insertion site was the area of anterior fibers near lateral intercondylar ridge,which carried a large portion of the total anterior cruciate ligament load.Generally,there was a scarce of clinical researches in the field of isometry of ACLR.For the purpose of attesting the accuracy of the results we found,a combination of intra-operative observation on the displacement of graft relative to bone-tunnel and post-operative imaging such as MRI and three dimensional CT should be considered.

The Osteogenesis of Hydroxyapatite and Gelatin Coating on the Polyethylene Terephthalate Artificial Ligament Graft / 中国运动医学杂志

Ojective To explore the effect of the hydroxyapatite(HAp)and gelatin(Gel)coating on the healing of the polyethylene terephthalate(PET)artificial ligament.Methods The artificial ligaments were divided into a PET group with a pure PET surface and a PET/HAp/Gel group coated with HAp and Gel.Both coatings were observed using the scanning electron microscope(SEM).Forty-eight male New Zealand rabbits were randomly divided into two groups and underwent anterior cruciate ligament reconstruction,before two kinds of artificial ligaments were implanted respectively.Four weeks and 8 weeks after the operation,the rabbits were sacrificed,and histological hematoxylin and eosin (HE)staining as well as the biomechanical examination were performed.Results HAp/Gel coating was found depositing on the surface of PET artificial ligaments.Histological HE staining showed a thick fibrous connective tissue forming at the graft-host bone interface 4 weeks postoperatively,and the interface width of both groups were narrowed,with significantly more shrinking in the PET/HAp/Gel coating group.And new bone tissues were found in the interface of PET/HAp/Gel group 8 weeks after the operation.The biomechanical examination found significant differences in the failure load between the PET(46.16 ± 2.88 N) and PET/HAp/Gel group(71.32 ± 3.92 N)8 weeks after the surgery(P=0.0021).And 4 weeks and 8 weeks after the surgery,significant differences were found in the stiffness between the PET group and the PET/HAp/Gel group(11.06 ± 1.14 N/mm vs 16.20 ± 1.17 N/mm,P=0.0199;14.37 ± 0.88 N/mm vs 24.35 ± 1.35 N/mm,P=0.0008).Conclusion HAp/Gel coating can enhance the osteogenesis of PET artificial ligaments,promoting the new bone formation at the graft-host bone interface and herein strengthening the graft-host bone healing.

Micro-CT Analysis of Bone Tunnel Area after Anterior Cruciate Ligament Reconstruction in the Animal Model / 中国运动医学杂志

Objective To assess the bone tunnel area at different times and sites of the tunnel after the anterior cruciate ligament(ACL) reconstruction in rabbits using Micro-CT.Methods Fifteen rabbits were performed ACL reconstruction using semitendinosus tendon autograft and randomly allocated into 3 groups and killed at 3,6,and 12 weeks after the operation.All samples undertook the micro-CT scanning(using SkyScan 1176,Bruker,U.S.A.) and were analyzed the areas of bone tunnels of femur and tibia after the 3-demension image rebuilding.For each tunnel,the area of the entrance,middle and exit of the tunnel were measured 3 times respectively and compared.Results The average area of the femoral tunnel did not change significantly with time,being 4.84 mm2,4.57 mm2 and 4.46 mm2 at 3,6 and 12 weeks after the operation(P=0.99).At the very beginning,the femoral tunnel area at the entrance was the biggest,while that of the middle was the smallest.Six weeks after the operation,significant differences were observed between the femoral tunnel area at the entrance and middle,as well as that between the exit and middle(P=0.0011,P=0.0106);However,12 weeks after the operation,significant differences were observed only between that at the entrance and middle(P=0.0227).The average tibial tunnel area increased significantly at 6 weeks(6.577 mm2) and decreased at 12 weeks(3.103 mm2) after the operation(P=0.0005).Moreover,no significant differences were observed in the average tibial tunnel area at different time points and sites(P＜0.05).At different sites,the average tibial tunnel area expanded at 6 weeks,and then declined at 12 weeks after the operation.Conclusion The bone tunnel area changes with time after the ACL reconstruction,first increasing followed by decreasing in the average tibial tunnel area.The femur and tibial tunnel have significant differences in the tunnel area at different sites,which change differently with time.The bone tunnel expansion after the anterior cruciate ligament reconstruction can be comprehensively measured repeatedly at different sites.

The Timing of Return to Sports after Anterior Cruciate Ligament Reconstruction in Elite Athletes: A Study Based on Isokinetic Knee Muscle Strength and Multiple Hop Tests / 中国运动医学杂志

Objective To compare the knee function recovery at different times of returning to sport after anterior cruciate ligament reconstruction(ACLR) among elite athletes using knee isokinetic muscle strength test and various hop test.Methods Forty-one elite athletes(14 males,27 females,mean age 22.6 ± 4.1 years) undergoing ACLR between January 2013 and September 2014 were chosen from the database of the National Institute of Sports Medicine and Shanghai Huashan Hospital.Rehabilitation was performed using the same protocol by professional physiotherapists and trainers,who recorded the time of returning to sport of each athlete.One week prior to the scheduled return,bilateral knee isokinetic muscle strength test(test value:peak torque;angle velocity:60°/s,180°/s;motion:flexion,extension) and four hop tests(single hop for distance,side-to-side hop,up-down hop and 8 hop) were applied with the limb symmetry index(LSI) calculated.The athletes were then grouped by their returntime referring to surgery into the premature group(6～8 months),timely return group(9～12 months) and delayed group(over 12 months).The tests results were recorded and compared among the three groups.Results Fourteen athletes were selected into the premature group,with 19 in the timely group and 8 in the delayed group.The average LSI of 60°/s flexion peak torque of the premature group (87.4％ ± 7.5％) was significantly lower than the timely group(95.8％ ± 6.6％) and the delayed group(96.0％ ± 2.4％) (P＜0.01).Significant differences were observed between the premature group and delayed group regarding the 60° extension peak torque(85.8％ ± 9.4％ and 94.8％ ± 4.8％,P＜0.05),180°/s flexion peak torque(90.7％ ± 8.7％ and 101.4％ ± 6.8％,P＜0.05),and 180°/s extension peak torque (90.6％ ± 5.2％ and 97.8％ ± 5.6％,P＜0.05).The average LSL of the premature group at single hop for distance,side-to-side hop and up-down hop(93.A％ ± 8.5％,84.7％ ± 7.3％ and 112.5％ ± 5.7％) was significantly lower than that of the timely group(95.7％ ± 6.0％,104.2％ ± 4.3％ and 105.3％ ± 7.9％) and the delayed group regarding(98.1％ ± 1.9％,104.7％ ± 4.0％ and 106.3％ ± 7.4％) (P＜0.01 for all).The relative peak torque of 60°/s extension of the premature group(2.48 ± 0.58 Nm/kg) was significantly lower than the delayed group(3.21 ± 0.51 Nm/kg) (P＜0.01).Conclusions For elite athletes,returning to sport within 9 months after ACLR results in insufficient restoration of the knee function.Delayed return to sport doesn't improve the outcomes of hop tests,but can enhance the maximum extension torque peak,which needs further study.

Arthroscopy-assisted latissimus dorsi transfer for posterosuperior massive rotator cuff tear: efficacy and analysis of risk factors / 中华创伤杂志

Objective To investigate the effect of arthroscopy-assisted latissimus dorsi transfer (LDT) on posterosuperior massive rotator cuff tear (psMRCT) and analyze factors related to the outcome.Methods A retrospective case cohort study was conducted to analyze 31 patients with psMRCT admitted from January 2013 to December 2015.There were 13 males and 18 females,aged 52-67 years [(58.4 ± 4.5) years].The mean duration of symptoms was (1.9 ± 0.9) years.All patients received arthroscopy assisted LDT combined with rotator cuff repair.Postoperative rehabilitation training was carried out according to the standard procedures.Before operation and at the last follow-up,X-ray films were taken to measure the acromiohumeral talus,and magnetic resonance imaging was obtained to check the integrity of repaired tissue.Visual analog scale (VAS),active range of motions,Constant-Murley score and Fudan University Shoulder Score (FUSS) were measured to assess the shoulder joint function,and complications were documented.Furthermore,subgroup analysis was made according to "concomitant subscapularis tendon tear or not","concomitant pseudoparalysis or not","Goutallier Ⅲ/Ⅳ level fatty infiltration","complete or partial rotator cuff repair",and " Hamada Ⅰ/Ⅱ level acromiohumeral distance".Pearson correlation analysis was performed to detect the relationship of subgroup factors with postoperative Constant-Murley score and FUSS score.Results All patients were followed up for (38.8 ± 13.0) months.No complications including fever,infection,adhesion or neural malfunction were reported.Mean acromiohumeral distance increased from preoperative (5.4 ± 0.9) mm to (7.0 ± 1.0) mm at the last follow-up (P ＜ 0.05).MRI image showed intact fixation of rotator cuff and transferred latissimus dorsi tendon.At the last follow-up,VAS score decreased from preoperative (4.8 ± 1.4)points to (0.6 ± 0.7)points;the active range of motions was restored significantly;the Constant-Murley score improved from (32.9 ± 9.5) points to (67.4 t 6.7) points;the FUSS score increased from (53.3 ± 9.1) points to (85.1 ± 4.8) points (all P ＜ 0.01).Pearson Correlation analysis indicated that,among subgroup factors,only partial rotator cuff repair was significantly inversely associated with ConstantMurley score (P ＜ 0.05) and FUSS score (P ＜0.01),and the Constant-Murley score and FUSS score of patients with complete repair were significantly higher than those of patients with partial repair (P ＜ 0.05 and P ＜ 0.01,respectively).Conclusions For psMRCT,the effect of arthroscopy-assisted LDT is confirmed,which can relieve pain,restore range of motion and improve shoulder function.Preoperative pseudoparalysis,subacapularis tendon tear,Goutallier Ⅳ level fatty infiltration and Hmada Ⅱ level acromiohumeral distance do not significantly influence postoperative outcome.The torn rotator cuff tear should be repaired as possible.

Clinical problems of structural failure after rotator cuff repairs / 中华骨科杂志

Arthroscopic rotator cuff repairs are preformed due to growing knowledge of rotator cuff tears among surgeons as well as patients.However,it is unavoidable and may sometimes very common that some patients develop structural failures or retears after surgical repairs because of unique blood supply and healing procedure of the rotator cuff,on which there is still much debate focusing on problems that one needs to deal with in clinical practice.Retears often occur,if without new trauma,during early postoperative period,or more specifically within the first 6 months after repair and are more frequently observed in those with old ages,diabetes or osteoporosis.In addition,risk factors of retears consist of longer preoperative duration of symptoms,larger primitive tear sizes,higher grades of fatty infiltration of muscles on preoperative imaging examinations,excessive tension within reconstructed structures,deteriorated quality of rotator cuff tissues and special shapes of the acromion,etc.Diagnosis is recently based on results of postoperative magnetic resonance imaging or echogram examination.MR/CT arthrography is also used.Each instrument has its advantages and limitations.However,the lack of a golden standard when establishing a diagnosis of rotator cuff retears makes integrating evaluations and comparisons of different methods a difficult question.It has been reported by many that the onset of retear leads to obvious shoulder pain or weakness,whereas more than a few studies demonstrated that very limited influences of retears in spite of generally unaffected shoulder functions,like decreased muscle strength on certain motions.The disagreement is possibly caused by specific methods of diagnosis,function instruments and time point of assessments used by different researchers as studies have displayed that feelings of patients after surgery and results attained by objective examinations are not always parallel.Moreover,some long-time follow-ups studies indicated that the impact posted by retears on shoulder functions evolves over a period of time.Owing to the varied opinions on actual symptoms and final functional outcomes caused by structural failure,the mainstay of treatment for rotator cuff tears are still conservative protocols,including observation and symptoms relief instead of second surgery.Second surgery could be an effective choice for certain patients,especially for those who have apparent symptoms.

Biological mechanism of periprosthetic osteolysis after total hip arthroplasty / 中华骨科杂志

Periprosthetic osteolysis and aseptic loosening after total hip arthroplasty are the common causes for revision surgery,which are initiated by wear particles released from the articular surfaces of prosthetic components.These components include ultra-high molecular weight polyethylene,titanium alloy,Al2O3,ZrO2 and polymethylmethacrylate.Wear particles activate macrophage via phagocytosis or pattern recognition receptor,resulting in release of inflammatory mediators such as macrophage colony-stimulating factor (M-CSF),macrophage chemotactic protein-1 (MCP-1),macrophage inhibitory protein-1 (MIP-1),IL-1β,IL-6 and TNF-α.Furthermore,wear particles stimulate M0 macrophage to polarize to M1 macrophage,promoting the release of inflammatory mediators.The periprosthetic osteolysis process is a cell/cytokine-mediated biological cascade induced by macrophage activation,involving the monocyte/macrophage cell line,such as macrophages,osteoclasts,and dendritic cells.The mesenchymal cells,including osteoblasts,osteocytes,fibroblasts and lymphocytes,lead to a deviation in the balance of osteoblast-osteoclast interactions within the basic multicellular unit,resulting in periprosthetic osteolysis.Fibrobalst,dendritic,and lymphocyte cells can enhance the recruitment and activation of macrophages by secreting MCP-1,MIP-1,and IL-8.Furthermore,the upregulated expression of RANKL,TNF-α,and IL-1 β facilitates the osteoclast differentiation from osteoclast precursor.TNF-α,IL-1 β together with wear particles can upregulate the expression of IL-6,MCP-1 and M-CSF of osteoblast and promote the recruitment and activation of macrophages.Nuclear transcriptional factor NF-κB plays a vital role in mediating periprosthetic inflammatory response and gene expression of bone metabolism.Different inflammatory factors can induce different expression of its downstream gene,ultimately,promoting or hindering the osteolysis process.The individual difference of periprosthetic osteolysis may also relate to single nucleotide polymorphism of IL-1RA,IL-6 and MMP-1 gene.

Naringenin Inhibits Skeletal Muscle Fibrosis after Acute Contusion in a Mouse Model / 中国运动医学杂志

Objectives To understand the effect of intraperitoneal injection of naringenin,a SMAD3 inhibitor,on the skeletal muscle after acute contusion in a mouse model.Methods Seventy-two mice of 7-8 weeks old (20-24 g)were randomly divided into a control group,an acute contusion (B)group,an acute contusion+1％DMSO injection (C)group and an acute contusion+naringenin injection (D)group,each of 18.The acute contusion model was created by hitting the right tibialis anterior muscle in mice of all groups except the control group.Intraperitoneal injection of I％DMSO and naringenin were given to group C and D respectively every day until execution,while the 18 mice in the control group were fed without injury or injection.The time of injury was set as Day 0.After being fed for 28 days,all mice were executed and the right tibialis anterior was harvested.Western blotting was used to detect the difference of SMAD3,pSMAD3,Collagen Ⅰ,and α-SMA expression among the 3 groups.Hematoxylin-Eosin (HE)staining and Masson staining were used to detect the difference of pathological changes.Moreover,the appearance of fast twitch contraction and tetanic contraction were also documented to figure out the quality of the injured skeletal muscle.Results Compared with the control group,the SMAD3 and pSMAD3 level in injured skeletal muscle increased,but both were less in group D than group B and C.Similarly,the average level of Collagen Ⅰ and α-SMA in all three injury groups was higher than the control group,but the level of these indexes were lower in group D than that in group B and C.HE staining showed more mesenchyme in injury groups than the control group.Masson staining found the upregulation of fibrosis in injured muscles,with the area of fibrosis in group D significantly lower than group B and C.Compared with control,the injured skeletal muscle had significantly poorer fast twitch and tetanic contraction performance,with the condition of group D significantly better than group B and C.Conculsion The naringenin,a SMAD3 inhibitor,mitigates the phosphorylation of SMAD3 after acute contusion in a mouse model.The fibrosis and scar formation was alleviated,hence improving the healing of the injured skeletal muscles.

Clinical and MRI Outcomes of Arthroscopic Repairing of Medium-sized Rotator Cuff Tears Using Single-row and Suture-bridge Techniques / 中国运动医学杂志

Objective To compare the outcomes of arthroscopic single-row and suture-bridge repair of medium-sized rotator cuff tears through clinical and MRI assessment.Methods Forty-five patients with medium-sized rotator cuff tears who underwent arthroscopic repair using single-row (SR,n=29) or suture-bridge (SB,n=26) technique between July 2014 to June 2015 in our hospital,were retrospectively enrolled in this study.All surgeries were performed by the same senior doctor.The functional outcomes were assessed using the rating scale of the University of California at Los Angeles (UCLA),American Shoulder and Elbow Surgeons shoulder index (ASES),Fudan University Shoulder Score (FUSS),visual analog pain scale score (VAS),and range of motion (ROM) before the operation and at the last follow-up.MRI examination was performed at the final follow-up.Results Finally 50 patients were followed up successfully,24 in SB group and 26 in SR group.There were no significant differences between the two groups in terms of age,sex,follow-up duration,and the affected side.Before the operation,no significant differences were observed between the 2 groups in all the measurements.After more than 1-year follow-up,significant improvement was found in all measurements for both groups,but without significant differences between them.MRI examination showed no re-tears in either group.According to the Sugaya's classification,there were more type Ⅰ patients in SB group than SR group (83.3％ vs 61.5％),but the difference was not significant.Conclusion Arthroscopic suture-bridge repairing of medium-sized rotator cuff tears results in safe and good early clinical outcomes.However,compared with the single-row technique,there was no significant advantage.Although the MRI examination showed a better result of rotator cuff healing in the early stage,its long-term outcomes need further studying.

Anatomical Landmarks for Lateral Ankle Ligament Reconstruction—a Cadaveric Study / 中国运动医学杂志

Purpose To clarify the morphological parameter and describe the distance from the insertion of the lateral ankle ligaments to the adjacent bony landmarks through precisely anatomical explore of human cadaveric ankles,so as to provide anatomical evidences for the reconstruction of lateral ankle ligaments.Methods Nineteen ankle specimens were dissected to isolate the lateral ankle ligaments and measure the morphological parameters such as length,width,thickness and the distance from the insertion of the lateral ankle ligaments to the adjacent bony landmarks.Results The average length of anterior talofibular ligaments (ATFL) was 23.1 ± 2.98 mm,among which 8 were single-banded(42.1％)and 11 were double-banded(57.9％).The average distance from the fibular origination of ATFL to the anterior tubercle of fibula(AA)was 17.1 ± 3.00 mm,to the fibular obscure tubercle(AO)was 5.1 ± 1.69 mm,to the tip of the fibula(AT)was 14.1 ± 2.86 mm.The distances from the talus insertion of ATFL to the superior and inferior talus articular surface were 11.4 ± 2.25 mm and 18.4 ± 2.30 mm respectively,to the anterior lateral talus chondral surface was 4.8 ± 1.42 mm.The average length of calcaneofibular ligament(CFL)was 31.4 ± 3.55 mm.The average distance of the fibular origination from ATFL to CFL was 6.4 ± 2.55 mm.The average angle between ATFL and CFL was 116.6 ± 12.69°.The distance from the calcaneus insertion of CFL to the peroneal tubercle(CP)was 15.4 ± 2.86 mm,to the posterior superior border of calcaneus(CC)was 13.9 ± 2.46 mm,to the subtalar joint surface was 15.2 ± 3.21 mm.The coefficient variation assessing the anatomical reliability of different bony landmarks were as follows:ATFL fibular origination AA(17.54％) ＜AT(20.28％) ＜ AO(33.14％),CFL calcaneus insertion CC(17.70％)＜CP(18.57％)＜CS(21.1％).Conclusion Certain variations exist in the morphological parameters and the distances from the insertion of the lateral ankle ligaments to the adjacent bony landmarks.It provides anatomical evidence for lateral ankle ligament reconstruction in treating chronic ankle instability.

Arthroscopic lattisimus dorsi transfer with rotator cuff repair for posterosuperior irreparable massive rotator cuff tear / 中华骨科杂志

Objective To discuss the effect of arthroscopic latissimus dorsi transfer with rotator cuff repair for posterosuperior irreparable massive rotator cuff tear (iMRCT).Methods From September 2014 to December 2015,data of 13 iMRCT including 4 male and 9 female who underwent arthroscopic latissimus dorsi transfer with rotator cuff repair were retrospectively analyzed.The age was ranged from 54 to 65,with a mean age of 58.5±4.3.The mean duration of symptom was 2.1±0.6 years.During operation,complete or partial rotator cuff repair was performed,followed by complete repair of injured subscapularis tendon and tenotomy or tenodesis of the long head of biceps tendon.An arc incision was then made in the axillary fossa to harvest latissimus dorsi tendon from its humeral insertion.The tendon was then introduced into subacromial space and fixed at the footprint of greater tuberosity arthroscopically.X-ray and MRI were conducted prior to and one day after the surgery and at the last follow-up.Pain visual analog scale (VAS) and active range of motion in all planes as well as Constant-Murley score and Fudan University shoulder score (FUSS) were documented before the surgery and at the last follow-up.Results All 13 patients accomplished the follow-up,with a duration from 17 to 22 months and a mean period of 19.6±0.9 months.No complications occurred.No re-tear was identified.The mean acromiohumeral distance increased from 5.4± 1.1 mm to 7.0±0.6 mm.The mean VAS decreased from 4.8± 1.3 to 0.5± 0.7.The mean 0° abduction external rotation,90° abduction external rotation,flexion,as well as abduction increased from 17.3°± 10.5°,12.4°±7.8°,89.2°±41.2°,87.3°±40.7° to 41.2°±12.5°,56.5°±16.6°,120.5°±25.1°,and 113.5°±25.4° respectively.Constant-Mur ley score and FUSS increased from 33.5±9.9 and 50.9±7.6 to 62.8±8.1,and 81.7±7.0,respectively.The improvement in all measurements was significant.Condclion For posterosuperior iMRCT,arthroscopic latissimus dorsi transfer with rotator cuff repair can decrease shoulder pain and improve shoulder function.

The Role of the ATFL and PTFL Angle in Diagnosing Chronic ATFL Tear / 中国运动医学杂志

Objective To evaluate the angle between the anterior talofibular ligament (ATFL) and posterior talofibular ligament (PTFL) in patients with mechanical ankle instability,so as to find out a new indirect diagnosis method for the chronic ATFL lesion.Methods One hundred subjects were included in this study,among which 50 patients with mechanical ankle instability were assigned to group A and 50 counterparts without it were selected into group B All patients were taken MR Images and the ATFL and PTFL angle at the axial plane was evaluated.The difference between two groups was evaluated.Results The ATFL and PTFL angle increased significantly in group A when compared to group B (82.1° ± 8.0° v.s,74.4° ± 5.9°,P＜0.01).The area under receiver operating characteristic curve (ROC)was 0.874 (P＜0.01),indicating great significance in diagnosing the chronic ATFL tear.Moreover,the angle was 79 degree,showing high sensitivity (0.88) and specificity (0.64) of diagnosing ATFL tear.Conclusion The ATFL and PTFL angle increases significantly in patients with the mechanical instability.Moreover,the possibility of ATFL tear increases when the ATFL and PTFL angle is greater than 79 degree.

Bioinformatics Analysis of Gene Arrays in an Early Osteoarthritis Model Induced by Anterior Cruciate Ligament Transection and Partial Medial Meniscectomy / 中国运动医学杂志

Objective To explore the changes in gene expression and biological process of the osteoarthritis (OA) induced by anterior cruciate ligament (ACL) transection and partial medial meniscectomy,so as to provide bioinformatic basis for further studying the molecular mechanism of OA.Methods The gene chip datasets of a rat model of early 0A induced by ACL transection and partial medial meniscectomy were downloaded from GEO databases (submitted by Appleton,et al.).The differential expression genes (DEGs)were identified,and the Gene ontology(GO) as well as the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses for DEGs were conducted using bioinformatic methods.Results A total of 170 DEGs including 97 up-regulated genes and 73 down-regulated genes were identified.The up-regulated genes were mainly enriched in the extracellular matrix (ECM) and were closely related to the ECM-receptor interaction,while the down-regulated genes were mainly enriched in the biological function of muscle contraction and were linked with the peroxisome proliferators-activated receptor (PPAR) signaling pathway.Conclusion The changes of ECM and muscle contraction play a key role in the occurrence and development of OA.The ECM-receptor interaction and PPAR signaling pathway are strongly associated with OA and worthy of further study.

Transcript assembly and quality assessment / 生物工程学报

The transcript assembly is essential for transcriptome studies trom next-generation sequencing data. However, there are still many faults of algorithms in the present assemblers, which should be largely improved in the future. According to the requirement of reference genome or not, the transcript assembly could be classified into the genome-guided and de novo methods. The two methods have different algorithms and implementation processes. The quality of assembled transcripts depends on a large number of factors, such as the PCR amplification, sequencing techniques, assembly algorithm and genome character. Here, we reviewed the present tools of transcript assembly and various indexes for assessing the quality of assembled transcripts, which would help biologists to determine which assembler should be used in their studies.

The investigation of thyroid function reference range during pregnancy in Chaoshan area / 国际检验医学杂志

Objective To investigate and establish thyroid function reference range during 3 pregnant stages in Chaoshan area:thyrotropin (TSH),free thyroxin (FT4).Methods 863 healthy pregnant women visited antenatal clinic in the Second Affiliated Hospital were included in this study.By detecting serum levels of TSH,FT4,thyroglobulin antibody (TgAb),and thyroid peroxi-dase antibody (TPOAb)in these women,the euthyroid reference ranges of serum TSH and FT4 in different pregnant stages were established based on the standards of the United States National Institute of Clinical Biochemical (NACB)guidelines.Results The ranges of serum TSH in the first,second and third trimester of pregnancy were 0.13-3.93 mIU/L,0.14-4.55mlU/L,and 0.42-3.85 mIU/L,respectively.The ranges of serum FT4 levels in these 3 stages were 12.00-23.34 pmol/L,6.27-12.65pmol/ L, and 9.80-18.20 pmol/L,respectively.The range of serum TSH levels in our study were similar with the reference range recom-mended by the guidelines in China,but were different compared with the American Thyroid Association (ATA)guidelines.Conclu-sion TSH,FT4 levels show dynamic changes during different stages of pregnancy.The thyroid function ranges of healthy pregnant women in Chaoshan area are quite different compared with non-pregnant population and pregnant women in distinct area.Due to the differences of diet,iodine intake,economy and culture in Chaoshan area,regional thyroid function reference ranges specific for differ-ent stages of pregnant women should be established.